IN THE SUPERIOR COURT OF FULTON COUNTY STATE OF GEORGIA FAMILY DIVISION Petitioner: ________________________________, and Respondent: _______________________________. CIVIL ACTION FILE NO.:________________________ PETITION FOR MODIFICATION OF VISITATION I,________________________________, representing myself, state my claim for a modification of visitation against __________________________________, the Respondent, as follows: 1. The Respondent is a resident of Fulton County and is subject to the jurisdiction of this Court and may be served with a copy of this petition and summons at ____________________________________________________________________________. 2. I desire to have (my visitation rights/ the Respondent's visitation rights) modified concerning the minor children: Name of Child(ren) _____________________________ _____________________________ _____________________________ Sex(m/f) _____ _____ _____ Year of birth _________ _________ _________ Resides with ___________________ ___________________ ___________________ 3. Pursuant to __________________________________________(Name of order awarding custody) in Civil Action, File No.: _______________ entered on ___________________, 20____ in the Superior Court of _______________ County, Georgia, hereinafter referred to as "Order" a copy of which is attached to the Petition: (Check a or b): a) b) I presently have legal custody of the minor child(ren); or 4. _____________________________________ presently has legal custody of the minor child(ren). The minor child(ren) currently reside at _________________________________________with _______________________. During the past five years, the minor child(ren) have lived at the addresses below with the following persons: Address Resided with ______________________________________________ _____________________ ______________________________________________ _____________________ ______________________________________________ _____________________ Form Modification of Visitation-rev. 7/2014 Fulton County Superior Court Family Division 1 f 3 American LegalNet, Inc. www.FormsWorkFlow.com 5. (Check a or b): a) I have not participated as a party, or witness, or in any capacity in any other litigation concerning the custody of the minor child(ren) in this or any other state except for the initial custody action as described in the Order set forth in paragraph (3) above. I do not know of any custody proceeding concerning the minor child(ren) which may be pending in a Court in this or any other state. The minor child(ren) have been involved in the following custody actions. b) County/State/Court Type of custody action Date Filed Status _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 6. (Check a or b) a) b) I know of no other person, not a party to this proceeding, who has physical custody of the child(ren) or claims to have custody or visitation rights with respect to the minor child(ren). The following persons who are not a party to this proceeding have custody or visitation rights with the minor child(ren): Name Claim ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 7. a) Since the date of the Order, there has been a change in circumstances materially affecting the welfare of the minor as follows: b) 8. No petition to modify visitation has been filed within two years of the filing of this petition. Therefore, I desire that (my visitation rights/ the Respondent's visitation rights), as set out in the Order, be modified as follows: ______________________________________________________________________________ THEREFORE, I request (a) That the Order be modified so as to provide for the requested change in (my visitation rights/Respondent's visitation rights); Form Modification of Visitation-rev. 6/2012 © 1999 Fulton County Superior Court Family Division 2 f 3 American LegalNet, Inc. www.FormsWorkFlow.com (b) (c) That the Respondent be served with a copy of my Petition for Modification of Visitation Any other appropriate relief. This _____ day of _______________, _____. _____________________________________________ (Sign your name here) Petitioner's name (print or type)____________________ Petitioner's address:_____________________________ ___________________________________________ Petitioner's telephone number:___________________________________ Form Modification of Visitation-rev. 6/2012 © 1999 Fulton County Superior Court Family Division 3 f 3 American LegalNet, Inc. www.FormsWorkFlow.com