Civil Practice Manual CH 8

MONTGOMERY COUNTY CIVIL PRACTICE MANUAL
Table of Contents
Section 8 - Family Law
FAMILY LAW .............................................................................................................................. 8-3
A. MONTGOMERY COUNTY DOMESTIC RELATIONS TELEPHONE NUMBERS ......... 8-3
B. INTRODUCTION TO FAMILY PRACTICE IN MONTGOMERY COUNTY ..................... 8-3
C. DIVORCE PRACTICE ................................................................................................. 8-4
1. Pleadings .......................................................................................................... 8-4
2. Service of the Complaint .................................................................................. 8-4
3. Answering the Complaint .................................................................................. 8-4
4. Discovery .......................................................................................................... 8-5
5. Obtaining a Final Decree .................................................................................. 8-5
6. Property Settlement Agreements ...................................................................... 8-6
7. Forms of Final Decrees or Orders for Disposition of Economic Issues ........... 8-6
8. Bifurcation ......................................................................................................... 8-6
9. Retaking of Maiden Name ................................................................................. 8-7
D. EQUITABLE DISTRIBUTION, ALIMONY AND FINAL COUNSEL FEES, COSTS
AND EXPENSES .............................................................................................................. 8-7
1. Practice and Procedure under the Montgomery County Conciliation System .. 8-7
2. The Equitable Distribution Hearing ................................................................... 8-8
E. SUPPORT/ALIMONY PENDENTE LITE ...................................................................... 8-8
1. Commencement of Action ................................................................................ 8-8
2. Conciliation/Hearings ........................................................................................ 8-9
3. Enforcement/Contempt ................................................................................... 8-11
4. Client Coordinator ............................................................................................ 8-11
F. CUSTODY/VISITATION ............................................................................................... 8-11
1. Commencement of Action ............................................................................... 8-11
2. Hearing Procedures ........................................................................................ 8-12
G. PROTECTION FROM ABUSE ................................................................................... 8-13
F O R M S:
FAMILY COURT COVER SHEET............................................................................................
EMERGENCY COURT COVER SHEET ................................................................................
NOTICE TO DEFEND AND CLAIM RIGHTS ...........................................................................
COMPLAINT ............................................................................................................................
ACCEPTANCE OF SERVICE BY ATTORNEY FOR DEFENDANT ........................................
ACCEPTANCE OF SERVICE BY DEFENDANT ....................................................................
AFFIDAVIT OF SERVICE OF DIVORCE COMPLAINT ...........................................................
ANSWER AND COUNTERCLAIM TO COMPLAINT IN DIVORCE ..........................................
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Index continued on Page 2

This Sections fillable forms are found in the Civil Practice Manual CD Version in the following formats:
Adobe PDF - Rich Text Format (MS Word - WordPerfect v11+) and Omni Form Format.
Directory: \\ Forms\Section 8\ Family Law\...
Rev: 08/2006
Published by the Montgomery Bar Association
8-1

AFFIDAVIT OF CONSENT UNDER SECTION 3301(c) ..........................................................
NOTICE TO DEFENDANT UNDER SECTION 3301(d) ..........................................................
COUNTER-AFFIDAVIT UNDER SECTION 3301(c) ................................................................
DEFENDANTS COUNTER-AFFIDAVIT UNDER SECTION 3301(d) ......................................
WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE ...
PRAECIPE TO TRANSMIT RECORD ....................................................................................
AFFIDAVIT OF NON-MILITARY SERVICE ...............................................................................
NOTICE OF INTENTION TO REQUEST ENTRY OF SECTION 3301(c)
DIVORCE DECREE .........................................................................................................
NOTICE OF INTENTION TO REQUEST ................................................................................
ENTRY OF SECTION 3301(d) DIVORCE DECREE ..............................................................
NOTICE OF INTENTION TO REQUEST ................................................................................
ENTRY OF DIVORCE DECREE ............................................................................................
