Motion to Modify Custody or Visitation · Step 3 of 6

Signature & Certification

Submitted By: (your name) Sign here and write your name to show you are the one filing this motion. Plaintiff Check this box if you are the plaintiff, the person who started the case. Defendant Check this box if you are the defendant, the other party in the case. DATED Write the date you sign this part of the form. Fill in the day, month, and year. Submitted By: (your signature) Sign your name here to confirm you are asking the court for this relief. (print your name) Print your full name clearly so the court knows who signed. DATED Write the date you sign this declaration. Fill in the day, month, and year. Submitted By: (your signature) Sign your name here to swear that everything you wrote is true. (print your name) Print your full name clearly so the court knows who signed this declaration.

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