Form 2 PETITION FOR APPEAL from FAMILY COURT FINAL ORDER County STATE OF WEST VIRGINIA Case Number Family Court Judge Final Order Date In Re: Marriage/Children of: Name of Petitioner Name of Respondent Address: Address: Daytime Phone: Daytime Phone: CHECK ONLY ONE NOTIC E I wish to appeal to the circuit court. If you wish to appeal directly to I wish to appeal directly to the Supreme Court. I have filed a Notice and the Supreme Court, both parties Waiver within 14 days of a family court final order. If the other party does not must file a Notice and Waiver agree to appeal directly to the Supreme Court, this petition will be treated as a within 14 days of the final order. petition to the circuit court. PETITION 1. If the petition for appeal is granted, would you like the opportunity to make an oral argument? YES NO 2. Have you, or another party, filed a previous appeal? YES NO If yes, give details: ____________________________________________________________________________ ____________________________________________________________________________________________ 3. State briefly each ground on which you claim that the family court erred in its final order. Summarize briefly the facts supporting each ground. Attach additional pages if necessary. If you wish to make further argument in support of the petition, you may file a memorandum of law. A. Ground one: ______________________________________________________________________________ _________________________________________________________________________________________ Supporting FACTS (state briefly without citing cases or law) ______________________________________ _________________________________________________________________________________________ 1 FCA Form 2 Confidentiality Notice: This document Dec. 2001 is not available for public inspection. >>>> 2 _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ B. Ground two: ______________________________________________________________________________ _________________________________________________________________________________________ Supporting FACTS (state briefly without citing cases or law) ______________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ C. Ground three: _____________________________________________________________________________ _________________________________________________________________________________________ Supporting FACTS (state briefly without citing cases or law) ______________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ D. Ground four: ______________________________________________________________________________ _________________________________________________________________________________________ Supporting FACTS (state briefly without citing cases or law) ______________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ 2 FCA Form 2 Confidentiality Notice: This document Dec. 2001 is not available for public inspection. >>>> 3 VERIFICATION I, _______________________________________, after making an oath or affirmation to tell the truth, say that the facts I have stated in this Petition for Appeal are true of my personal knowledge; and if I have set forth matters upon information given to me by others, I believe that information to be true. __________________________________ _____________________ Signature Date This Verification was sworn to or affirmed before me on the _______ day of ______________________, _______. ________________________________________ Notary Public My commission expires: ___________________________________________________________________________. CERTIFICATE OF SERVICE State of West Virginia County of ______________________________ I, _______________________________________, the person making this Petition for Appeal, mailed the Petition to the following persons by first class United States Mail. Mailed to: _______________________________________________________ Address: ________________________________________________________ Date mailed: ________________________________ _____________________ Mailed to: _______________________________________________________ Address: ________________________________________________________ Date mailed: ________________________________ _____________________ ________________________________ __________________________________ _____________________ (Print your name) Signature Date 3 FCA Form 2 Confidentiality Notice: This document Dec. 2001 is not available for public inspection.