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NamePLAINTIFF
vs.
NameDEFENDANT 1
and (if applicable)
NameDEFENDANT 2
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Initials of Child 1Child's Year of Birth
Initials of Child 2Child's Year of Birth
Initials of Child 3Child's Year of Birth
Initials of Child 4Child's Year of Birth
Initials of Child 5Child's Year of Birth
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The Respondent has violated the Order in the following way:", "marker": "5.", "list_id": "L5", "level": 0, "reading_order": 16 }, { "page": 2, "type": "FORM_FIELD", "location": { "l": 72.3209, "t": 463.028, "r": 539.761, "b": 361.602 }, "text": "Violation(PCCOForm)", "field_kind": "text", "label": "Violation(PCCOForm)", "pdf_field_name": "Violation(PCCOForm)", "pdf_field_type": "Text", "reading_order": 17 }, { "page": 2, "type": "LIST_ITEM", "location": { "l": 68.64, "t": 339.36, "r": 490.32, "b": 325.68 }, "text": "6.I last visited with the child(ren) on _____.", "marker": "6.", "list_id": "L6", "level": 0, "reading_order": 18 }, { "page": 2, "type": "FORM_FIELD", "location": { "l": 252.96, "t": 354.72, "r": 486.96, "b": 328.2 }, "text": "Date(PCCOForm)", "field_kind": "text", "label": "Date(PCCOForm)", "pdf_field_name": "Date(PCCOForm)", "pdf_field_type": "Text", "reading_order": 19 }, { "page": 2, "type": "TEXT", "location": { "l": 286.32, "t": 326.16, "r": 306, "b": 317.04 }, "text": "Date", "reading_order": 20 }, { "page": 2, "type": "LIST_ITEM", "location": { "l": 70.08, "t": 302.64, "r": 540.96, "b": 247.2 }, "text": "7. _____ is now in contempt for failing to obey the Order\nRespondent's Name\ndated ___.\nDate of Order", "marker": "7.", "list_id": "L7", "level": 0, "reading_order": 21 }, { "page": 2, "type": "FORM_FIELD", "location": { "l": 84, "t": 317.88, "r": 306.12, "b": 291.36 }, "text": "RespondentsName(PCCOForm)", "field_kind": "text", "label": "RespondentsName(PCCOForm)", "pdf_field_name": "RespondentsName(PCCOForm)", "pdf_field_type": "Text", "reading_order": 22 }, { "page": 2, "type": "FORM_FIELD", "location": { "l": 101.04, "t": 281.16, "r": 197.04, "b": 259.2 }, "text": "Date of Order2(PCCOForm)", "field_kind": "text", "label": "Date of Order2(PCCOForm)", "pdf_field_name": "Date of Order2(PCCOForm)", "pdf_field_type": "Text", "reading_order": 23 }, { "page": 2, "type": "LIST_ITEM", "location": { "l": 69.84, "t": 224.64, "r": 233.76, "b": 211.2 }, "text": "8. Request for Emergency Order", "marker": "8.", "list_id": "L8", "level": 0, "reading_order": 24 }, { "page": 2, "type": "TEXT", "location": { "l": 75.12, "t": 197.04, "r": 482.88, "b": 156 }, "text": "The following emergency situation requires immediate attention by the Court.\nDescribe this situation in detail:", "reading_order": 25 }, { "page": 2, "type": "FORM_FIELD", "location": { "l": 72.3209, "t": 155.223, "r": 539.761, "b": 66.9981 }, "text": "Situation(PCCOForm)", "field_kind": "text", "label": "Situation(PCCOForm)", "pdf_field_name": "Situation(PCCOForm)", "pdf_field_type": "Text", "reading_order": 26 } ] }, { "page": 3, "items": [ { "page": 3, "type": "LIST_ITEM", "location": { "l": 69.36, "t": 719.52, "r": 268.8, "b": 704.88 }, "text": "9. Emergency Contact Information:", "marker": "9.", "list_id": "L8", "level": 0, "reading_order": 0 }, { "page": 3, "type": "TEXT", "location": { "l": 141.12, "t": 694.56, "r": 451.2, "b": 679.44 }, "text": "Plaintiff: _____", "reading_order": 1 }, { "page": 3, "type": "FORM_FIELD", "location": { "l": 252, "t": 702.24, "r": 450, "b": 682.32 }, "text": "Emergency Contact Information(PCCOForm)", "field_kind": "text", "label": "Emergency Contact Information(PCCOForm)", "pdf_field_name": "Emergency Contact Information(PCCOForm)", "pdf_field_type": "Text", "reading_order": 2 }, { "page": 3, "type": "TEXT", "location": { "l": 142.08, "t": 673.68, "r": 451.92, "b": 658.08 }, "text": "Telephone Number: ___", "reading_order": 3 }, { "page": 3, "type": "FORM_FIELD", "location": { "l": 252, "t": 681.48, "r": 450.12, "b": 661.68 }, "text": "Telephone Number(PCCOForm)", "field_kind": "text", "label": "Telephone Number(PCCOForm)", "pdf_field_name": "Telephone Number(PCCOForm)", "pdf_field_type": "Text", "reading_order": 4 }, { "page": 3, "type": "TEXT", "location": { "l": 142.08, "t": 631.92, "r": 