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
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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]
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