STATE OF NORTH CAROLINA County Name Of Plaintiff File No. In The General Court Of Justice District Court Division Name Of Defendant Date of Original Custody Order VERSUS MOTION TO MODIFY CUSTODY Date(s) Of Order(s) Modifying Original Order G.S. 50-13.1, -13.7 MOTION Pursuant to G.S. 50-13.7, Plaintiff Defendant moves the court to modify the custody order originally entered on the date shown above. and modified on the subsequent date(s) shown above. In support of this motion, as follows: Plaintiff Defendant states that since the entry of the current order, circumstances have changed . Date Address Signature Plaintiff Plaintiff's Attorney Defendant Defendant's Attorney CERTIFICATE OF SERVICE I certify that I served the above Motion by: delivering a copy personally to: Name Of Person With Whom Copy Left Name Of Person With Whom Copy Left depositing a copy in the United States mail in an envelope bearing proper postage and addressed as follows: Name And Address Name And Address leaving a copy at the office of the attorney named below, with a partner or employee Name Of Attorney Party Represented Name Of Person With Whom Copy Left Name Of Attorney Party Represented Name Of Person With Whom Copy Left Date Of Service Signature Of Person Who Served Motion NOTE TO MOVING PARTY: Complete the Certificate of Service and file the original with the Clerk. AOC-CV-634, Rev. 4/15 © 2015 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkFlow.com