IN THE TENTH CIRCUIT OF JEFFERSON COUNTY

STATE OF ALABAMA

In re: The Marriage of:

PXXX MXXX WXXXX,

Petitioner CASE NO.: _____________

and

VXXX LXXX. WXXX,

Respondent

PETITION FOR VISITATION

1. Your Personal Information:

Name: PMW, Jr. Age: 29

Relationship to the children: Father

Address: 636 Wildass Dr, Pelham, AL 35124 Phone: (205) xxx-xxxx

2. Information about the other parent

Name: VLW Phone: (205) xxx-xxxx

Address: 821 BaloneyButt Way., Fairfield, AL 35064

3. Information about the children

Names and dates of birth of the children under 19 involved in this visitation

Name: KAW Date of birth: 08/16/2005

Where does the child live now?

With her mother at: 821 BaloneyButt Way., Fairfield, AL 35064

Information about the custody order you have now

There has been no custody order to date. The child is living with her mother.

4. Other cases involving these children

There are no other cases involving the child in any other City, County or State.

5. Best place to pick up and drop off children

Pick up and Drop off at: 821 BaloneyButt Way., Fairfield, AL 35064

6. Visitation Schedule Requested

Wednesday and Thursday of every week, and every other weekend. See attached

Proposed Parenting Plan for a more thorough explanation of visitation/custody.

7. The person asking for visitation must read and sign below:

• I am asking the Court to make the visitation order I have asked for in this

Petition. I want to be involved in raising my child and I believe visitation is

in the child’s best interest.

• I have a safe place for the child to stay during visitation.

• I will support the child as ordered by the court to the best of my ability.

• I want to have access to the child’s medical, school, and court records.

• I swear that I am able to take care of the child listed above. I am a fit and

proper person.

___________________________________________ Date: ____________

Signature of person asking for visitation