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Information Requested By Division Of Vital Statistics (Pertaining To Divorces And Annulments) SCA-F-104 - West Virginia
| Information Requested By Division Of Vital Statistics (Pertaining To Divorces And Annulments) Form. This is a West Virginia form and can be used in Divorce Family Court Statewide . |
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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 No. _______________________________________________________________ Husbands Full Name: __________________________________________________________ Wifes Maiden Name: ___________________________________________________________ Age of Husband: ___________________ Age of Wife: __________________Place of Marriage: _____________________________________________________________ [COUNTY] [STATE]Date of Marriage: ______________________________________________________________Name of Petitioner: ______________________________________________________________Divorce: 9 Yes 9 No Annulment: 9 Yes 9 NoNames of Children Under 18 Years of Age Date of Birth ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ______________________________________________________________________________ Date of Decree: ________________________________________________________________ [To be Completed by Clerk] SCA-F-104 (Revised 12/01) VITAL STATISTICS
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