{ "document_id": 16164, "page": 36, "width_pt": 612, "height_pt": 792, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "engine": "paddleocr_vl", "source_run_id": 16275, "item_count": 31, "counts_by_type": { "form_field": 13, "heading": 1, "table": 1, "table_cell": 7, "text": 9 }, "build_ms": 2, "items": [ { "id": "p36.1", "order": 1, "type": "text", "bbox": { "l": 47.76, "t": 741.36, "r": 553.68, "b": 684.72 }, "text": "8a. Are you aware of any pending investigations of abuse of either party or members of either party’s household by any children & youth services agency, child protective services, or general protective services agency, or the equivalent agency in another jurisdiction, concerning the children in this custody case or any other children?" }, { "id": "p36.2", "order": 2, "type": "text", "bbox": { "l": 84.24, "t": 668.64, "r": 178.08, "b": 654.96 }, "text": "YES NO", "children": [ { "id": "p36.2.1", "order": 3, "type": "form_field", "bbox": { "l": 109.38, "t": 669.227, "r": 124.775, "b": 653.832 }, "text": "", "attrs": { "field_kind": "checkbox", "label": "YES □", "pdf_field_name": "Check BoxS(PlCH)", "source": "acroform", "label_source": "parent_text", "label_ref": "p36.2", "text_offset": 0, "text_span": 0 } } ] }, { "id": "p36.3", "order": 4, "type": "form_field", "bbox": { "l": 176.346, "t": 669.227, "r": 191.369, "b": 653.832 }, "text": "", "attrs": { "field_kind": "checkbox", "label": "NO □", "pdf_field_name": "Check BoxT(PlCH)", "source": "acroform" } }, { "id": "p36.4", "order": 5, "type": "text", "bbox": { "l": 47.52, "t": 640.08, "r": 397.2, "b": 625.2 }, "text": "8b. If you answered YES to question 8a, please complete the following:" }, { "id": "p36.5", "order": 6, "type": "text", "bbox": { "l": 47.76, "t": 612.72, "r": 537.6, "b": 597.36 }, "text": "Name of agency where investigation is pending: ___", "children": [ { "id": "p36.5.1", "order": 7, "type": "form_field", "bbox": { "l": 302.4, "t": 627, "r": 536.4, "b": 600.48 }, "text": "", "attrs": { "field_kind": "text", "label": "Name of agency where investigation is pending: ___", "pdf_field_name": "NameofAgency(PlCH)", "source": "acroform", "label_source": "parent_text", "label_ref": "p36.5", "text_offset": 47, "text_span": 3 } } ] }, { "id": "p36.6", "order": 8, "type": "heading", "bbox": { "l": 47.76, "t": 585.12, "r": 179.28, "b": 570.48 }, "text": "Status of the investigation:", "level": 3 }, { "id": "p36.7", "order": 9, "type": "text", "bbox": { "l": 48.72, "t": 584.88, "r": 538.32, "b": 570 }, "text": "of the investigation: ___", "children": [ { "id": "p36.7.1", "order": 10, "type": "form_field", "bbox": { "l": 194.4, "t": 599.4, "r": 536.4, "b": 572.88 }, "text": "", "attrs": { "field_kind": "text", "label": "of the investigation: ___", "pdf_field_name": "Status of the investigation(PlCH)", "source": "acroform", "label_source": "parent_text", "label_ref": "p36.7", "text_offset": 22, "text_span": 3 } } ] }, { "id": "p36.8", "order": 11, "type": "text", "bbox": { "l": 47.76, "t": 557.52, "r": 288.96, "b": 542.64 }, "text": "The circumstances surrounding the investigation:" }, { "id": "p36.9", "order": 12, "type": "form_field", "bbox": { "l": 50.5972, "t": 541.246, "r": 541.012, "b": 442.607 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Circumstances3(PlCH)", "source": "acroform" } }, { "id": "p36.10", "order": 13, "type": "text", "bbox": { "l": 47.28, "t": 402.72, "r": 560.16, "b": 360.24 }, "text": "I verify that the information above is true and correct to the best of my knowledge, information or 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." }, { "id": "p36.11", "order": 14, "type": "text", "bbox": { "l": 263.04, "t": 320.64, "r": 484.32, "b": 276.48 }, "text": "SIGNATURE\n_____", "children": [ { "id": "p36.11.1", "order": 15, "type": "form_field", "bbox": { "l": 266.4, "t": 306.84, "r": 482.4, "b": 280.32 }, "text": "", "attrs": { "field_kind": "text", "label": "SIGNATURE\n_____", "pdf_field_name": "Printed Name(PlCH)", "source": "acroform", "label_source": "parent_text", "label_ref": "p36.11" } } ] }, { "id": "p36.12", "order": 16, "type": "text", "bbox": { "l": 47.52, "t": 320.16, "r": 335.52, "b": 306.24 }, "text": "DATE", "children": [ { "id": "p36.12.1", "order": 