Rule 1910.27. Form of Complaint. Order. Income Statements and Expense Statements. Health Insurance Coverage Information Form. Form of Support Order. Form Petition for Modification. Petition for Recovery of Support Overpayment.

 (a)  The complaint in an action for support shall be substantially in the following form:

 (Caption)
COMPLAINT FOR SUPPORT

 

      1. Plaintiff resides at


,
(Street)      (City)    (Zip Code)

County. Plaintiff’s Social Security Number is
, and date of birth is
.

     2. Defendant resides at


,
(Street)    (City)    (Zip Code)
County. Defendant’s Social Security Number is
, and date of birth is
.

      3. (a) Plaintiff and Defendant were married on


, (Date)
at
.
   (City and State)

        (b) Plaintiff and Defendant were separated on


.
(Date)

        (c) Plaintiff and Defendant were divorced on


, at (Date)

.
(City and State)

      4. Plaintiff and Defendant are the parents of the following children:

        (a) Born of the Marriage:
Name    Birth Date    Age    Residence

     


   

        (b) Born out of Wedlock:
Name    Birth Date    Age    Residence

     


   

      5. Plaintiff seeks to pay support or receive support for the following persons:


.

      6. (a) Plaintiff is (not) receiving public assistance in the amount of $


per
for the support of
.
(Name(s))

         (b) Plaintiff is receiving additional income in the amount of $


from
.

      7. A previous support order was entered against the plaintiff
defendant on


in an action at
in
(Court, term and docket number)
the amount of $
for the support of
.
(Name)

   

   There are (no) arrearages in the amount of $


.
The order has (not) been terminated.

      8.  Plaintiff Defendant last received support from the other party in the amount of $


on
.
(Date)

 WHEREFORE, Plaintiff requests that an order be entered on behalf of the aforementioned child(ren) and/or spouse for reasonable support and medical coverage.

   

   



  Date              Plaintiff or 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.

   



  Date                    Plaintiff

NOTICE


 Guidelines for child and spousal support, and for alimony pendente lite have been prepared by the Court of Common Pleas and are available for inspection in the office of Domestic Relations Section,



(Address)   


   Official Note

   See Pa.R.C.P. No. 1930.1(b). To the extent this rule applies to actions not governed by other legal authority regarding confidentiality of information and documents in support actions or that attorneys or unrepresented parties file support-related confidential information and documents in non-support actions (e.g., divorce, custody), the Case Records Public Access Policy of the Unified Judicial System of Pennsylvania shall apply.

 (b) The order to be attached at the front of the complaint in subdivision (a) shall be substantially in the following form:

 (Caption)

 ORDER OF COURT

 Plaintiff,


and
, defendant, are ordered to appear at
before
, a conference officer of the Domestic Relations Section, on the
day of
, 20
, at
.M., for a conference, after which the officer may recommend that an order for support be entered against you.
 You are further ordered to bring to the conference
 (1) a true copy of your most recent Federal Income Tax Return, including W-2s, as filed,
 (2) your pay stubs for the preceding six months,
 (3) the Income Statement and the appropriate Expense Statement, if required, attached to this order, completed as required by Rule 1910.11(c),
 (4) verification of child care expenses, and
 (5) proof of medical coverage which you may have, or may have available to you.
 If you fail to appear for the conference or to bring the required documents, the court may issue a warrant for your arrest and/or enter an interim support order. If paternity is an issue, the court shall enter an order establishing paternity.
 (6) If a physician has determined that a medical condition affects your ability to earn income you must obtain a Physician Verification Form from the domestic relations section, sign it, have it completed by your doctor, and bring it with you to the conference.
 
