• iii.3(c) – Print the name(s) and address(es) of all persons with whom the child(ren) is presently living.
• iv.3(d) – Print the name(s), address(es), and time period of all persons with whom the child(ren) has resided within the last five years.
• v.3(e) – Print the name and address of a parent of the child(ren). Also, please check whether the parent is married, divorced, or single.
• vi.3(f) – Print the name and address of a parent of the child(ren). Also please check whether the parent is married, divorced or single.

6. PARAGRAPH 4

• i.i. Indicate what relationship the Plaintiff has to the child(ren) and print the names of all persons with whom the Plaintiff resides, and their relationship to the children.

7. PARAGRAPH 5

• i.i. Indicate what relationship the Defendant(s) has to the child(ren) and print the names of all persons with whom the Defendant resides, and their relationship to the children.

8. PARAGRAPH 6

• i.6(a) – Circle whether you have or have not participated as a party or witness or in any capacity in other litigation concerning the child(ren). If you have been involved in litigation, then please provide the name of the court, case number, and its relationship to this custody action.
• ii.6(b) – Circle whether you have or don’t have any information of a custody proceeding concerning the child(ren) pending in this Commonwealth or another state. If you have information, then please provide the name of the court, term and number, and its relationship to this action.
• iii.6(c) – Circle whether you know or don’t know of a person not a party to the proceedings who has physical custody of the child(ren) or claims to have custody or visitation rights with respect to the child(ren). If you have information, then please provide their name(s) and address(es).

9. PARAGRAPH 7

• i.i. Explain fully why you believe it would be in the best interests of the child(ren) for the Court to grant your request.

10. PARAGRAPH 8

• i.i. Print the name and address of any person who may claim a right to custody of the child(ren) along with the basis for their claim.

11. PARAGRAPH 9

• i.i. 9(a) – If you, the plaintiff are seeking physical and/or legal custody of the child, and you believe that you meet the requirements to stand in loco parentis to the child, then you must state facts that establish standing pursuant to 23 Pa.C.S. § 5324(2).

Instructions