§ Rule 1915.15 Form of Complaint Caption Order Petition to Modify a Partial Custody or Visitation Order

Rule 1915.15. Form of Complaint. Caption. Order. Petition to Modify a Partial Custody or Visitation Order

(a) The complaint in an action for custody, partial custody or visitation shall be in substantially the following form:

(Caption)

COMPLAINT FOR (CUSTODY)

(PARTIAL CUSTODY) (VISITATION)

1. The plaintiff is

_____________________________________________________________________________,

residing at _________________________________________________________________.

(Street) (City) (Zip Code) (County)

2. The defendant is

_____________________________________________________________________________,

residing at _________________________________________________________________.

(Street) (City) ( Zip Code) (County)

3. Plaintiff seeks (custody)(partial custody)(visitation) of the following child(ren):

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)

_______________________________ _______________________________ ____________

The mother of the child is __________, currently residing at ____________________.

She is (married)(divorced)(single).

The father of the child is __________, currently residing at ____________________.

He is (married)(divorced)(single).

4. The relationship of plaintiff to the child is that of _____________________
.
The plaintiff currently resides with the following persons:

Name Relationship

______________________________________ ______________________________________

5. The relationship of defendant to the child is that of __________.

The defendant currently resides with the following persons:

Name Relationship

______________________________________ ______________________________________

6. Plaintiff (has) (has not) participated as a party or witness, or in another capacity, in other litigation concerning the custody of the child in this or another court. The court, term and number, and its relationship to this action is:

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: __________

7. The best interest and permanent welfare of the child will be served by granting the relief requested because (set forth facts showing that the granting of the relief requested will be in the best interest and permanent welfare of the child:

8. Each parent whose parental rights to the child have not been terminated and the person who has physical custody of the child have been named as parties to this action. All other persons, named below, who are known to have or claim a right to custody or visitation of the child will be given notice of the pendency of this action and the right to intervene:

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

Note: The form of complaint is appropriate where there is one plaintiff and one defendant and where the custody of one child is sought, or where the custody of several children is sought and the information required by paragraphs 3 to 7 is identical for all of the children. Where there are multiple parties, the complaint should be appropriately adapted to accommodate them. Where the custody of several children is sought and the information required is not identical for all, the complaint should contain a separate paragraph for each child.

(b) A petition to modify a partial custody or visitation order shall be in substantially the following form:

(Caption)

PETITION FOR MODIFICATION

OF A PARTIAL CUSTODY

OR VISITATION ORDER

1. The petition of ____________________ respectfully represents that on ____________________, 19____ an

Order of Court was entered for (PARTIAL CUSTODY) (VISITATION), a true and
correct copy of which is attached.

2. This Order should be modified because: _________________________________

_________________________________

.
WHEREFORE, Petitioner requests that the Court modify the existing Order for (PARTIAL CUSTODY) (VISITATION) because it will be in the best interest of the child(ren).

______________________________________

(Attorney for Petitioner) (Petitioner)

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.

______________________________________ ______________________________________

Date Petitioner

(c) The order to be attached at the front of the complaint or petition for modification shall be in substantially the following form:

(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 ______(Day and Date), at ______(Time), ____.M., for

[ ] 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 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)

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:

Date: ______________________________________ ______________________________________