THE TRIER OF FACT SHALL ENTER AN APPROPRIATE CHILD SUPPORT ORDER BASED UPON THE EVIDENCE PRESENTED, WITHOUT REGARD TO WHICH PARTY INITIATED THE SUPPORT ACTION. THE DETERMINATION OF WHICH PARTY WILL BE THE OBLIGEE AND WHICH WILL BE THE OBLIGOR WILL BE MADE BY THE TRIER OF FACT BASED UPON THE RESPECTIVE INCOMES OF THE PARTIES, CONSISTENT WITH THE SUPPORT GUIDELINES AND EXISTING LAW, AND THE CUSTODIAL ARRANGEMENTS AT THE TIME OF THE INITIAL OR SUBSEQUENT CONFERENCE, HEARING, OR TRIAL. IF SUPPORTED BY THE EVIDENCE, THE PARTY NAMED AS THE DEFENDANT IN THE INITIAL PLEADING MAY BE DEEMED TO BE THE OBLIGEE, EVEN IF THAT PARTY DID NOT FILE A COMPLAINT FOR SUPPORT.
Date of Order:
     
J.

 YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. 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.

 (c)  The Income Statements and Expense Statements to be attached to the order in subdivision (b) shall be substantially in the following form:

   (1)  Income Statements. This form must be filled out in all cases.

   Official Note

   See Pa.R.C.P. No. 1930.1(b). To the extent this rule applies to actions not governed by other legal authority regarding confidentiality of information and documents in support actions or that attorneys or unrepresented parties file support-related confidential information and documents in non-support actions (e.g., divorce, custody), the Case Records Public Access Policy of the Unified Judicial System of Pennsylvania shall apply.


v.
  No.

 THIS FORM MUST BE FILLED OUT
(If you are self-employed or if you are salaried by a business of which you are owner in whole or in part, you must also fill out the Supplemental Income Statement which appears below.
INCOME STATEMENT OF
        (Name)              (PACASES Number)


 I verify that the statements made in this Income Statement are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S.A. §  4904 relating to unsworn falsification to authorities.
Date:


        
Plaintiff or Defendant    



INCOME
 Employer:
 Address:
 Type of Work:
 Payroll Number:
 Pay Period (weekly, biweekly, etc);
 Gross Pay per Pay Period:$
 Itemized Payroll Deductions:
  Federal Withholding$
  FICA
  Local Wage Tax
  State Income Tax
  Mandatory Retirement
  Union Dues
  Health Insurance
  Other (specify)




 Net Pay per Pay Period:$
Other Income:
Week
Month
Year
(Fill in Appropriate Column)
  Interest$
$
$
  Dividends


  Pension Distributions


  Annuity


  Social Security


  Rents


  Royalties


  Unemployment Comp.


  Workers Comp.


  Employer Fringe Benefits


  Other








Total$
$
$
TOTAL INCOME$


PROPERTY OWNED
Ownership*
Description
Value
H
W
J
Checking accounts




Savings accounts




Credit Union




Stocks/bonds




Real estate




Other








Total

INSURANCE
Policy
Coverage*
CompanyNo.
H
W
C
Hospital
 Blue Cross




 Other




Medical
 Blue Shield




 Other




Health/Accident




Disability Income




Dental




Other




   


*H=Husband; W=Wife; J=Joint; C=Child

 SUPPLEMENTAL INCOME STATEMENT

  (a) This form is to be filled out by a person (check one):

   (1) who operates a business or practices a profession, or

   (2) who is a member of a partnership or joint venture, or

   (3) who is a shareholder in and is salaried by a closed corporation or similar entity.

  (b) Attach to this statement a copy of the following documents relating to the partnership, joint venture, business, profession, corporation or similar entity:

   (1) the most recent Federal Income Tax Return, and

   (2) the most recent Profit and Loss Statement.

  (c) Name of business:



Address and
Telephone Number:





(d) Nature of business (check one)(e) Name of accountant, controller or other person in charge of financial records:
(1) partnership
(2) joint venture
(3) profession(f) Annual income from business:
(4) closed corporation
(5) other(1) How often is income received?

