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

Name_1(ConCM)

CONCILIATION CONFERENCE MEMORANDUM

And now, comes the undersigned party who submits the following custody conference memorandum pursuant to Adams C.Civ.R. No. 1915.4-3.2(h):

1. Brief factual background, including current custody schedule for the child/ren:

Background(ConCM)

2. Initials and current age of each child:

Child #1:_____

Child 1(ConCM)

Child#3:

Child 3(ConCM)

Child #2:_____ Child#3:_____

Child 2(ConCM)

Child #4:_____

Child 4(ConCM)

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3. Factual and Legal Issues for Resolution:

Issues(ConCM)

4. Are you requesting a home study of your house? YES NO

Check Box1(ConCM)

Check Box2(ConCM)

5. Are you requesting a home study of the other party's house? YES NO

Check Box3(ConCM)

Check Box4(ConCM)

6. Are you requesting a custody evaluation? YES NO

Check Box5(ConCM)

Check Box6(ConCM)

7. A proposed resolution of all matters, which may be in the form of a Parenting Plan:

Resolution(ConCM)

CERTIFICATE OF COMPLIANCE

I certify that this filing complies with the provisions of the Case Records Public Access Policy of the Unified Judicial System of Pennsylvania that require filing confidential information and documents differently than non-confidential information and documents.

2023

DATE(ConCM)

Respectfully Submitted,

DATE: ___

Signature

Printed Name City State Zip Code

Printed Name(ConCM)

City(ConCM)

State(ConCM)

Zip Code(ConCM)

Street Address

Street Address/P.O. Box(ConCM)

Telephone Number(ConCM)

Street Address/P.O. Box Telephone Number

Telephone Number