DEPARTMENT OF HEALTH - VITAL RECORDS ...................................................................
ORDER TO SCHEDULE HEARING .......................................................................................
DIVORCE DECREE ...............................................................................................................
PETITION FOR BIFURCATION ..............................................................................................
BIFURCATED DIVORCE DECREE ........................................................................................
NOTICE TO RETAKE PRIOR SURNAME ..............................................................................
MOTION FOR APPOINTMENT OF A MASTER IN DIVORCE .................................................
INVENTORY ............................................................................................................................
CHECK LIST FOR LIABILITIES ..............................................................................................
COMPLAINT FOR SUPPORT ................................................................................................
PETITION FOR MODIFICATION OF AN EXISTING SUPPORT ORDER ...............................
ORDER OF COURT (SUPPORT HEARING) .........................................................................
HISTORY / FACE SHEET (SUPPORT) ..................................................................................
INCOME AND EXPENSE STATEMENT (SUPPORT) .............................................................
COMPLAINT FOR CUSTODY, PARTIAL CUSTODY AND VISITATION ..................................
UN-REIMBURSED EXPENSE ................................................................................................
PETITION TO MODIFY (CUSTODY) (VISITATION) ORDER ..................................................
AGREEMENT FOR CUSTODY ..............................................................................................
PROTECTION FROM ABUSE (HEARING NOTICE) ..............................................................
PETITION FOR PROTECTION FROM ABUSE ......................................................................
TEMPORARY PROTECTION FROM ABUSE ORDER ..........................................................
FINAL ORDER OF COURT (PROTECTION FROM ABUSE).................................................
PROTECTION FROM ABUSE ORDER VACATING/EXTENDING/AMENDING
FINAL ORDER ..................................................................................................................
EXTENDED FINAL PROTECTION FROM ABUSE ORDER ..................................................
AMENDED FINAL PROTECTION FROM ABUSE ORDER ....................................................
PROTECTION FROM ABUSE ORDER (NO HEARING HELD) .............................................
ORDER VACATING FINAL PROTECTION FROM ABUSE ORDER .......................................
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FAMILY LAW
A. MONTGOMERY COUNTY DOMESTIC RELATIONS TELEPHONE NUMBERS
AREA CODE (610) 278
TELEPHONE
NUMBERS
NAME
POSITION
3903
1482
3945
3904
3940
3940
3940
Director
Deputy Director/PACSES
Adminstrative Assistant
Staff Attorney
Support Master
Support Master
Secretary to Support Masters
GARY KLINE
LINDA GRILL
HEATHER ANTONACIO
JENNIFER HEKKING
FRED COHEN
LUKE MCLAUGHLIN
JANICE WILSON
ESTABLISHMENT UNIT
3653
CHRISTINA GOULD
Unit Manager
ENFORCEMENT UNIT
3659
MICHAEL RAU
Unit Manager
ED CLARK
Unit Manager
INTAKE UNIT
3517
FISCAL/AUDITING
3969
KELLE McCLAIN
B. INTRODUCTION TO FAMILY PRACTICE IN MONTGOMERY COUNTY

There are generally six separate areas in Montgomery County family practice: (1) divorce or annulment;
(2) equitable distribution, alimony and counsel fees; (3) interim matters such as discovery and special
relief; (4) spousal and child support, and alimony pendente lite; (5) custody; and (6) protection from
abuse. The above matters are heard in separate proceedings which cause multiple hearings in almost
every case. Most matters are heard originally by a hearing officer, conciliator or a master, with the
assigned judge becoming involved only if there is an appeal from the recommendation of the hearing
officer, conciliator or master. There are local rules for most of these matters and the practitioner is
advised to review them in full.
A Judge is assigned to each case on a random basis upon the initial pleading being filed in the
Prothonotarys Office. The assigned Judge hears all issues on a case which are scheduled for judicial
hearings. Montgomery County has a Family Court composed of judges who hear only domestic relations
cases.