451.92, "b": 617.28 }, "text": "Defendant number 1: _____", "reading_order": 5 }, { "page": 3, "type": "FORM_FIELD", "location": { "l": 252, "t": 640.2, "r": 450, "b": 620.28 }, "text": "Defendant number 1(PCCOForm)", "field_kind": "text", "label": "Defendant number 1(PCCOForm)", "pdf_field_name": "Defendant number 1(PCCOForm)", "pdf_field_type": "Text", "reading_order": 6 }, { "page": 3, "type": "TEXT", "location": { "l": 142.32, "t": 611.28, "r": 451.92, "b": 595.92 }, "text": "Telephone Number: _____", "reading_order": 7 }, { "page": 3, "type": "FORM_FIELD", "location": { "l": 252, "t": 619.44, "r": 450.12, "b": 599.52 }, "text": "Telephone Number_2(PCCOForm)", "field_kind": "text", "label": "Telephone Number_2(PCCOForm)", "pdf_field_name": "Telephone Number_2(PCCOForm)", "pdf_field_type": "Text", "reading_order": 8 }, { "page": 3, "type": "TEXT", "location": { "l": 141.84, "t": 570, "r": 451.92, "b": 555.6 }, "text": "Defendant number 2: _____", "reading_order": 9 }, { "page": 3, "type": "FORM_FIELD", "location": { "l": 252, "t": 578.16, "r": 450, "b": 558.24 }, "text": "Defendant number 2(PCCOForm)", "field_kind": "text", "label": "Defendant number 2(PCCOForm)", "pdf_field_name": "Defendant number 2(PCCOForm)", "pdf_field_type": "Text", "reading_order": 10 }, { "page": 3, "type": "TEXT", "location": { "l": 142.32, "t": 549.36, "r": 452.16, "b": 534.24 }, "text": "Telephone Number: ___", "reading_order": 11 }, { "page": 3, "type": "FORM_FIELD", "location": { "l": 252, "t": 557.4, "r": 450.12, "b": 537.48 }, "text": "Telephone Number_3(PCCOForm)", "field_kind": "text", "label": "Telephone Number_3(PCCOForm)", "pdf_field_name": "Telephone Number_3(PCCOForm)", "pdf_field_type": "Text", "reading_order": 12 }, { "page": 3, "type": "LIST_ITEM", "location": { "l": 70.08, "t": 519.84, "r": 513.84, "b": 490.32 }, "text": "10. Petitioner has attached the Criminal Record / Abuse History Verification form required pursuant to Pa.R.C.P. 1915.3-2.", "marker": "10.", "list_id": "L9", "level": 0, "reading_order": 13 }, { "page": 3, "type": "TEXT", "location": { "l": 105.6, "t": 482.64, "r": 456.72, "b": 468 }, "text": "FOR THESE REASONS, I request the Court to issue an Order finding", "reading_order": 14 }, { "page": 3, "type": "TEXT", "location": { "l": 79.2, "t": 454.08, "r": 535.2, "b": 412.32 }, "text": "in contempt, enforce custody, and order any other\nRespondent's Name\noppropriate relief relating to custody with the child(ren), including:", "reading_order": 15 }, { "page": 3, "type": "FORM_FIELD", "location": { "l": 72, "t": 463.08, "r": 294.12, "b": 443.16 }, "text": "Respondent’s Name3(PCCOForm)", "field_kind": "text", "label": "Respondent’s Name3(PCCOForm)", "pdf_field_name": "Respondents Name3(PCCOForm)", "pdf_field_type": "Text", "reading_order": 16 }, { "page": 3, "type": "FORM_FIELD", "location": { "l": 72.3209, "t": 403.936, "r": 539.761, "b": 276.052 }, "text": "ReliefSought(PCCOForm)", "field_kind": "text", "label": "ReliefSought(PCCOForm)", "pdf_field_name": "ReliefSought(PCCOForm)", "pdf_field_type": "Text", "reading_order": 17 }, { "page": 3, "type": "TITLE", "location": { "l": 258.48, "t": 243.36, "r": 352.8, "b": 229.92 }, "text": "VERIFICATION", "reading_order": 18, "level": 2 }, { "page": 3, "type": "TEXT", "location": { "l": 69.6, "t": 222.96, "r": 503.52, "b": 180.48 }, "text": "I verify that the statements made in the foregoing document are true and correct. I understand that false statements herein are made subject to the penalties of perjury of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities.", "reading_order": 19 }, { "page": 3, "type": "TEXT", "location": { "l": 69.6, "t": 152.64, "r": 216.48, "b": 138.96 }, "text": "Date: _____", "reading_order": 20 }, { "page": 3, "type": "FORM_FIELD", "location": { "l": 101.04, "t": 161.88, "r": 215.04, "b": 141.96 }, "text": "Date4(PCCOForm)", "field_kind": "text", "label": "Date4(PCCOForm)", "pdf_field_name": "Date4(PCCOForm)", "pdf_field_type": "Text", "reading_order": 21 }, { "page": 3, "type": "TEXT", "location": { "l": 286.08, "t": 149.28, "r": 523.2, "b": 137.52 }, "text": "Signature", "reading_order": 22 }, { "page": 3, "type": "TEXT", "location": { "l": 284.4, "t": 141.6, "r": 522.96, "b": 130.08 }, "text": "Signature", "reading_order": 23 } ] } ]