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

   2. The defendant is

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

   The child (was) (was not) born out of wedlock.

   The child is presently in the custody of

   During the past five years, the child has resided with the following persons and at the following addresses:

   The mother of the child is

   The father of the child is

   4. The relationship of plaintiff to the child is that of

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

   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:

   Wherefore, plaintiff requests the court to grant (custody) (partial custody) (visitation) of the child.

   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.

   Official 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

   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).

 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.

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

 You,

 You are ordered to appear in person at

      (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 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.

 The Court of Common Pleas of

 BY THE COURT:

   The provisions of this Rule 1915.15 amended November 8, 1982, effective January 1, 1983, 12 Pa.B. 4040; amended April 29, 1991, effective July 1, 1991, 21 Pa.B. 2337; amended December 2, 1994, effective March 1, 1995, 24 Pa.B. 6263; amended March 2, 2000, effective immediately, 30 Pa.B. 1646; amended March 18, 2004, effective June 16, 2004, 34 Pa.B. 1754. Immediately preceding text appears at serial pages (202642), (265467) to (265469).