Rev: 08/2006
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C. DIVORCE PRACTICE
1. Pleadings
The divorce process begins with the filing of a divorce complaint with the Prothonotary. The filing fee
is currently $229.50. There is an additional cost of $33.00 per count for each of the following counts:
equitable distribution; spousal and child support; alimony; alimony pendente lite; and an additional filing
fee of $39.50 for a custody count. In Montgomery County, certified copy of the marriage certificate
does not have to be attached to the complaint. A family law cover sheet must be attached to all
pleadings. Of course, verify that Montgomery County has venue, which is controlled by Pa. R.C.P.
1920.2, and jurisdiction of the parties. Any action in divorce can be brought only in the county (1) in
which the Plaintiff or the Defendant resides, or (2) upon which the parties agree either in writing or by
proceeding in the action. Pa. R.C.P. 1920.2(c) provides that, notwithstanding an agreement between
the parties, the court on its own motion may transfer the action to a county where the parties reside if
neither party has resided within the county in which the action has been brought.
The form complaint which follows has multiple counts. When you first file the complaint all counts
may not be necessary. The facts of your case will dictate which counts have to be filed, and thus the
fee to be paid. The form complaint also lists counts for a fault divorce which is still permitted in
Pennsylvania although rarely used.
Local Rule 1915.3 (Seminar for Children and Divorce) requires parents to attend an educational
seminar on their general responsibilities toward raising children. Parents must complete this seminar
within 60 days of commencement of any action for custody or divorce (where there are minor children).
2. Service of the Complaint
Service of the complaint is controlled by Pa. R.C.P. 1920.4 and 1930.4. The complaint may be
served upon the Defendant, whether the Defendant resides in Montgomery County, in another county
or outside of Pennsylvania, (a) by both certified U.S. mail restricted to addressee only, return receipt
requested, and first class mail; (b) by the Sheriff of the county where the Defendant resides; (c) by a
competent adult who is not a party to the divorce action; or, (d) by having the Defendant accept service
of the complaint.
If service of the complaint is made by U.S. mail or by a competent adult, you will have to file an
affidavit of service with the Prothonotary. If the Sheriff makes service, his office will file the appropriate
proof of service. If service is made by the Defendant accepting service, the affidavit of acceptance of
service must be filed with the Prothonotary. The appropriate form for the affidavit of service is attached
hereto.
3. Answering the Complaint
Divorce complaints generally are not answered: Pa. R.C.P. 1920.14 states that all averments in a
complaint for divorce or annulment and all other claims which may be joined under the Divorce Code
are deemed denied unless admitted by an answer. The Defendant can respond to a divorce complaint
with a counterclaim raising issues that were not raised in the complaint even though the Defendant
does not file an answer to the complaint. If an answer is not filed, the Plaintiff can withdraw the divorce
complaint at any time. To avoid the risk of the Plaintiff withdrawing the divorce complaint, the complaint
should be answered with new matter, even if the new matter is a repeat of the divorce complaint.
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4. Discovery
Discovery is permitted without leave of Court in Pennsylvania for domestic relations matters that
pertain to alimony, equitable distribution, counsel fees and expenses, and complex support proceedings.
Leave of Court for discovery is required on matters of custody, simple support or protection from
abuse cases. See Pa.R.C.P. 1930.5. All discovery matters in domestic relations actions are governed
by Montgomery County Local Rules dealing with the discovery master program, as discussed in section
4 of this manual. The masters in equitable distribution and support will hear the domestic relations
discovery matters. All motions for discovery shall be filed with the Prothonotary and will have attached
a cover sheet in which the appropriate blocks will be marked indicating that the motion is a domestic
relations matter. The motion will then be forwarded to the Court Administrators Office for a rule return
date and the scheduling of argument. The rule return date and the argument date are the same for
domestic relations matters. All domestic relations discovery matters will have a return and hearing
date on a Wednesday at 1:00 P.M. to be heard at 321 Swede Street, Norristown.
