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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. _____
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. Brief factual background, including current custody schedule for the child/ren:
2. Initials and current age of each child:
Child #1:_____
Child #2:_____
Child#3:_____
Child #4:_____
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3. Factual and Legal Issues for Resolution:
4. Are you requesting a home study of your house? YES NO
5. Are you requesting a home study of the other party's house? YES NO
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.
Respectfully Submitted,
The quick brown fox jumps over the lazy dog.
DATE: ___
_____
| Signature |
| Printed Name |
| Street Address |
City State Zip Code
Street Address/P.O. Box
Telephone Number
