Pennsylvania Code › Title 231 - RULES OF CIVIL PROCEDURE › Part I - GENERAL › Chapter 1915 - ACTIONS FOR CUSTODY OF MINOR CHILDREN › Rule 1915.15 - Form of Complaint. Caption. Order. Petition to Modify a Custody Order

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The complaint
				in a custody action shall be substantially in the following form:
(Caption)
COMPLAINT FOR CUSTODY
1. The plaintiffis is
				_________________________,
residing at
				  __________________________________________
(Street)
(City)
(Zip Code)
(County)
2.
				The defendant is_________________________ ,
residing. _________________________.
(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)
____________
____________
____________
____________
____________
____________
____________
____________
____________
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).
4. plaintiffis relationship of the
				child is that of _________________________ .
Plaintiff currently resides with the following
				  persons:
Name
Relationship
____________
____________
____________
____________
5.
				Defendant's relationship to the child is that of ____________ .
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 child's interest and permanent welfare will be served by granting the
				relief requested because (set forth facts showing that the granting of the
				relief requested will be in the child's best interest and permanent welfare):
____________________________
____________________________.
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
____________
____________
____________
____________
____________
____________
____________
____________
____________
9.
(a) If the plaintiff is seeking physical or
				legal custody of a child and is in loco parentis to the child, the plaintiff
				shall plead facts establishing standing under
				23 Pa.C.S. §
												5324(2). ____________
____________
____________
____________
(b) If the plaintiff is a grandparent or
				seeking physical or legal custody of a grandchild and is not local parentis to
				the child, the plaintiff shall plead facts establishing standing
				23Pa.C.S §
												5324(3). ____________
____________
____________
____________
(c) If the palintiff is a seeking physical or
				legal custody of a child is not local parentis to the child, the plaintiff
				shall plead facts establishing standing
				23Pa.C.S §
												5324(4) and
				(5). ____________
____________
____________
____________
(d) If the plaintiff is a grandparent or
				great-grandparents seeking partial physical custody or supervised physical
				custody grandchild or great grandchild, the plaintiff shall plead facts
				establishing standing
				23Pa.C.S §
												5325.____________
____________
____________
____________
10. Plaintiff has attached the Criminal
				Record/Abuse History Verification form required pursuant to Pa.R.C.P. No.
				1915.3-2.
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