received. This is not the Child Custody docket number. This is a separate docket number that will appear in the caption of the Protection Order you received. On the third line you should print the Court or County in which you received the Protection Order.
In the second block you should print your address, your Employer's Name and Address, your Work Schedule, and any Other Contact Information.
There is also an additional Abuse Victim Addendum page, if you have additional information that will not fit on the first Abuse Victim Addendum page.
Once you have completed the Confidential Information Form and the Abuse Victim Addendum, then you should sign and date the second page of the Confidential Information Page. You must also include your printed name, address, telephone, and email address, so the Court can reach you.
Print your name on the Plaintiff line and the name of the other parent(s) or guardian(s) of the child on the Defendant line(s).
The line for the Case No. should be left blank because the Prothonotary will fill in this blank when you bring your completed form to their office, along with your COMPLAINT FOR CUSTODY.
i. Check the box indicating that you are the Plaintiff.
i. Check the box indicating that this is a custody case.
i. Check the box next to "a" to indicate that you are representing yourself in this custody case.
i. State your name, address, and telephone numbers in the spaces provided, or an alternate address and phone number where you may be served by mail and contacted by telephone.
i. Sign and date the ENTRY OF APPEARANCE.
Instructions