90fdce07-c6ae-4263-92db-680eed562b05_PreTrialStatementConfInfoFormParentingPlanHistoryVerificationPacket080524_need_help-artifacted.pdf — PaddleOCR-VL (Baidu)

CONFIDENTIAL INFORMATION FORM

Abuse Victim Addendum

Instructions for Completing the Abuse Victim Addendum: The Abuse Victim Addendum shall accompany a filing where confidential information is being provided by an abuse victim, as defined in this policy, in family court actions (see Pa.R.C.P. No. 1931(a)), as required by law, ordered by the court, or otherwise necessary to effect the disposition of a matter. This addendum, and any additional pages, shall only be provided to the court and shall remain confidential. The best way to protect confidential information is not to provide it to the court. Therefore, only provide confidential information to the court when it is required by law, ordered by the court or is otherwise necessary to effect the disposition of a matter.

Type of Family Court Action

Divorce, Annulment, Dissolution of Marriage

Support	Paternity	Protection from Abuse
This Information Pertains to:	Confidential Information:	References in Filing:
	AV Address:	Alternative Reference:AV 1 Address
(full name of abuse victim)	AV Employer's Name & Address:	Alternative Reference:AV 1 Employer's Name & Address
Docket/Case No. of Protection Order	AV Work Schedule:	Alternative Reference:AV 1 Work Schedule
Court/County	AV Other contact information:	Alternative Reference:AV 1 Other contact information

Check if divorce, annulment or dissolution of marriage3

Child Custody

check if support

check if paternity

check if protection from abuse

Full name of abuse victim AV addendum

Abuse victim address AV Addendum

Abuse victim employer name and address AV Addendum

Docket/Case No. of Protection Order AV Addendum

Abuse victim work schedule AV Addendum

Court/County AV Addendum

Abuse victim other contact information AV Addendum

Attach additional page(s) if necessary.