Fillable Printable Request for Virginia Registration of a Child Custody and/or Visitation Determination from Another State

Request for Virginia Registration of a Child Custody and/or Visitation Determination from Another State

REQUEST FOR VIRGINIA REGISTRATION OF A CHILD

CUSTODY AND/OR VISITATION DETERMINATION

FROM ANOTHER STATE

Case No.

Commonwealth of Virginia Va. Code § 20-146.26

Juvenile and Domestic Relations District Court

CITY/COUNTY

COURT ADDRESS

In re:

NAME OF CHILD WHO IS SUBJECT OF DETERMINATION TO BE REGISTERED DATE OF BIRTH OF CHILD

Name of Person Requesting Registration:

Address of Person Requesting Registration:

I allege under oath that the health, safety or liberty of a party or child would be jeopardized by

disclosure of identifying information. Therefore, I request that this document be sealed pursuant to the

provisions of subsection E of Virginia Code § 20-146.20 and the address above not be disclosed.

[ ]

Name and Address of Persons other than the person requesting registration who have been awarded custody or

visitation in the attached child custody and/or visitation determination:

NON-REGISTERING PARTY

OTHER INTERESTED PERSON

ADDRESS

I request that the clerk of the above-named court register the attached certified child custody and/or

visitation determination. Two copies (including at least one certified copy) of the child custody and/or visitation

determination are attached.

I state, under penalty of perjury, that to the best of my knowledge and belief, the attached child custody

and/or visitation determination has not been modified.

DATE

SIGNATURE OF REQUESTOR

Subscribed and sworn to before me this day by

[ ] CLERK [ ] DEPUTY CLERK [ ] MAGISTRATE

DATE

[ ] NOTARY PUBLIC: My Commission Expires:

FORM DC-582 (PAGE ONE OF ONE) REVISED 9/02 PDF