Form Shc 1124 – Fill Out and Use This PDF

You must use black ink to fill out this form.

Your Name:

Mailing Address:

Telephone:	Message phone:
NOTE: If for any reason you do not wish the other party to know your
physical address, you must still provide a mailing address so that the
court and the other party can serve you by mail.
	IN THE SUPERIOR COURT FOR THE STATE OF ALASKA
		AT
			City or Town where Court is located
	)
					)
Plaintiff,	)
	)
vs.	)
	)
					)
Defendant.	)
						)	Your Case No.			______

POST-JUDGMENT ORDER

FOR MODIFICATION of CUSTODY AND VISITATION

After considering all evidence submitted and applying the relevant factors listed in AS 25.24.150 and AS 25.20.090, the court finds this Order for Modification to be in the child(ren)’ s best interests.

1.This Order applies to the following minor child(ren):

Name	Date of Birth

CUSTODY AND VISITATION MODIFICATION ORDER	Page 1 of 4
	SHC-1124 (9/04)

You must use black ink to fill out this form.

2.	Legal Custody
	Joint legal custody is awarded to both parents.
	Sole legal custody is awarded to	Father or	Mother.

Special findings:

3.Physical Custody

Shared Physical Custody is awarded to both parents. The residential schedule is set forth below in section 4.

Primary Physical Custody is awarded to Father Mother. The visitation schedule is set forth below in section 4.

4. Residential Schedule of Child(ren)

The child(ren) shall reside with Father Mother, except for the following days and times when the child(ren) shall reside with or be with the other parent:

i.	from:			to
			(Day and time)		(Day and Time)
	other:

Frequency:
	every week		every other week	every two weeks
ii.	and from:				to
		(Day and time)		(Day and Time)
	other:

CUSTODY AND VISITATION MODIFICATION ORDER	Page 2 of 4
	SHC-1124 (9/04)

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5.Place For Transfer Between Parents

The transfer between parents shall take place at the following location(s):

6.Transportation For Transfer Between Parents

(Name of person who will be helping)

shall be responsible for transporting the child(ren). Comments:

7.Third Party Assistance With Transfer Between Parents

The following third party(ies) shall conduct or supervise the transfer between parents:

Name		Phone	Conduct Supervise

8.Safety Concerns

Based on the evidence taken, this Court finds that there are legitimate safety concerns

and therefore orders that visitation be restricted as follows:

An ORDER FOR VISITATION FACILITATION (Form DR-865) is attached.

9.Out-Of-State Travel

A.		Father and/or	Mother shall not travel out-of-state with the minor child(ren) during
his or her custody or visitation time.
B.		Father and/or	Mother may travel out-of-state with the minor child(ren) during his
or her custody or visitation time without restrictions				with the following restrictions:

CUSTODY AND VISITATION MODIFICATION ORDER	Page 3 of 4
	SHC-1124 (9/04)

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10.VACATION, HOLIDAY, BIRTHDAY AND SPECIAL OCCASION SCHEDULE

The vacation and holiday schedule shall be the same as the regular schedule on pages 2-3 except as indicated below:

With Dad

With Mom

Date/time begin and end

Winter vacation

Spring vacation

Summer vacation

Christmas Eve

Christmas Day

Father’s birthday

Mother’s birthday

Child(ren)’s birthday(s)

Father’s Day

Mother’s Day

11.Other (including findings regarding domestic violence):

12.Neither parent shall speak badly of the other parent in front of the child(ren).

Dated at		, Alaska this _____ day of		, 20 .

Judge

I certify that on

a copy of this Order was mailed to each of the following at

their addresses of record. (List names if not an agency)

Deputy Clerk / Secretary

CUSTODY AND VISITATION MODIFICATION ORDER	Page 4 of 4
	SHC-1124 (9/04)