West Virginia Vital Statistics Form

In every divorce case, the court must be informed of all parties involved, especially minor children (if there are any). To inform the court, the divorcing couple must fulfill this form and submit.Download

Extracted Text for Proper Search

SCA-F-104 (Revised 12/01)         VITAL STATISTICS	
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. _______________________________________________________________
Husband's Full Name: __________________________________________________________
Wife's 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	  No
Names of Children Under 18 Years of Age                        Date of Birth
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
______________________________________________________________________________
Date of Decree:  ________________________________________________________________
   [To be Completed by Clerk]