i. Indicate by checking the appropriate box if you are the mother, father or have another relationship with the child(ren). Also print the initials of the child(ren), and their year of birth.

i. Write the date of the current Court Order. Also, indicate by circling the appropriate language what type(s) of custody you were granted by the Order. Please be sure that a copy of the current Order is attached. Please ensure that the Child’s full name and date of birth is not included on the current Order. You should white out this confidential information and write in the Child’s initials and year of birth.

i. In the space provided, explain to the Court the reason you are seeking a change in the current custody schedule.

i. Complete this section only if you have checked “Yes” to Emergency Order Requested on Page 1 of Form #3. Describe in detail the emergency situation which needs the Court’s immediate attention. Be sure to complete PARAGRAPH 7 with Emergency Contact Information for all parties.

i. Please include Emergency Contact Information for both the Plaintiff and the Defendant(s).

i. Attach the completed Petitioner's Criminal Record / Abuse History Verification form to the Petition.

i. In the space provided, indicate what new custody schedule you are requesting the Court to order.

Read carefully, and then date and sign the form.

CERTIFICATE OF COMPLIANCE: Fill in the caption of the Certificate of Compliance. Then sign and date the Certificate of Compliance. This document is filed at the same time with the Petition to Modify Custody.

Instructions for completing the PETITIONER'S CRIMINAL RECORD / ABUSE HISTORY VERIFICATION – Form #5.