Fill and Sign the Of the Following Minor Children Form

Name Address Name Address Plaintiff Defendant No. 1 Name Address Defendant No. 2 COMPLAINT FOR CUSTODY I, , representing myself, state that: 1. I am the mother father or of the following minor child(ren): Relationship (for example, aunt, grandfather, guardian, etc.) 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 (5) years: Time Period Place Name(s)/Current Address of Person(s) With Whom Child Lived Page 1 of 3 CC-DR-004 (Rev. 06/2018) vs.CIRCUIT COURT FOR , MARYLAND Case No. City/County Located at NameDate of Birth Name Date of Birth Name Date of Birth Name Date of Birth Name Date of Birth Name Date of Birth City, State, Zip TelephoneCity, State, Zip Telephone City, State, Zip Telephone 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 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 (check one) physical custody of the child(ren). Grant me sole joint (check one) legal custody of the child(ren). Allow to visit with the child(ren). Name(s) Page 2 of 3 CC-DR-004 (Rev. 06/2018) Name Current Address Name Current Address Allow to visit with the child(ren) on Name(s) the following terms: Allow no visitation because Order to pay health insurance for child(ren). Order to pay child support (attach Financial Statement. Use Financial Statement (Child Support Guidelines) (CC-DR-030) or Financial Statement (General) (CC-DR-031)). (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 CC-DR-004 (Rev. 06/2018) Name(s) Name(s) X