Form DC-630 MOTION TO AMEND OR REVIEW ORDER Form DC-630

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Using This Form 1. Copies (Contact the court or court services unit (Intake Office) to determine if you should bring copies with you or if copies will be made upon filing.) a. Original to court. b. First copy to person being served. c. Additional copies as determined by local practice. 2. Motion portion prepared by person requesting that order be amended. Notice portion prepared by clerk. Order portion prepared by clerk and signed by judge. 3. Attachments a. Copy of underlying court order to be changed, amended and/or modified. b. Cases in which legal custody, physical custody or visitation with respect to a child is an issue, district court form DC-620, AFFIDAVIT. 4. Preparation details a. This form may be used when requesting the court to change, amend or modify an existing court order. b. Data Element Nos. 5 or 6 and 7 should show original style of case. Signature line enables person making the Motion to indicate whether he was the original petitioner or respondent.

MOTION TO AMEND OR REVIEW ORDER Case No.... Commonwealth of Virginia 1 5 [ ] General District Court... 2 [ ] Juvenile and Domestic Relations District Court COURT ADDRESS This motion is filed in connection with Case No.... [ ] In re... NAME OF CHILD [ ]... v.... PETITIONER 3 6 7 4 RESPONDENT 13 ADDRESS/LOCATION ADDRESS/LOCATION TELEPHONE NUMBER TELEPHONE NUMBER The undersigned respectfully represents to the Court that an order dated... was entered 9 by the [ ] above-named Court [ ]... Court REQUIREMENTS OF ORDER [ ] The undersigned moves that the attached order be changed, amended, and/or modified as follows: 10 CHANGES, AMENDMENTS AND/OR MODIFICATIONS TO ORDER 11... for the following reason(s): 12 [ ] The undersigned moves for a hearing on the modifications of the above order proposed by the Department of Social Services and that the Court take whatever other action it deems necessary.... [ ] PETITIONER [ ] RESPONDENT 8 14 15 FORM DC-630 FRONT 05/05

Data Elements, front 1. Court case number. If form is clipped to file at top of page, put case number at bottom of page. Otherwise, put case number at top of page. 2. Court name. 3. Court address. 4. Reference the case number of the connected case. 5. Check and indicate the name of the child if this is an in re case. 6. Name, street address and telephone number of original petitioner in case. 7. Name, street address and telephone number of original respondent in case. 8. Date of entry of earlier order which this Motion seeks to amend. 9. Check and, when necessary, complete the name of the court which entered the earlier order. 10. Provisions of earlier order which person making Motion seeks to change. 11. Provisions which the person making Motion would like to have added to order or have order changed to include. 12. Reasons for the desired changes in the order. 13. Check if a hearing is requested on the changes to the specified order proposed by the Department of Social Services. 14. Date of signing of Motion. 15. Signature of person making Motion.

1 Case No.... NOTICE 2 (PARTY TO BE SERVED) You are hereby notified that on..., a hearing will be held by this AND TIME Court to consider a motion to change, amend, and/or modify the terms of an order as described in the Request on the reverse side. 3 4 5... CLERK SERVICE OF PROCESS ON PARTY TO BE SERVED 6 [ ] Personal service Being unable to make personal service, a copy was delivered in the following manner: 7 [ ] Delivered to family member (not temporary sojourner or guest) age 16 or older at usual place of abode of party named above after giving information of its purport (List name, ages, of the recipient and relation to party named above.)... [ ] Posted on front door or such other door as appears to be the main entrance of usual place of abode, address listed above. (Other authorized recipient not found.) 8 9 [ ] Not found 10 CASES TO ENFORCE CHILD SUPPORT ONLY: [ ] Delivered to... the [ ] residential [ ] business address of record. 11 12... SERVING OFFICER 13 for FORM DC-630 REVERSE 10/13

Data Elements, reverse 1. Court case number. If form is clipped to file at top of page, put case number at bottom of page. Otherwise, put case number at top of page. 2. Name of person to be served. 3. Date and time of hearing on Motion. 4. Date of issuance. 5. Signature of clerk. 6. Serving officer to check this box if personal service obtained. 7. Serving officer to check the appropriate box to designate type of substitute service. 8. If served by leaving a copy with a family member age 16 or older, check appropriate box and insert required information. 9. Serving officer to check this box if unable to serve process. 10. Child support enforcement cases only: check applicable boxes and insert address where delivered. 11. Date of signature. 12. Signature of serving officer. 13. Name of sheriff if served by deputy sheriff.