(Caption)
COMPLAINT FOR CUSTODY
residing at __________________________________________
(Street) | (City) | (Zip Code) | (County) |
residing. _________________________.
(Street) | (City) | (Zip Code) | (County) |
Name | Present Residence | Age |
____________ | ____________ | ____________ |
____________ | ____________ | ____________ |
____________ | ____________ | ____________ |
The child (was) (was not) born out of wedlock.
The child is presently in the custody of____________ ,
(Name) who resides at_________________________.
(Street) | (City) | (State) |
During the past five years, the child has resided with the following persons and at the following addresses:
(List All Persons) | (List All Addresses) | (Dates) |
____________ | ____________ | ____________ |
____________ | ____________ | ____________ |
____________ | ____________ | ____________ |
A parent of the child is __________ ,
currently residng at ___________.
This parent is (married) (divorced) (single).
A parent of the child is __________, currently residing at __________.
This parent is (married) (divorced) (single).
Plaintiff currently resides with the following persons:
Name | Relationship |
____________ | ____________ |
____________ | ____________ |
Defendant currently resides with the following persons:
Name | Relationship |
____________ | ____________ |
____________ | ____________ |
______________________________
______________________________
______________________________.
Plaintiff (has) (has no) information of a custody proceeding concerning the child pending in a court of this Commonwealth or any other state. The court, term and number, and its relationship to this action is: _____________.
Plaintiff (knows) (does not know) of a person not a party to the proceedings who has physical custody of the child or claims to have custody or visitation rights with respect to the child. The name and address of such person is: ____________.
____________________________
____________________________.
Name | Address | Basis of Claim |
____________ | ____________ | ____________ |
____________ | ____________ | ____________ |
____________ | ____________ | ____________ |
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
____________
Wherefore, Plaintiff requests the court to grant (custody) (partial custody) (visitation) of the child.
____________
Attorney for Plaintiff
I verify that the statements made in this Complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities.
____________
Plaintiff
(Caption)
PETITION FOR MODIFICATION OF A CUSTODY ORDER
_____________________________________________________
_____________________________________________________
WHEREFORE, Petitioner requests that the Court modify the existing Order because it will be in the best interest of the child(ren).
__________________________________
(Attorney for Petitioner) (Petitioner)
I verify that the statements made in this petition are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities.
________ ______________________
Date Petitioner
(Caption)
ORDER OF COURT
You, ____________, (defendant) (respondent), have been sued in court to (OBTAIN) (MODIFY) custody, partial custody or visitation of the child(ren): ____________.
You are ordered to appear in person at _________________________ ,
(Address)
on _________________________, at ____________, ____________ .M., for
(Day and Date) (Time)
[] a conciliation or mediation conference.
[] a pretrial conference.
[] a hearing before the court.
If you fail to appear as provided by this order, an order for custody, partial custody or visitation may be entered against you or the court may issue a warrant for your arrest.
You must file with the court a verification regarding any criminal record or abuse history regarding you and anyone living in your household on or before the initial in-person contact with the court (including, but not limited to, a conference with a conference officer or judge or conciliation) but not later than 30 days after service of the complaint or petition.
No party may make a change in the residence of any child which significantly impairs the ability of the other party to exercise custodial rights without first complying with all of the applicable provisions of 23 Pa.C.S. § 5337 and Pa.R.C.P. No. 1915.17 regarding relocation.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE.
______________________________________
(Name)
______________________________________
(Address)
______________________________________
(Telephone Number)
AMERICANS WITH DISABILITIES ACT OF 1990
The Court of Common Pleas of____________ County is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the court, please contact our office. All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled conference or hearing.
BY THE COURT:
______________________________________
J.
Date: ____________
231 Pa. Code r. 1915.15