GUILFORD COUNTY NORTH CAROLINA IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION ______CvD___________ ________________________, Plaintiff VISITATION MOTION (pro se) vs. ________________________, Defendant 1. The Plaintiff/Defendant (circle one) requests visitation. 2. The parties are parents of the following children: ___________________________, date of birth _______________. ___________________________, date of birth _______________. ___________________________, date of birth _______________. 3. Attached hereto and filed herewith is my Affidavit as to Status of Minor Child (Form AOC-CV-609) for each child. 4. We do / do not (circle one) have an existing child custody/visitation order. If an order exists, the following has changed since the entry of that order: ___________________________________________ _____________________________________________________________________________________ ____________________________________________________________________________________. 5. I have been visiting my child(ren) as follows:______________________________________________ _____________________________________________________________________________________ ____________________________________________________________________________________. 6. I am requesting court-ordered visitation for the following reasons: _____________________________ _____________________________________________________________________________________ ____________________________________________________________________________________. 7. I request that the Court order the following visitation: _______________________________________ _____________________________________________________________________________________ ____________________________________________________________________________________. ________________________ Date ______________________________ Signature of Movant The other parent can be served at: __________________________________ __________________________________ The other parent's lawyer is: ______________________________ ______________________________ Return of Service: (Fee $5 per defendant to be served) I, (print name) _______________________, Deputy Sheriff of _________________ County, NC, did receive this Motion on (date)____________ and serve it on the defendant on (date)__________________at (time)________ by (manner of service) ____________________________________________________. Signed: ___________________________ Appendix B, Form 2 (Rev. 04/02) 1 American LegalNet, Inc. www.USCourtForms.com