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Form Shc-1500 - Motion And Affidavit To Modify Custody, Visitation And/or Child Support Page 4

You must use black ink to fill out this form.

Other: _________________________________________________________________

Comments: I am concerned about my safety or the safety of the children when with the other

parent. Therefore, I request that visitation be restricted as follows:

5. Best Interests – Describe why your plan is best for the child(ren) and what concerns you

may have about the other parent by filling in section a-h below (see AS 25.24.150):

a. Our child(ren) have the following physical, emotional, mental, religious, and social

needs, which my plan meets in the following ways:

b. Each parent has the following capability and desire to meet these needs:

Me:

Other parent:

c. The child(ren)’s preference is described as follows:

(There is no absolute rule on how old a

child must be to form a preference; it depends on each child. You can explain your thoughts on this issue

here.)

d. The love and affection existing between the child(ren) and each parent is described as

follows:

(Describe for you and how you think it is with the other parent.)

Me:

MOTION TO MODIFY

Page 4 of 9

Docket: DR705 or DR705UISFA

SHC-1500 (02/18)

Form Shc-1500 - Motion And Affidavit To Modify Custody, Visitation And/or Child Support Page 4