IN THE FAMILY CO URT OF ________________ COUN TY, W EST VIR GIN IA In Re: The Marria ge / Children of: Civil Action No. ____________ _________________________, and _________________________. Petitioner Respondent _________________________ _________________________ _________________________ _________________________ Address Address ________________ ________________ Daytime phone Daytime phone PETIT ION FOR CONTEMPT 1. Your name: ___________________________. List any other name(s) you were known by during this case. _____________________________________________________ Your current address: __________________________________________________________ 2. Name of the person you want the court to hold in contempt: ________________________ Address: _________________________________________________________________ Daytime telephone number: ________________ Social Security number: ________________ 3. Your Reasons for Making this Contempt Petition A. Failure to Make Payments of Money ___ I believe the person I want the court to hold in contempt has failed to make court ordered payments of: ___ Child support ___ Spousal support ___ Separate maintenance ___ Equitable distribution ___ Medical support ___ Other (List, and be specific.) _____________________________________________________________ You must attach a copy of the order requiring these payments. List the due dates and amounts for all payments that have not been made. ___________________________________________________________________________ ___________________________________________________________________________ SCA -FC-25 1 (12/01) Contempt Peti tion Page 1 of 3>>>> 2 ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ List the total amount due and unpaid on the date you sign this petition: $___________. B. Failure to Obey Court Ordered Parenting Plan ___ I believe the person I want the court to hold in contempt has failed to abide by the terms and conditions of a court ordered Parenting Plan. For each instance you believe the person has failed to abide by the Parenting Plan, you must list the date, and explain specifically how the person failed to abide by the plan; and you MUST attach a copy of the Parenting Plan. ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ C. Failure to Obey Other Terms, Conditions, or Requirements of a Court Order ___ I believe the person I want the court to hold in contempt has failed to abide by the terms, conditions, or requirements of a court order in some way other than those listed in items A. and B. above. For each instance you believe the person has failed to abide by the terms, conditions, or requirements of an order, you must list the date, and explain specifically how the person failed to abide by the order; and you MUST attach a copy of the order. ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 4. I have attached to this Petition documents I believe prove the person I have named has failed to obey a court order. The documents I have attached are: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ SCA -FC-25 1 (12/01) Contempt Peti tion Page 2 of 3>>>> 3 For the reasons stated above, I request that the Court issue a Notice of Contempt Hearing / Rule to Show Cause setting a hearing to determine if the person named in this Petition should be held in Contempt of Court. __________________________ ____________________ Your Signature / Petitioner Date VERIFIC ATION of CONTEMPT P ETITION I, ____________________________, after making an oath or affirmation to tell the truth, say that the facts I have stated in this Contempt Petition 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 __________________, 200__. _________________________ Notary Public / Other Official My commission expires:______________________. SCA -FC-25 1 (12/01) Contempt Peti tion Page 3 of 3