Petition For Appeal From Family Court Final Order (Page 3 of 3) in pdf

Petition For Appeal From Family Court Final Order Page 3

VERIFICATION

I, _______________________________________, after making an oath or affirmation to tell the truth, say that the

facts I have stated in this Petition for Appeal are true of my personal knowledge; and if I have set forth matters upon

information given to me by others, I believe that information to be true.

__________________________________

_____________________

Signature

Date

This Verification was sworn to or affirmed before me on the _______ day of ______________________, _______.

________________________________________

Notary Public

My commission expires: ___________________________________________________________________________.

CERTIFICATE OF SERVICE

State of West Virginia

County of ______________________________

I, _______________________________________, the person making this Petition for Appeal, mailed the Petition to

the following persons by first class United States Mail.

Mailed to: _______________________________________________________

Address: ________________________________________________________

Date mailed: _____________________________________________________

Mailed to: _______________________________________________________

Address: ________________________________________________________

Date mailed: _____________________________________________________

________________________________

__________________________________

_____________________

(Print your name)

Signature

Date

FCA Form 2

Confidentiality Notice: This document

is not available for public inspection.

Dec. 2001

Petition For Appeal From Family Court Final Order Page 3