17, "type": "form_field", "bbox": { "l": 50.4, "t": 348.24, "r": 176.4, "b": 321.72 }, "text": "", "attrs": { "field_kind": "text", "label": "DATE", "pdf_field_name": "DATE(PlCH)", "source": "acroform", "label_source": "parent_text", "label_ref": "p36.12" } } ] }, { "id": "p36.13", "order": 18, "type": "table", "bbox": { "l": 263.28, "t": 284.88, "r": 485.04, "b": 113.44799999999998 }, "text": "", "attrs": { "block_label": "table", "n_rows": 7, "n_cols": 1, "integrity": { "cells_checked": 4, "cells_flagged": 0 } }, "children": [ { "id": "p36.13.1", "order": 19, "type": "table_cell", "bbox": { "l": 266.4, "t": 278.53200000000004, "r": 340.6656, "b": 265.24800000000005 }, "text": "(Printed Name)", "attrs": { "row": 0, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "children": [ { "id": "p36.13.1.1", "order": 20, "type": "form_field", "bbox": { "l": 266.4, "t": 265.44, "r": 482.4, "b": 238.92 }, "text": "", "attrs": { "field_kind": "text", "label": "(Printed Name)", "pdf_field_name": "AddressLine1(PlCH)", "source": "acroform", "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p36.13.1" } } ] }, { "id": "p36.13.2", "order": 21, "type": "table_cell", "bbox": { "l": 263.28, "t": 260.7771, "r": 485.04, "b": 236.6743 }, "text": "", "attrs": { "row": 1, "col": 0, "rowspan": 1, "colspan": 1 } }, { "id": "p36.13.3", "order": 22, "type": "table_cell", "bbox": { "l": 266.4, "t": 209.53200000000004, "r": 313.7712, "b": 196.24800000000005 }, "text": "(Address)", "attrs": { "row": 2, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "children": [ { "id": "p36.13.3.1", "order": 23, "type": "form_field", "bbox": { "l": 266.4, "t": 237.84, "r": 482.4, "b": 211.32 }, "text": "", "attrs": { "field_kind": "text", "label": "(Address)", "pdf_field_name": "AddressLine2(PlCH)", "source": "acroform", "row": 2, "col": 0, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p36.13.3" } } ] }, { "id": "p36.13.4", "order": 24, "type": "table_cell", "bbox": { "l": 263.28, "t": 212.5714, "r": 485.04, "b": 188.4686 }, "text": "(__________)", "attrs": { "row": 3, "col": 0, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p36.13.4.1", "order": 25, "type": "form_field", "bbox": { "l": 316.44, "t": 196.44, "r": 418.44, "b": 169.92 }, "text": "", "attrs": { "field_kind": "text", "label": "(_______)_________________", "pdf_field_name": "HomePhone(PlCH)", "source": "acroform", "row": 3, "col": 0, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p36.13.5", "order": 26, "type": "table_cell", "bbox": { "l": 266.4, "t": 168.13199999999995, "r": 336.7584, "b": 154.84799999999996 }, "text": "(Home Phone)", "attrs": { "row": 4, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "children": [ { "id": "p36.13.5.1", "order": 27, "type": "form_field", "bbox": { "l": 270.36, "t": 196.44, "r": 312.36, "b": 169.92 }, "text": "", "attrs": { "field_kind": "text", "label": "(Home Phone)", "pdf_field_name": "AreaCode1(PlCH)", "source": "acroform", "row": 4, "col": 0, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p36.13.5" } } ] }, { "id": "p36.13.6", "order": 28, "type": "table_cell", "bbox": { "l": 263.28, "t": 164.3657, "r": 485.04, "b": 140.2629 }, "text": "(__________)", "attrs": { "row": 5, "col": 0, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p36.13.6.1", "order": 29, "type": "form_field", "bbox": { "l": 316.44, "t": 155.04, "r": 418.44, "b": 128.52 }, "text": "", "attrs": { "field_kind": "text", "label": "(_______)_________________", "pdf_field_name": "WorkPhone(PlCH)", "source": "acroform", "row": 5, "col": 0, "rowspan": 1, "colspan": 1 } } ] }, { "id": "p36.13.7", "order": 30, "type": "table_cell", "bbox": { "l": 266.4, "t": 126.73199999999997, "r": 334.7172, "b": 113.44799999999998 }, "text": "(Work Phone)", "attrs": { "row": 6, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "children": [ { "id": "p36.13.7.1", "order": 31, "type": "form_field", "bbox": { "l": 270.36, "t": 155.04, "r": 312.36, "b": 128.52 }, "text": "", "attrs": { "field_kind": "text", "label": "(Work Phone)", "pdf_field_name": "AreaCode2(PlCH)", "source": "acroform", "row": 6, "col": 0, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p36.13.7" } } ] } ] } ], "excluded_furniture": { "first": [], "last": [] } }