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Form Shc-1500 - Motion And Affidavit To Modify Custody, Visitation And/or Child Support Page 5

You must use black ink to fill out this form.

Other parent:

e. The child(ren)’s living arrangements have been as follows, and I believe those

arrangements should

stay the same or

change for the following reasons:

(The court

will consider the length of time the child(ren) has(have) lived in a stable, satisfactory environment and the

desirability of maintaining continuity.)

f. I think that each parent has the following desire and ability to allow an open and loving

frequent relationship between the child and the other parent:

(Describe for you and how you

think it is for the other parent.)

Mother:

Father:

g. There

has

has not been domestic abuse, child abuse, or child neglect in the

proposed custodial household or a history of violence between the parents.

(If “yes,”

explain briefly what has happened and how the Custody and Visitation Plan addresses this issue. NOTE:

see No. 4(b)(iii) above for information about how a history of domestic violence can affect the outcome of

the custody issues in your case.)

MOTION TO MODIFY

Page 5 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 5