Fill and Sign the Petition Modify Form

Form 351 (Rev. 10/11) The Family Court of the State of Delaware In and For New Castle Kent Sussex County PETITION TO MODIFY VISITATION Petitioner Respondent Name D.O.B Name D.O.B. File Number                         Street Address Street Address                   P.O. Box Number P.O. Box Number Petition Number             City/State/Zip Code City/State/Zip Code                   Attorney Name Attorney Name             Interpreter needed? Yes No Interpreter needed? Yes No Language       Language       2 nd Petitioner (if any) 2 nd Respondent (if any) Name D.O.B Name D.O.B.                         Street Address Street Address             P.O. Box Number P.O. Box Number             City/State/Zip Code City/State/Zip Code             Attorney Name Attorney Name             Interpreter needed? Yes No Interpreter needed? Yes No Language       Language       IN THE INTEREST OF the following child(ren): Name Date of Birth Name Date of Birth                         Name Date of Birth Name Date of Birth                         Name Date of Birth Name Date of Birth                         The said child(ren) live with (Name):       Relationship to child(ren):                             (STREET ADDRESS) (CITY) (STATE) (ZIP CODE) 1 of 2 Form 351 (Rev. 10/11) Petitioner requests the Court enter an order modifying a prior visitation order of this Court issued by       , dated       , and in support there of alleges the following (Judicial Officer) (MM/DD/YY) circumstances. (Please list in consecutively numbered paragraphs):       Petitioner requests that Visitation be as follows:       WHEREFORE, Petitioner prays that a Summons issue to Respondent and that the Court grant relief prayed for or such other relief as may be just. SWORN TO AND SUBSCRIBED before me this date,             Petitioner/Attorney       Clerk of Court/Notary Public 2 of 2