Rotating Parenting Visitation Schedule Template Page 4
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4Date:
Date:
_
Signature of the Petitioner
Signature of Respondent
Printed Name:
Printed Name:
_
Address:
Address:
_
_
City:
_______________________
City:
_______________________
State:
_______________________
State:
_______________________
Telephone:
_______________________
Telephone:
_______________________
Facsimile:
_______________________
Facsimile:
_______________________
STATE OF
STATE OF
_
COUNTY OF
COUNTY OF
_
Sworn to or affirmed and signed before me
Sworn to or affirmed and signed before me
on _____ day of ___________ by the
on _____ day of ___________ by the
Petitioner, _____________________
Respondent, ________________________
_
Notary Public or Deputy Clerk
Notary Public or Deputy Clerk
(Print, type or stamp commission name of notary)
(Print, type or stamp commission
name of notary)
___ personally known to me
___ personally known to me
___ produced the following identification:
___ produced the following identification:
____________________________________
______________________________________
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