5. Obtaining a Final Decree
a. Procedure when each party files an Affidavit of Consent under Section 3301(c) of the
Divorce Code
There is a 90 day waiting period after divorce complaint has been filed and served before the parties
can sign an Affidavit of Consent. Once the Affidavit of Consent has been signed, it must be filed with
the Prothonotary within 30 days of signing the Affidavit. Once the Affidavit of Consent has been filed, it
cannot be withdrawn without leave of court. The party moving for the divorce sends a 20 day notice to
the opposing party after 90 days have passed after the complaint was filed and served. The 20 day
notice period can be waived by the parties by filing a separate waiver of notice in addition to the affidavit
of consent with the Prothonotary. The 20 day notice is generated by Pa. R.C.P. 1920.42(d)(1), giving
the opposing party notice that a Praecipe to Transmit the Record will be filed in 20 days. A copy of the
Praecipe must be enclosed with the notice.
If no objections to the Praecipe to Transmit the Record are filed after the 20 day notice is received or
the right to receive a 20 day notice is waived, the Praecipe and an Affidavit of Vital Statistics are filed
together with a copy of the twenty (20) day notice if one was sent. (Note: The Commonwealth of
Pennsylvania requires that the Vital Statistics form be submitted on 8 1/2 x 7 paper.) There is a filing
fee for the Praecipe of $38.00.
b. Procedure when one party files an Affidavit under Section 3301(d) alleging
irretrievable breakdown of the marriage and a 2 year separation period
When proceeding under Section 3301(d), the Plaintiff must serve upon the Defendant a Section
3301(d) Affidavit, Defendants Counter Affidavit (unless Defendant is represented by an attorney, then
you do not have to send Defendants Counter Affidavit), 20 day notice, Praecipe to Transmit the Record
and an Affidavit of Non Military Service if an attorney has not entered his appearance for the Defendant.
If no Counter Affidavit is filed, the Plaintiffs Affidavit is deemed admitted.
If the non-moving party denies the allegations of the Section 3301(d) Affidavit, the matter is referred
to a master for hearing on the disputed matters. The moving party must file a Praecipe to Appoint a
master and pay a fee of $185.00. A master will then be appointed by the court. The moving party must
further pay the masters fee as charged by the master on an hourly basis.
If no answer is filed within 20 days of service of the Section 3301(d) Affidavit together with the other
required documents as specified above, the moving party may then file the Praecipe to Transmit the
Record together with a copy of the 20 day notice that was sent, an Affidavit of Non Military Service and
an Affidavit of Vital Statistics. (Note: The Commonwealth of Pennsylvania requires that the vital statistics
form be submitted on 8 1/2 x 7" paper.)
Rev: 08/2006
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NOTE: Under a 3301(d) Divorce, if the parties have been separated for two years prior to the filing of
the Divorce Complaint, the Plaintiff does not have to wait for 90 days to pass after the filing and service
of the complaint for Plaintiff to file his or her Affidavit under 3301(d) of the Divorce Code. Plaintiffs
affidavit under 3301(d), 20 day notice and the other papers noted above can be served on the Defendant
at the same time that the complaint is served on the Defendant.
c. Procedure when party proceeds on fault grounds
If a party wants to secure a fault divorce, they must file a Motion for Appointment of a Master in
Divorce and pay a filing fee of $185.00. The case is then referred to a Judge who appoints an attorney
in the county to hear testimony and make a recommendation as to whether a divorce should be granted.
The specific proceeding utilized depends upon the master appointed. Upon completion of the testimony,
the master is required to file a report and recommendation. A party has 10 days from the filing of the
report by the master to take exceptions. If exceptions are filed, the matter will then be heard by the
assigned Judge.