(2) Gross income per pay period:

(3) Net income per pay period:

(4) Specified deductions, if any:

   (2)  Expense Statements. An Expense Statement is not required in cases that can be determined pursuant to the guidelines unless a party avers unusual needs and expenses that may warrant a deviation from the guideline amount of support pursuant to Pa.R.C.P. No. 1910.16-5 or seeks an apportionment of expenses pursuant to Pa.R.C.P. No. 1910.16-6. See Pa.R.C.P. No. 1910.11(c)(1). Child support is calculated under the guidelines based upon the monthly net incomes of the parties, with additional amounts ordered as necessary to provide for child care expenses, health insurance premiums, unreimbursed medical expenses, mortgage payments, and other needs, contingent upon the obligor’s ability to pay. The Expense Statement in subparagraph (A) shall be utilized if a party is claiming that he or she has unusual needs and unusual fixed expenses that may warrant deviation or adjustment in a case determined under the guidelines. In child support, spousal support, and alimony pendente lite cases calculated pursuant to Pa.R.C.P. No. 1910.16-3.1 and in divorce cases involving claims for alimony, counsel fees, or costs and expenses pursuant to Pa.R.C.P. No. 1920.31(a), the parties shall complete the Expense Statement in subparagraph (B).

   Official Note

   See Pa.R.C.P. No. 1930.1(b). To the extent this rule applies to actions not governed by other legal authority regarding confidentiality of information and documents in support actions or that attorneys or unrepresented parties file support-related confidential information and documents in non-support actions (e.g., divorce, custody), the Case Records Public Access Policy of the Unified Judicial System of Pennsylvania shall apply.

   (A)  Guidelines Expense Statement. If the combined monthly net income of the parties is $30,000 or less, it is not necessary to complete this form unless a party is claiming unusual needs and expenses that may warrant a deviation from the guideline amount of support pursuant to Rule 1910.16-5 or seeks an apportionment of expenses pursuant to Rule 1910.16-6. At the conference, each party must provide receipts or other verification of expenses claimed on this statement. The Guidelines Expense Statement shall be substantially in the following form.

EXPENSE STATEMENT OF

 


    (Name)        (PACSES Number)

 I verify that the statements made in this Expense Statement are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S.A. §  4904 relating to unsworn falsification to authorities.

 Date:


  

             Plaintiff or Defendant


Weekly Monthly Yearly
(Fill in Appropriate Column)
Mortgage (including real estate taxes and homeowner’s insurance) or Rent $
$
$
Health Insurance Premiums  
 
 
Unreimbursed Medical  Expenses:
 Doctor  
 
 
 Dentist  
 
 
 Orthodontist  
 
 
 Hospital  
 
 
 Medicine  
 
 
 Special Needs (glasses,  braces, orthopedic devices,  therapy)  
 
 
Child Care  
 
 
Private school  
 
 
Parochial school  
 
 
Loans/Debts  
 
 
Support of Other Dependents:
 Other child support  
 
 
 Alimony payments  
 
 
 Other: (Specify)  
 
 
 
 
 
 
Total $
$
$

 (B)  Expense Statement for Cases Pursuant to Rule 1910.16-3.1 and Rule 1920.31. No later than five business days prior to the conference, the parties shall exchange this form, along with receipts or other verification of the expenses set forth on this form. Failure to comply with this provision may result in an appropriate order for sanctions and/or the entry of an interim order based upon the information provided.

EXPENSE STATEMENT OF

 


    (Name)        (PACSES Number)

 I verify that the statements made in this Expense Statement are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S.A. §  4904 relating to unsworn falsification to authorities.

 Date:


  

             Plaintiff or Defendant


EXPENSES MONTHLY
TOTAL
MONTHLY
CHILDREN
MONTHLY
PARENT
HOME
 Mortgage or Rent


 Maintenance


 Lawn Care


 2nd Mortgage


UTILITIES
 Electric


 Gas


 Oil


 Telephone


 Cell Phone


 Water


 Sewer


 Cable TV


 Internet


 Trash/
 Recycling



TAXES
 Real Estate


 Personal Property


INSURANCE
 Homeowners/
  Renters



 Automobile


 Life


 Accident/Disability


 Excess Coverage


 Long-Term Care


AUTOMOBILE
 Lease or Loan Payments


 Fuel


 Repairs


 Memberships


MEDICAL
 Medical Insurance


 Doctor


 Dentist


 Hospital


 Medication


 Counseling/Therapy


 Orthodontist


 Special Needs
  (glasses, etc.)



