Transcription of IN THE FAMILY/CIRCUIT COURT OF COUNTY, WEST …
1 IN THE FAMILY/CIRCUIT COURT OF COUNTY, WEST VIRGINIA. INFORMATION REQUESTED BY DIVISION OF VITAL statistics . [Pertaining to Divorces and Annulments]. Chapter 16, Article 5, Section 34 of Code of West Virginia, as Amended Civil Action Number: Petitioner's Full Name: Respondent's Full Name: Petitioner's and/or Respondent's Maiden Name: Petitioner's Date of Birth: / / Respondent's Date of Birth: / /. Place of Marriage: [COUNTY] [STATE]. Date of Marriage: / /. Divorce: Yes / No Annulment: Yes / No Names of Children Under 18 Years of Age Date of Birth / /. / /. / /. / /. / /. / /. / /. Date of Decree: _____. [To be Completed by Clerk]. SCA-FC-104: Information Requested by the Division of Vital statistics Page 1 of 1. Review Date: 06/2017; Revision Date: 06/10/2017; WVSCA Approved: 6/13/2017.
