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

(a) Complaint. The complaint in a custody action shall be substantially in the following form: (Caption) COMPLAINT FOR CUSTODY 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 (shared legal custody) (sole legal custody) (partial physical custody) (primary physical custody) (shared physical custody) (sole physical custody) (supervised physical custody) 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 residing at . This parent is (married) (divorced) (single). A parent of the child is , currently residing at . This parent is (married) (divorced) (single). 4. Plaintiff’s relationship to 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 custodial rights with respect to the child. The name and address of such person is: . 7. The child’s best 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 of the child will be given notice of the pendency of this action and the right to intervene: Name AddressBasis of Claim 9. Standing.

(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 seeking physical or legal custody of a grandchild and is not in loco parentis to the child, the plaintiff shall plead facts establishing standing under 23 Pa.C.S. § 5324(3).

(c) If the plaintiff is seeking physical or legal custody of a child and is not in loco parentis to the child, the plaintiff shall plead facts establishing standing pursuant to 23 Pa.C.S. § 5324(4) and (5).

(d) If the plaintiff is a grandparent or great-grandparent seeking partial physical custody or supervised physical custody of a grandchild or great-grandchild, the plaintiff shall plead facts establishing standing under 23 Pa.C.S. § 5325. 10. Plaintiff has attached the Criminal Record/Abuse History Verification form required pursuant to Pa.R.Civ.P. 1915.3-2. Wherefore, Plaintiff requests the court to grant (shared legal custody) (sole legal custody) (partial physical custody) (primary physical custody) (shared physical custody) (sole physical custody) (supervised physical custody) of the child. Plaintiff/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

(b) Petition for Modification. A petition for modification of a custody order shall be substantially in the following form: (Caption) PETITION FOR MODIFICATION OF A CUSTODY ORDER 1. Petitioner is and resides at . 2. Respondent is and resides at . 3. Petitioner respectfully represents that on , 20 , an Order of Court was entered for (shared legal custody) (sole legal custody) (partial physical custody) (primary physical custody) (shared physical custody) (sole physical custody) (supervised physical custody). A true and correct copy of the Order is attached. 4. This Order should be modified because: 5. Petitioner has attached the Criminal Record/ Abuse History Verification form required pursuant to Pa.R.Civ.P. 1915.3-2. WHEREFORE, Petitioner requests that the Court modify the existing Order because it will be in the best interest of the child(ren). (Attorney for Petitioner) (Petitioner) I verify that the statements made in this petition 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) Order. The order to be attached at the front of the complaint or petition for modification shall be substantially in the following form: (Caption) ORDER OF COURT You, , (defendant) (respondent), have been sued in court to (OBTAIN) (MODIFY) (shared legal custody) (sole legal custody) (partial physical custody) (primary physical custody) (shared physical custody) (sole physical custody) (supervised physical custody) 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 may be entered against you or the court may issue a warrant for your arrest. You must file with the court a verification regarding any criminal record or abuse history regarding you and any member of your household at the initial in-person contact with the court (including, but not limited to, a conference with a conference officer or judge or conciliation) or within 30 days of service of the initiating pleading, whichever occurs first. No party may make a change in the residence of any child which significantly impairs the ability of the other party to exercise custodial rights without first complying with all of the applicable provisions of 23 Pa.C.S. § 5337 and Pa.R.Civ.P. 1915.17 regarding relocation. 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 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. BY THE COURT: J. Date:

Comment. The form of complaint is appropriate if there is one plaintiff, one defendant, and the custody of one child is sought or the custody of several children is sought, and the information required by Paragraphs 3 to 7 is identical for all of the children. If there are more than two parties, the complaint should be appropriately adapted to accommodate them. If the custody of several children is sought and the information required is not identical for all of the children, the complaint should contain a separate paragraph for each child. Pa.R.Civ.P. 1930.1(b) may require attorneys or unrepresented parties to file confidential documents and documents containing confidential information that are subject to the Case Records Public Access Policy of the Unified Judicial System of Pennsylvania.

Historical Commentary The following commentary related to Pa.R.Civ.P. 1915.15 is historical in nature and represents statements of the Committee at the time of rulemaking:

Explanatory Comment— 2008 In an effort to promote uniformity of practice throughout the Commonwealth, several forms are included in the rules. Two aspects of these forms are worthy of mention. First, much of the information which must be set forth in the complaint is required by the Uniform Child Custody Jurisdiction and Enforcement Act, 23 Pa.C.S.A. § 5429. Second, the complaint is verified by use of a statement that it is subject to the penalties of the Crimes Code relating to unsworn falsification to authorities. A notary public is not needed.

Explanatory Comment— 2020 Act of May 4, 2018, P.L. 112, No. 21, amended 23 Pa.C.S. § 5324 by adding a new class of third-party standing for individuals seeking custody of a child whose parents do not have care and control of the child. The individual seeking custody may or may not be related to the child. Subject to the limitations in 23 Pa.C.S. § 5324(5), the newly added standing provision requires that: (1) the individual has assumed or is willing to assume responsibility for the child; (2) the individual has a sustained, substantial, and sincere interest in the child’s welfare; and (3) the child’s parents do not have care and control of the child. A plaintiff proceeding under Section 5324(4) shall satisfy the requirements of that provision by clear and convincing evidence. Additionally, if a juvenile dependency proceeding has been initiated, or is ongoing, or if there is an order for permanent legal custody, Section 5324(5) provides that an individual cannot assert standing under Section 5324(4). Consistent with the Act’s statutory change, the Complaint for Custody Paragraph 9 has been revised to include a third party seeking custody of a child under 23 Pa.C.S. § 5324(4) and has been reorganized to sequentially follow the statutory provisions in 23 Pa.C.S. § § 5324(2)—(4) and 5325. Similarly, Pa.R.C.P. No. 1915.3(e) has been reorganized to sequentially follow the statutory provision sequence. See Pa.R.C.P. No. 1915.3(e).