EDUCATION
 Tuition


 Tutoring


 Lessons


 Other


PERSONAL
 Debt Service


 Clothing


 Groceries


 Haircare


 Memberships


MISCELLANEOUS
 Child Care


 Household Help


 Summer Camp


 Papers/Books/Magazines


 Entertainment


 Pet Expenses


 Vacations


 Gifts


 Legal Fees/Prof. Fees


 Charitable Contributions


 Children’s Parties


 Children’s Allowances


 Other Child Support


 Alimony Payments


TOTAL MONTHLY EXPENSES



 (d)  The form used to obtain information relating to health insurance coverage from a party shall be in substantially the following form:

(Caption)
HEALTH INSURANCE COVERAGE INFORMATION
REQUIRED BY THE COURT


This form must be completed and returned to the domestic relations section.


IF YOU FAIL TO PROVIDE THE INFORMATION REQUESTED, THE COURT MAY FIND THAT YOU ARE IN CONTEMPT OF COURT.

 Do you provide insurance coverage for the dependents named below? (Check each type of insurance which you provide).

 Type of Coverage


Full Name SS # Hospital-
zation
Medical Dental Eye Prescrip-
tion
Other


















 Note: Before forwarding the form to the party, the domestic relations section should fill in the names and Social Security numbers of the dependents about whom the information is sought.

 Provide the following information for all types of insurance you maintain, whether or not any of the above-named dependents is covered at this time:

 Insurance company (provider): 


Group #: 
 Plan #: 
 Policy #: 
Effective coverage date: 
 Type of coverage: 
Employee cost of coverage for dependents: 

 Insurance company (provider): 


Group #: 
 Plan #: 
 Policy #: 
Effective coverage date: 
 Type of coverage: 
Employee cost of coverage for dependents: 

 Insurance company (provider): 


Group #: 
 Plan #: 
 Policy #: 
Effective coverage date: 
 Type of coverage: 
Employee cost of coverage for dependents: 

 Insurance company (provider): 


Group #: 
 Plan #: 
 Policy #: 
Effective coverage date: 
 Type of coverage: 
Employee cost of coverage for dependents: 

 If the above-named dependents are not currently covered by insurance, please state the earliest date coverage could be provided. 


 (e)  The form of a support order shall be substantially as follows:

(Caption)
(FINAL) (TEMPORARY) (MODIFIED)
ORDER OF COURT

 AND NOW,


, based upon the Court’s determination that Payee’s monthly net income is $
, and Payor’s monthly net income is $
, it is hereby ordered that the Payor pay to the Domestic Relations Section, Court of Common Pleas,
Dollars ($
.
) a month payable (WEEKLY/BI-WEEKLY/SEMI-MONTHLY/MONTHLY) as follows:
. Arrears set at $
as of
are due in full IMMEDIATELY. Contempt proceedings, credit bureau reporting and tax refund offset certification will not be initiated, and judgment will not be entered, as long as payor pays $
on arrears on each payment date. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all of the means listed above.

 For the support of:














 Said money to be turned over by the domestic relations section to:





 Payments must be made (STATE ACCEPTABLE FORMS OF PAYMENT). All checks and money orders must be made payable to (NAME OF ENTITY TO WHOM CHECKS SHOULD BE MADE PAYABLE) and mailed to (NAME OF OFFICE) at (MAILING ADDRESS). Each payment must bear your (FILE/CASE/FOLIO/DOMESTIC RELATIONS) number in order to be processed. Do not send cash by mail.