6. Property Settlement Agreements
Whenever possible, it is good practice to settle all issues regarding assets or minor children by
including a marital settlement agreement with the divorce. It is also wise to have a paragraph in any
property settlement agreement stating that it is to be incorporated into the divorce decree. Some of the
surrounding counties will not incorporate the property settlement agreement into the divorce decree
without such a paragraph or a separate agreement between the parties authorizing the agreement to
be incorporated into the divorce decree. If the parties cannot agree on the division of property, custody
of the children or support payments (both spousal and child), then the court will impose a settlement on
the parties. The sections that follow deal with the procedures to follow when the parties cannot agree
on a division of property, support and/or custody.
7. Forms of Final Decrees or Orders for Disposition of Economic Issues
Check the appropriate box in paragraph 6 on the Praecipe to Transmit the Record. If the first box is
checked, a decree incorporating but not merging the property settlement agreement will be entered. If
the second box is checked, a decree in divorce will be entered with no further relief granted. If the case
is a bifurcated case, consents of both parties to the case being bifurcated or a court order granting
bifurcation must be attached and the third box would be checked. When the third box is checked, a
decree granting the divorce is granted with the court retaining the right to resolve other issues. If the
fourth box is checked, an order will be entered that a hearing be scheduled before the equitable
distribution master to resolve claims of either party to equitable distribution, alimony, counsel fees,
costs and expenses, and related claims. This is not a divorce decree, and a divorce decree will not be
entered until the related matters are disposed of, unless a petition for bifurcation is filed and granted or
the parties agree to bifurcate the case.
8. Bifurcation
Montgomery County does not automatically bifurcate a divorce case. To have a divorce case
bifurcated, a petition for bifurcation must be filed with the Prothonotary, whereupon it will be automatically
listed for a hearing. An Affidavit of Service must also be filed with the Prothonotary. If the opposing side
wishes to contest the bifurcation, it is suggested that they file an answer within 20 days. A case can
also be bifurcated if the parties stipulate to the bifurcation and the stipulation is filed with the Prothonotary.
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9. Retaking of Maiden Name
After a divorce decree is entered, a spouse can retake her maiden name by filing an Election to
Retake Maiden Name. If the divorce decree was entered in Montgomery County, there is no filing fee.
If the divorce decree was obtained in another county but the party resides in Montgomery County, she
may file the election in Montgomery County by paying a $12.00 fee.
D. EQUITABLE DISTRIBUTION, ALIMONY AND FINAL COUNSEL FEES, COSTS AND
EXPENSES
1. Practice and Procedure under the Montgomery County Conciliation System
Once you have established grounds for divorce and an Order is entered, the matter is then
automatically scheduled for a hearing before one of the equitable distribution masters. There is generally
a four to five month time lag between the date of the divorce grounds order and the equitable distribution
hearing.
At this time, two part-time masters hear equitable distribution issues: Gordon Mair has hearings on
Monday, Tuesday, and Wednesday, and Bruce Goldenberg has hearings on Thursday and Friday.
Approximately two hearings are scheduled for 9:30 A.M. and two hearings for 1:30 P.M. on each of
these days.
The masters are located at 321 Swede Street across from the Court House. Continuances by
agreement of counsel are usually granted by the Masters when requested.
It is also possible to have a brief conference with the master with only counsel present to discuss
any difficult issues in the case or to secure a preliminary opinion on the economic issues when the
facts and values are not in dispute. This enables counsel to get an idea of how the master feels about
the issues in the case. These are scheduled for 9:00 A.M. and 1:00 P.M., and are available within
several weeks of the request. Pursuant to Local Rule 1920.33(f), at least ten days prior to the first
hearing each party must file an initial hearing statement which includes the following information:
(a) a statement of all marital and non-marital assets with verification of values, indicating date of
valuation used;
(b) a summary of all marital and non-marital liabilities, indicating dates of valuation;
(c) verification of any post-separation payment of marital debt;
(d) an expense statement in the form provided for in the Rule;
(e) verification of current gross and net income in the form provided in the Rule;
(f)
the last two filed federal and state income tax returns;
(g) all present or past spousal support, alimony, alimony pendente lite or child support orders
between the parties; any presently existing alimony or child support order involving either
party separately; and verification of any arrearages;
(h) the date of the parties separation; and
(I)
verification of counsel fees, costs and expenses, if claimed.
