City or Town where Court is located




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You must use black ink to fill out this form.

Your Name:

IN THE SUPERIOR COURT FOR THE STATE OF ALASKA

AT

City or Town where Court is located


)

)

Plaintiff, )

)

vs. )


)

) Your Case No.

Defendant. )



) CUSTODY & VISITATION ORDER (Short)
The  plaintiff  defendant filed a motion and the opposing party  did did not respond in writing. A hearing  was  was not held on ,which  plaintiff and/or  defendant attended.

After considering the motion and any opposition thereto, and good cause being found, the following custody and visitation IS HEREBY ORDERED for the following child(ren):


Child(ren)’s Name(s) Date(s) of Birth
















1) Legal Custody shall be with the  Mother  Father or  both parents.
2) Physical Custody shall be  shared between the parents or  primarily with

the  Mother  Father. The child(ren) shall reside with the  Mother  Father except for the following days and times when the child(ren) shall reside with or be with the other parent:









  1. Other:




Dated at , Alaska this _____ day of , 20 .

Judge


I certify that on a copy

of the above was mailed to each of the following at

their addresses of record. (List names if not an agency)

 CSSD/AG  CI



Deputy Clerk / Secretary



Page 1 of 1

Order For Custody & Visitation (Short) SHC-1123 (4/05)






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