 Unreimbursed medical expenses are to be paid


% by defendant and
% by plaintiff. (PLAINTIFF/DEFENDANT/NEITHER) to provide medical insurance coverage. Within 30 days after the entry of this order, the party ordered to provide medical insurance shall submit to the other party written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at a minimum, of: 1) the name of the health care coverage provider(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms.

 IMPORTANT LEGAL NOTICE

   PARTIES MUST WITHIN SEVEN DAYS INFORM THE DOMESTIC RELATIONS SECTION AND THE OTHER PARTIES, IN WRITING, OF ANY MATERIAL CHANGE IN CIRCUMSTANCES RELEVANT TO THE LEVEL OF SUPPORT OR THE ADMINISTRATION OF THE SUPPORT ORDER, INCLUDING, BUT NOT LIMITED TO, LOSS OR CHANGE OF INCOME OR EMPLOYMENT AND CHANGE OF PERSONAL ADDRESS OR CHANGE OF ADDRESS OF ANY CHILD RECEIVING SUPPORT. A PARTY WHO WILLFULLY FAILS TO REPORT A MATERIAL CHANGE IN CIRCUMSTANCE MAY BE ADJUDGED IN CONTEMPT OF COURT, AND MAY BE FINED OR IMPRISONED.

   PENNSYLVANIA LAW PROVIDES THAT ALL SUPPORT ORDERS SHALL BE REVIEWED AT LEAST ONCE EVERY THREE (3) YEARS IF SUCH A REVIEW IS REQUESTED BY ONE OF THE PARTIES. IF YOU WISH TO REQUEST A REVIEW AND ADJUSTMENT OF YOUR ORDER, YOU MUST DO THE FOLLOWING: AN UNREPRESENTED PERSON WHO WANTS TO MODIFY (ADJUST) A SUPPORT ORDER SHOULD (insert instructions for local domestic relations section).

   ALL CHARGING ORDERS FOR SPOUSAL SUPPORT AND ALIMONY PENDENTE LITE, INCLUDING UNALLOCATED ORDERS FOR CHILD AND SPOUSAL SUPPORT OR CHILD SUPPORT AND ALIMONY PENDENTE LITE, SHALL TERMINATE UPON THE DEATH OF THE PAYEE.

   A MANDATORY INCOME ATTACHMENT WILL ISSUE UNLESS THE DEFENDANT IS NOT IN ARREARS IN PAYMENT IN AN AMOUNT EQUAL TO OR GREATER THAN ONE MONTH’S SUPPORT OBLIGATION AND (1) THE COURT FINDS THAT THERE IS GOOD CAUSE NOT TO REQUIRE IMMEDIATE INCOME WITHHOLDING; OR (2) A WRITTEN AGREEMENT IS REACHED BETWEEN THE PARTIES WHICH PROVIDES FOR AN ALTERNATE ARRANGEMENT.

   DELINQUENT ARREARAGE BALANCES MAY BE REPORTED TO CREDIT AGENCIES. ON AND AFTER THE DATE IT IS DUE, EACH UNPAID SUPPORT PAYMENT SHALL CONSTITUTE A JUDGMENT AGAINST YOU.

   IT IS FURTHER ORDERED that, upon payor’s failure to comply with this order, payor may be arrested and brought before the Court for a Contempt hearing; payor’s wages, salary, commissions, and/or income may be attached in accordance with law; this Order will be increased without further hearing to $


a month until all arrearages are paid in full. Payor is responsible for court costs and fees.

   Copies delivered to parties


(INDICATE DATE DELIVERED).



Consented:


PlaintiffPlaintiff’s Attorney


DefendantDefendant’s Attorney
BY THE COURT:

J.     

 (f)  A petition for modification of support shall be in substantially the following form:

 (Caption)

 PETITION FOR MODIFICATION
OF AN EXISTING SUPPORT ORDER

   1. The petition of


respectfully represents that on
, 19
, an Order of Court was entered for the support of
. A true and correct copy of the order is attached to this petition.

   2. Petitioner is entitled to


* of this Order because of the following material and substantial change(s) in circumstance:


*Fill in the relief sought, i.e. increase, decrease, modification, termination, suspension, vacation

 WHEREFORE, Petitioner requests that the Court modify the existing order for support.

