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# IN THE COURT OF COMMON PLEAS FOR ADAMS COUNTY, PENNSYLVANIA CIVIL ACTION - LAW
PLAINTIFF
Name
CASE NO. _____
Name DEFENDANT 1
and (if applicable)
ACTION IN CUSTODY
Name DEFENDANT 2
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:
2. Initials and current age of each child:
Child #1:_____
Child #2:_____
Child#3:_____
Child #4:_____
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3. Factual and Legal Issues for Resolution:
4. Are you requesting a home study of your house? YES NO
5. Are you requesting a home study of the other party's house? YES NO
6. Are you requesting a custody evaluation? YES NO
7. A proposed resolution of all matters, which may be in the form of a Parenting Plan:
## 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.
Respectfully Submitted,
2023
DATE: ___
| Signature |
| Printed Name | City | State | Zip Code |
| Street Address | | | |
Street Address/P.O. Box
Telephone Number