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If a subsequent hearing is scheduled, no later than twenty days prior to that hearing, each party must
file a pre-trial statement as provided in Pa. R.C.P. 1920.33(b). Failure to comply with these provisions
may subject a party to serious sanctions which are set forth in the local rules.
The approach of the masters to expert reports is that they will accept reports from experts (pension
valuators, business valuators, real estate appraisers, etc.) without the expert being present so long as
the reports have been exchanged in advance. You may bring your expert if you choose to, but generally
the expense of doing same is not necessary. An exception is in cases where there is a material
difference between the opinions of the experts, and it would be helpful to have the expert appear to
provide an explanation of his/her findings and be subject to cross examination. An interesting note is
that the masters are available by telephone to suggest names of experts in given fields with whom they
have dealt previously and find to be credible. Pursuant to local rules, the masters can now hear issues
regarding third party claims such as debts or property interests when those parties have been properly
joined.
Like a hearing before support officers, a hearing before the equitable distribution master is a nonrecord proceeding.
2. The Equitable Distribution Hearing
Before entering the courtroom, the master will ask counsel for both parties to meet in chambers to
review the assets and arguments applicable to the case. The master expends a great deal of time with
counsel in an attempt to narrow the issues, value the assets and settle the case. He attempts to
eliminate advocacy at this level with the goal of settlement in mind. Often counsel for the parties and
the masters discuss an overall proposal for settlement which is taken back to the parties and reviewed
to see if the matter can be resolved. If not, it proceeds back into the courtroom where testimony is
taken (though, no record is made) if time is available that day. If not, a new hearing date is scheduled.
If an agreement is reached between the parties, a court reporter is called and the agreement is
recorded.
The masters favor an additional percentage of property as equitable distribution, where possible,
instead of alimony, provided alimony is warranted, as they feel that alimony creates a tie between the
parties following the dissolution of their marriage. In addition alimony can create future issues of
collection and modification. Once again, instead of ordering counsel fees in many cases, they will
adjust the percentage of equitable distribution to the dependent spouse where appropriate. This is not
to say that alimony and counsel fees are not awarded in appropriate cases, but the general approach
is to factor both aspects in the equitable distribution plan.
If no agreement is reached, the hearing is held and the master enters a Report and Recommendation
regarding the issues. Either party may file Exceptions to this Report and Recommendation within
twenty days after the notice of filing was mailed to counsel for each party (Note: Check the rules of
Civil Procedure). Along with the Exceptions, the practitioner should attach an Order scheduling a
de novo hearing before the Court. If no Exceptions are filed to the report of the Master, it will become an
Order of Court and a final decree will be entered.
It should be noted that the masters boast a 94% settlement rate of all cases which are listed before
them.
E. SUPPORT/ALIMONY PENDENTE LITE
1. Commencement of Action
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As indicated previously, a count for support or alimony pendente lite may be included in the initial
divorce complaint or answer filed with the Prothonotary. However, as local rules make clear, a complaint
for support must also be filed at the Domestic Relations Office in order to start the support procedure.
After the complaint with a count for support is filed with the Prothonotary, you then have to file the
complaint with Domestic Relations. An action for support can be filed directly with the Domestic
Relations Office without first filing the complaint with the Prothonotary. The Montgomery County
Domestic Relations Office is located on the first floor of One Montgomery Plaza which is directly
across Swede Street from the Courthouse.
A docket number and PACSES number are assigned upon filing at the Domestic Relations Office.
These numbers follow the support action throughout the system. All initial filings for support with
Domestic Relations must have an Intake Information Questionnaire/Data Sheet (the same form is
used for Plaintiff or Defendant).
