IN THE FAMILY COURT OF ________________ COUNTY, WEST VIRGINIA. In Re: The Marriage / Children of: Civil Action No. ____________  _________________________, and _________________________. Petitioner Respondent __________________ __________________ Social Security Number Social Security Number _________________________ _________________________ _________________________ _________________________ Address Address ________________ ________________ Daytime phone Daytime phone ANSWER TO DIVORCE PETITION Are you currently a party to a domestic violence proceeding? [ ] Yes [ ] No In answer to the Petition for Divorce, the Respondent says the following : 1. The Respondent admits irreconcilable differences exist between the Petitioner and the Respond ent. 2. The Respondent admits all of the allegations in the Petition except the matters contained in the items numbered: _____________________________________________________________. 3. The Petitioner and Respondent are the parents of: [ ] No children born during this marriage, and none are expected. [ ] ____ children, whose names, dates of birth, and social security numbers Name Date Of Birth Social Security No. ________________________________________________________________________ ______ ________________________________________________________________________ ______ ________________________________________________________________________ ______ ________________________________________________________________________ ______ In the rest of this Answer, the children always means the childr en whose names you just listed. SCA-FC-108 4(1/0) Divorce Answer Page 1 of 5 >>>> 2 [ ] A child is currently expected, and the estimated date of delivery is ____________________ 4. The children currently live with: [ ] Mother [ ] Father [ ] Another person, or persons, whose name(s) and address(es) are: _______________________ ________________________________________________________________________ ________ ________________________________________________________________________ ________ ________________________________________________________________________ ________ 5. During the last five years, if any of the children have lived at addresse s other than their current address, use the following space to list where they lived, and for how l ong. If there is not enough room in the following space, use an additional sheet of paper. I have attached ____ additional sheet(s). Childs Name Address Dates of Residence ________________________________________________________________________ ___ ________________________________________________________________________ ___ ________________________________________________________________________ ___ ________________________________________________________________________ ___ ________________________________________________________________________ ___ 6. Who provides health insurance for the children? [ ] Mother [ ] Father [ ] Medicaid [ ] WV CHIP [ ] Another person, whose name and address are: _____________________________________ _______________________________________________________. [ ] The children DO NOT have health insurance coverage. The West Virginia Childrens Health Insurance Program (WV CHIP) can help parents obtain free or low cost health care for their children. For more information, call 1-877-982- 2447, or ask the Family Court Staff about WV CHIP. 7. Answer all of the following questions. a. Has the Respondent been a party or witness in any other proceeding, in a ny state, concerning the allocation of custodial responsibility for the children? [ ] Yes [ ] No b. Is the Respondent aware of any other proceeding, past or present, in any state, concerning allocation of custodial responsibility for the children? [ ] Yes [ ] No c. Is the Respondent aware of any person, other than the Petitioner and Res pondent, who has SCA-FC-108 4(1/0) Divorce Answer Page 2 of 5 >>>> 3 physical custody of, or claims any custodial right concerning the children? [ ] Yes [ ] No THEREFORE, the Respondent asks that the Court grant a divorce, and to gr ant such other relief as the Court considers proper, including the matters specifically stated below: [ ] Approve the Proposed Parenting Plan filed by the Respondent. [ ] Order the Petitioner to pay support for the minor children. [  ] Order the Petitioner to maintain health insurance coverage on the children, if reasonably available, and to assist with reasonable health care expenses not covere d by insurance or by a government medical card. [ ] Order the Petitioner to pay spousal support. [ ] Make a fair and equitable division of marital property. [ ] Award ____________________________ the exclusive use and possession of t he marital home located at __________________________________________________________. [ ] Award ____________________________ the exclusive use and possession of t he following motor vehicles: _________________________________________________________ __. [ ] Award ____________________________ the exclusive use and possession of the furniture, furnishings and appliances located in the marital home. [ ] Award the Respondent the exclusive use, possession and ownership of the following marital property: Description of Property Estimated Value ________________________________________________________________________ __ ________________________________________________________________________ ___ ________________________________________________________________________ ___ ________________________________________________________________________ ___ ________________________________________________________________________ ___ [ ] Order that the Respondent be held solely responsible for the following debts: Description of Debt Amount Owed ________________________________________________________________________ __ ________________________________________________________________________ ___ SCA-FC-108 4(1/0) Divorce Answer Page 3 of 5 >>>> 4 ________________________________________________________________________ ___ ________________________________________________________________________ ___ ________________________________________________________________________ ___ [ ] Order that the Petitioner be held solely responsible for the following debts: Description of Debt Amount Owed ________________________________________________________________________ __ _______________________