eb304d0f-d2c6-408f-9a6d-9340107f8821_PetitionforCivilContemptOrder010418_need_help-artifacted.pdf — PaddleOCR-VL (Baidu)

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

Name_6(PCCOForm)

Name	PLAINTIFF
vs.
Name	DEFENDANT 1
and (if applicable)
Name	DEFENDANT 2

Name_7(PCCOForm)

Name_8(PCCOForm)

CASE NO_2(PCCOForm)

CASE NO. _____

ACTION IN CUSTODY

PETITION FOR CIVIL CONTEMPT FOR DISOBEDIENCE OF CUSTODY ORDER

If you believe the circumstances in your case require the Court’s immediate attention, please check “Yes” in the box below. If not, please check “No”:

Emergency Order Requested Yes No

your

No □

I, ___, representing myself, state that: Name of Petitioner

Name of Petitioner(PCCOForm)

1. I, ___, Petitioner, currently reside at Name of Petitioner.

Name of Petitioner_2(PCCOForm)

Address, including City, State, Zip and County(PCCOForm)

Address, including City, State, Zip and County

___ of:

State the Relationship (for example, grandparent(PCCOForm)

2. I am the mother, father, or	State the Relationship (for example, grandparent)
Initials of Child 1	Child's Year of Birth
Initials of Child 2	Child's Year of Birth
Initials of Child 3	Child's Year of Birth
Initials of Child 4	Child's Year of Birth
Initials of Child 5	Child's Year of Birth

Address,

State the Relationship (for example, grandparent)

Initials of Child 1(PCCOForm)

Child(PCCOForm)

Initials of Child 2(PCCOForm)

Child_2(PCCOForm)

Initials of Child 3(PCCOForm)

Child_3(PCCOForm)

Initials of Child 4(PCCOForm)

Child_4(PCCOForm)

Initials of Child 5(PCCOForm)

Initials of Child 5 Child's Year of Birth

Child_5(PCCOForm)