In Montgomery County, alimony pendente lite actions proceed in the same manner as spousal support
actions, the difference being that a divorce action must be pending for alimony pendente lite to be
ordered. Spousal support, of course, requires entitlement.
Modifications of existing support/alimony pendente lite Orders are commenced in the same fashion
as an initial order. A Petition to Modify (see attached forms) must be filed with the Domestic Relations
Office, together with a filing fee of $20.00, which triggers the scheduling of the first of three levels of
hearings, the Domestic Relations conciliation. There is a filing fee of $30.00 if you request the audit of
an account.
2. Conciliation/Hearings
a. Domestic Relations Conciliation (Preliminary Conciliation)
The Montgomery County system is a three-tier system. The first level is a Domestic Relations
conciliation before a support conciliator. At this level, the parties appear with their attorneys in the
Domestic Relations Office. A conciliation is conducted before a support conciliator and information is
exchanged and submitted to the Conciliator at that time. The information required to be exchanged is
set forth in Pa. R.C.P. 1910.11(c). The parties have to exchange their most recent tax returns, pay
stubs for the proceeding six months, verification of child care expenses and proof of medical insurance.
If the joint income of the parties falls within the support guidelines ($20,000.00 net income per month),
then the parties have to show only the income and extraordinary expenses on the Income and Expense
statement. If the joint income of the parties exceeds the support guidelines, then the Income and
Expense statement must be filled out in its entirety. At this time, an Intake Questionnaire must be
submitted by each party. If counsel for the Defendant has not yet entered an appearance, it should be
done at the time of the Domestic Relations conciliation.
If the Complaint for Support alleges that the children were born out of wedlock, a paternity coordinator
will take a sample for genetic testing. If the genetic testing proves that the alleged father is not the
father of the child, then the support case is dismissed. If the genetic testing proves that the person is
the father, then another hearing is scheduled to determine the amount of support. If you represent the
father, take the father at least two weeks before the hearing to Domestic Relations to have him go
before the paternity coordinator. Also make arrangements with the custodian of the child to have the
child taken to the paternity coordinator on the same day (it doesnt have to be at the same time) to have
the child tested as well. By taking your client to be tested before the hearing, there is a savings to your
client for the test and if he is not the father the matter will be dismissed at the first hearing.
Though no witnesses are permitted at a Domestic Relations conciliation, certain documentary
evidence, specifically pertaining to a persons medical condition, may be and should be submitted.
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The hearing is an informal one. The support conciliator reviews the data submitted by the parties
and asks relevant questions pertaining to income and expenses. Each party is given the opportunity to
ask questions of the other party. After gathering the information, the support conciliator makes a
recommendation pertaining to the requested issues (spousal support, child support, alimony pendente lite).
The conciliators recommendation follows the state guidelines as provided in Pa. R.C.P. 1910.16-2.
Once the support conciliator advises the parties of the recommendation, the parties have the option
of either accepting it or rejecting it. If both parties agree to accept the recommendation, an Agreed
Order is prepared at that time and signed by the parties at which point the proceeding is over. (See the
attached forms for an Agreed Order and accompanying documents which may also be used in submitting
an agreement between the parties.) If the parties do not agree on the recommendation, a temporary
order for support based on the recommendation of the support conciliator is entered. Questions of
entitlement to spousal support must be raised before the support conciliator. The awarding of alimony
pendente lite is without consideration of the fault of the parties.
If the parties do not agree to the recommendation of the support conciliator, the parties will receive a
date for the next level of hearing, before a support master at the conclusion of the Domestic Relations
conciliation. If no date is given at the time of the Domestic Relations conciliation, a date will be assigned
thereafter and notice will be sent to the parties of the scheduled date before the support master. Counsel
must rely upon their client to advise them when the notice is received.