 


(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    

 (g)  The order to be attached at the front of the petition for modification set forth in subdivision (f) shall be in substantially the following form:

 (Caption)

 ORDER OF COURT

 You,


, Respondent, have been sued in Court to modify an existing support order. You are ordered to appear in person at
on
at

.M., for a conference/ hearing and to remain until dismissed by the Court. If you fail to appear as provided in this Order, an Order for Modification may be entered against you.

 You are further ordered to bring to the conference

   (1)  a true copy of your most recent Federal Income Tax Return, including W-2s, as filed,

   (2)  your pay stubs for the preceding six months,

   (3)  the Income Statement and appropriate Expense Statement, if required, attached to this order, completed as required by Rule 1910.11(c),

   (4)  verification of child care expenses, and

   (5)  proof of medical coverage which you may have, or may have available to you.

   (6)  If a physician has determined that a medical condition affects your ability to earn income, you must obtain a Physician Verification Form from the domestic relations section, sign it, have it completed by your doctor, and bring it with you to the conference.

 THE TRIER OF FACT MAY INCREASE, DECREASE OR TERMINATE THE EXISTING ORDER BASED UPON THE EVIDENCE PRESENTED. AN ORDER MAY BE ENTERED AGAINST EITHER PARTY WITHOUT REGARD TO WHICH PARTY FILED THE MODIFICATION PETITION.
Date of Order:


  
J.

  YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. 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.

 (h)  A petition for recovery of a support overpayment when a support order remains in effect shall be in substantially the following form:

(Caption)
Petition for Recovery of Support Overpayment in Active Case.


   1.  Obligor and Obligee are parties in a support action at the docket number captioned above.

   2.  There is an overpayment owing to Obligor in an amount in excess of two months of the monthly support obligation.

   

   Wherefore, Obligor requests that, pursuant to Pa.R.C.P. No. 1910.19(g)(1), the charging order be reduced by 20% or an amount sufficient to retire the overpayment by the time the charging order is terminated.

   



  Date          Petitioner or Attorney for Petitioner

   I verify that the statements in this petition are true and correct to the best of my knowledge, information and belief. 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 signature)

 (i)  A petition for recovery of a support overpayment when a support order has been terminated shall be in substantially the following form:

(Caption)
Petition for Recovery of Support Overpayment in Closed Case.

   1.  Plaintiff is an adult individual residing at:

   


   


   2.  Defendant is an adult individual residing at:

   


   


   3.  Plaintiff and defendant were parties in a prior support action that was terminated by order dated


at docket number
.

   4.  There is an overpayment owing to the instant plaintiff.

   Wherefore, the plaintiff requests that, pursuant to Pa.R.C.P. No. 1910.19(g)(2), an order be entered against the defendant and in favor of the plaintiff in the amount of the overpayment.

   



  Date          Petitioner or Attorney for Petitioner

   I verify that the statements in this petition are true and correct to the best of my knowledge, information and belief. 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 signature)

 (j)  The order to be attached at the front of the petition for recovery of support overpayment in closed case set forth in subdivision (i) shall be in substantially the following form:

(Caption)
ORDER OF COURT

 You,


, defendant, are ordered to appear at
before
, a conference officer of the Domestic Relations Section, on the
day of
, 20
, at
.M., for a conference, after which the officer may recommend that an order for the recovery of a support overpayment be entered against you.

 You are further ordered to bring to the conference

   (1)  a true copy of your most recent federal income tax return, including W-2s, as filed,

   (2)  your pay stubs for the preceding six months, and

   (3)  the Income Statement and the appropriate Expense Statement, if you are claiming that you have unusual needs or unusual fixed obligations.

 Date of Order:




J.

 YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. 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.

Explanatory Comment—1994

   The support complaint and Income and Expense Statements contain a verification which states that the documents are subject to the penalties of the Crimes Code relating to unsworn falsification to authorities. A notary public is not needed.

