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West Virginia Answer to Divorce Petition Form

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West Virginia Answer to Divorce Petition Form Page 2
West Virginia Answer to Divorce Petition Form
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
[ ] A child is currently expected, and the estimated date of delivery is ____________________
4. The children currently live with:
[ ] Mother [ ] Father
[ ] Another person, or persons, whose name(s) and address(es) are: _______________________
5. During the last five years, if any of the children have lived at addresses other than their current
address, use the following space to list where they lived, and for how long. If there is not enough
room in the following space, use an additional sheet of paper. I have attached ____ additional
sheet(s).
Child’s Name
Address Dates of Residence
6. Who provides health insurance for the children
[ ] Mother [ ] Father [ ] Medicaid [ ] WV CHIP
[ ] Another person, whose name and address are: _____________________________________
_______________________________________________________.
[ ] The children DO NOT have health insurance coverage.
The West Virginia Children’s Health Insurance Program (WV CHIP) can help parents
obtain free or low cost health care for their children. For more information, call 1-877-982-
2447, or ask the Family Court Staff about WV CHIP.
7. Answer all of the following questions.
a. Has the Respondent been a party or witness in any other proceeding, in any state, concerning the
allocation of custodial responsibility for the children [ ] Yes [ ] No
b. Is the Respondent aware of any other proceeding, past or present, in any state, concerning
allocation of custodial responsibility for the children [ ] Yes [ ] No
c. Is the Respondent aware of any person, other than the Petitioner and Respondent, who has
SCA-FC-108 (1/04) Divorce Answer Page 2 of 5
West Virginia Answer to Divorce Petition Form