- Petition/Motion to Modify Custody/Visitation Instructions For Completing DOM REL 7 - Colorado
- Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit - Florida
- Supplemental Petition to Modify Parental Responsibility - Florida
- Non-Custodial Parent Application for Child Support Services - South Carolina
- Child Custody Form - California
- Custodial Parent Application for Child Support Services - South Carolina
Fillable Printable Complaint for Custody - Maryland
Fillable Printable Complaint for Custody - Maryland
Complaint for Custody - Maryland
Circuit Court for
Case No.
Name
Street Address
Apt. #
City State Zip Code
Area
Code
Telephone
City or County
Name
Street Address
Apt. #
City State Zip Code
Area
Code
Telephone
Plaintiff Defendant No. 1
Name
Street Address
Apt. #
City State Zip Code
Area
Code
Telephone
Defendant No. 2
COMPLAINT FOR CUSTODY
(DOM REL 4)
I, , representing myself, state that:
Your name
1. I am the mother father or
of the following minor child(ren):
Relationship (for example, aunt, grandfather, guardian, etc.)
Name of Child
Date of Birth
Name of Child
Date of Birth
Name of Child
Date of Birth
Name of Child
Date of Birth
Name of Child
Date of Birth
Name of Child
Date of Birth
2. is the mother father or
of the child(ren). Defendant No. 2 is the mother father of the child(ren).
Defendant
Relationship
3. The child(ren) live(s) at
with .
Address
Name of person
4. The child(ren) have lived in the following places, with the persons indicated during the last
five years:
(check one)
(check one)
Time Period Place Name(s)/Current Address of Person(s) with whom Child Lived
Page 1 of 3
DR 4 (Rev. 9/2005)
5. I know of the following cases concerning the child(ren) (such as domestic violence
(protective order), paternity, divorce of the child(ren)'s parents, custody, visitation,
termination of parental rights, adoption or other cases):
Court Case No. Kind of Case Year Filed Results or Status (if you know)
Attach the most recent court order for the above-referenced court cases.
6. I have been a party, witness, or otherwise involved in the following cases about custody or
visitation of the child(ren):
State Court Case No. Date of Child Custody Determination
Attach the most recent court order for the above-referenced court cases.
7. I know of the following people, not parties to this case, who have physical custody of, or
claim rights of legal custody or physical custody of, or visitation with the child(ren):
Name
Name
Name
Current Address
Current Address
Current Address
8. It is in the best interests of the child(ren) to be in my custody because:
FOR THESE REASONS, I request the court (check all that apply):
Grant me sole joint physical custody of the child(ren).
Grant me sole joint legal custody of the child(ren).
Allow to visit with the child(ren).
(check one)
(check one)
Name(s)
Page 2 of 3
DR 4 (Rev. 9/2005)
Allow to visit with the child(ren) on
the following terms:
Name(s)
Allow no visitation because
Order to pay health insurance for child(ren).
Order to pay child support (attach Financial
Statement. Use Form Dom. Rel. 30 or Dom. Rel. 31).
(State other requests relating to the children.)
Order any other appropriate relief.
I, solemnly affirm under the penalties of
perjury, that the contents of this document are true to the best of my knowledge,
information and belief.
Date
Signature
Page 3 of 3
DR 4 (Rev. 9/2005)
Name(s)
Name(s)
Your Name
