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IN THE COURT OF COMMON PLEAS FOR ADAMS COUNTY, PENNSYLVANIA CIVIL ACTION - LAW

Name PLAINTIFF vs. Name DEFENDANT 1 and (if applicable) Name DEFENDANT 2 CASE NO. _____

CASE NO.

ACTION IN CUSTODY

CONCILIATION CONFERENCE MEMORANDUM

And now, comes the undersigned party who submits the following custody conference memorandum pursuant to Adams C.Civ.R. No. 1915.4-3.2(h):

1. 1. Brief factual background, including current custody schedule for the child/ren:

2. 2. Initials and current age of each child:

Child #1:_____

Child#3:

Child #2:_____ Child#3:_____

Child #4:_____

3. 3. Factual and Legal Issues for Resolution:

4. 4. Are you requesting a home study of your house? YES NO

5. 5. Are you requesting a home study of the other party's house? YES NO

6. 6. Are you requesting a custody evaluation? YES NO

• 7. A proposed resolution of all matters, which may be in the form of a Parenting Plan:

CERTIFICATE OF COMPLIANCE

I certify that this filing complies with the provisions of the Case Records Public Access Policy of the Unified Judicial System of Pennsylvania that require filing confidential information and documents differently than non-confidential information and documents.

The quick brown fox jumps over the lazy dog.

Respectfully Submitted,

DATE: ___

_____

City State Zip Code

Signature

Printed Name

Street Address

City State Zip Code

Street Address/P.O. Box

Telephone Number