In the superior court for the state of alaska




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You must use black ink to fill out this form.

Your Name:

Mailing Address:



Telephone: Message phone:

IN THE SUPERIOR COURT FOR THE STATE OF ALASKA

AT

City or Town where Court is located


)

)

Plaintiff, )

)

vs. )


)

)

Defendant. )



) Your Case No.

CUSTODY & VISITATION PLAN FOR _


(child’s name)
Because it is in the child(ren)’s best interests, I request:

 Legal Custody (Decision making)  Sole Legal Custody  Joint Legal Custody

 Physical Custody (Where the child(ren) should live(s))


 Primary Physical Custody Child(ren) will live with me

 Shared Physical Custody I request that we have shared physical custody with the following schedule: ________________



 Other Custody Arrangement as follows: ________________________________

______________________________________________________________________

 Visitation I request that the other parent have the following visitation schedule:

Summer Vacation:

Holidays & Birthdays:

Weekends:

Other:

 Safety Concern I am concerned about my safety or the children’s safety when with the other parent. Therefore, I request that visitation be restricted as follows:

Date Signature


I certify that on a copy of the above was mailed or hand delivered to:

 Opposing Party  Opposing :Lawyer  Other___________________ S
Your Signature: ________________________________________

Page 1 of ______

CUSTODY & VISITATION PLAN (Short) SHC-1122 (06/09)






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