Explanatory Comment—2006

   Rule 1910.27(c) is amended to separate income and expense information and to elicit the expense information relevant in cases that fall within the guidelines, as well as those that do not. In cases which can be determined under the guidelines, no expense information need be provided unless a party is claiming unusual needs and expenses that may warrant a deviation pursuant to Rule 1910.16-5 or an apportionment of expenses pursuant to Rule 1910.16-6. If a party is claiming such expenses, the form at subsection (c)(2)(A) should be submitted. A separate expense form for cases in which the parties’ combined monthly net income exceeds $20,000 is set forth at subsection (c)(2)(B).

   Rule 1910.11(c) was amended, effective in March 1995, to provide that only income and extraordinary expenses need be shown on the Income and Expense Statement in cases which can be determined pursuant to the guidelines. The Explanatory Comment—1994 explained the rationale for the amendment.

   Nevertheless, because space for both income and expense information was provided on the same form Income and Expense Statement, parties often needlessly expended time and effort to provide expense information that was not relevant at the conference. The amendments are intended to clarify and simplify the submission of expense information.

Explanatory Comment—2010

   When the combined net monthly income of the parties exceeds $30,000, the case will be decided pursuant to Rule 1910.16-3.1 and the Income Statement and the Expense Statement at Rule 1910.27(c)(2)(B) must be submitted.

Explanatory Comment—2012

   The form complaint for support in subdivision (a) has been amended to accommodate cases initiated pursuant to Rule 1910.3(a)(6). Because a support order may be entered against either party without regard to which party initiated the support action pursuant to Rule 1910.3(b), a party who believes that he or she may owe a duty of support may use the complaint form to initiate the action even if he or she ultimately is determined to be the obligor. In active charging support cases in which there is an overpayment in an amount in excess of two months of the monthly support obligation and the domestic relations section fails to reduce the charging order automatically to recoup the overpayment pursuant to Rule 1910.19(g)(1), the obligor may file a petition for recovery as set forth in subdivision (h) above. A separate form petition has been added in subdivision (i) by which a former support obligor may seek recovery of an overpayment in any amount in terminated cases pursuant to Rule 1910.19(g)(2).

Source

   The provisions of this Rule 1910.27 amended March 23, 1987, effective July 1, 1987, 17 Pa.B. 1499; amended November 7, 1988, effective January 1, 1989, 18 Pa.B. 5326; amended March 30, 1994, effective July 1, 1994, 24 Pa.B. 1953; amended December 2, 1994, effective March 1, 1995, 25 Pa.B. 6263; amended March 24, 1997, effective July 1, 1997, 27 Pa.B. 1549; amended May 31, 2000, effective July 1, 2000, 30 Pa.B. 3155; amended June 5, 2001, effective immediately, 31 Pa.B. 3306; amended June 24, 2002, effective immediately, 32 Pa.B. 3389; amended March 18, 2004, effective June 16, 2004, 34 Pa.B. 1754; amended November 8, 2006, effective February 6, 2007, 36 Pa.B. 7113; amended August 13, 2008, effective October 12, 2008, 38 Pa.B. 4736; amended January 12, 2010, effective May 12, 2010, 40 Pa.B. 586; amended August 26, 2011, effective November 1, 2011, 41 Pa.B. 4847; amended November 5, 2012, effective December 5, 2012, 42 Pa.B. 7091; amended November 30, 2012, effective December 30, 2012, 42 Pa.B. 7522; amended September 25, 2014, effective in 30 days on October 25, 2014, 44 Pa.B. 6553; amended January 5, 2018, effective January 6, 2018, 48 Pa.B. 477; amended June 1, 2018, effective July 1, 2018, 48 Pa.B. 3520. Immediately preceding text appears at serial pages (390099) to (390106), (365307) to (365312), (374093) to (374094) and (390107).



No part of the information on this site may be reproduced for profit or sold for profit.

This material has been drawn directly from the official Pennsylvania Code full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.