Continuances are generally granted by agreement of counsel pending settlement negotiations or
may be requested before the signing Judge.
b. Hearing Before the Support Conference Officer
Frederick Cohen and Luke McLaughlin are the conference officers in Montgomery County. When
cases are not resolved at the Domestic Relations conciliation level, they are scheduled for a hearing
before them. Mr. Cohen hears cases on Monday, Tuesday and Wednesday, and Mr. McLaughlin hears
cases on Thursday and Friday.
Hearings before the support conference officers are scheduled approximately five to eight weeks
after the Domestic Relations conciliation. All cases are listed for 9:00 A.M. at 321 Swede Street in
Norristown. Approximately 13 to 15 cases are listed each day. As they are all listed for the same time,
it behooves the parties and counsel to arrive in a timely fashion as the cases are usually taken on a
first come, first serve basis, so long as all parties and counsel are present and ready to proceed.
The procedure before the support conference officers is in accordance with Pa.R.C.P. 1920.55-3.
There is no court reporter present. The hearing is usually abbreviated in nature with stipulations
encouraged. When a case is first called, counsel for the parties usually begin by presenting their
positions as to income of the parties and issues before the conference officer. It is then determined
whether there can be a stipulation as to certain facts pertaining to income and expenses and, if not, the
conference officer determines whether testimony should be offered on to a particular issue, specifically
but not limited to income, earning capacity or expenses.
Although witnesses are often subpoenaed to this proceeding, the conference officers have no
jurisdiction to enforce a subpoena. Make certain that you review the preamble to the support guidelines
and utilize the aspects of the preamble as they pertain to your case in the presentation of your argument.
Within five (5) days of the conference, a written copy of the recommended Order should be received.
This recommendation becomes an Order of the Court and must be paid in full, even if Exceptions to
same are filed. Exceptions may be filed by either party within twenty (20) days of the mailing of the
recommended Order. The attached Montgomery County form is used for the filing of those exceptions.
Rev: 08/2006
8-10

A hearing de novo will be scheduled before a judge if exceptions are timely filed.
3. Enforcement/Contempt
Enforcement hearings are held in the Domestic relations Section on the first floor of One Montgomery
Plaza in Norristown. If no resolution is reached at the hearing, the matter will be heard by a judge. The
time of the hearing before the judge will depend on whether the party alleged to be in default has private
counsel. If the alleged defaulting party has private counsel, the matter will be listed to be heard by the
Court on the next available date on a Friday. If a party wishes to waive his right to an attorney, then the
matter will be heard again on the next available Friday. If the party in default elects to have counsel, the
matter will be continued for thirty days to allow the party to obtain counsel or a public defender. Notice
of the hearing before Domestic Relations is sent to the Defendant who has the opportunity to come into
the Domestic Relations Office and offer an explanation which could negate the issue of contempt.
Plaintiff is also sent a notice but the attendance of the Plaintiff is not mandatory; however, a Plaintiff
should appear if at all possible. NOTE: Notices of the enforcement hearing are not sent to counsel.
It should be noted that a pending Petition to Modify requesting a decrease will not stop a wage
attachment from issuing and is no reason to reduce or stop making support payments. Also, it should
be noted that an employer may be cited for contempt where there is non-compliance with a wage
attachment Order.
Concerning unreimbursed expenses, please refer to the instructions of the Domestic Relations
Enforcement Unit contained in the form section that follows.
4. Client Coordinator
If an attorney wishes to examine a file or file an Agreed Order, please see the Client Coordinator. The
Client Coordinator is located on the first floor of One Montgomery Plaza and is available to see clients
and counsel. A sign up sheet on a first-come, first-serve basis is located at the counter of the Domestic
Relations Office.
F. CUSTODY/VISITATION
1. Commencement of Action
All complaints for custody whether included within a divorce complaint or filed as a separate complaint,
must include the information required by the Pa. R.C.P. 1915.15. Montgomery County Local Rule
1915.3 requires parents involved in a custody action or divorce involving minor children to attend an
educational seminar on their responsibilities toward minor children. Parents must complete this seminar
within 60 days of commencement of a custody action or divorce action. For cases where custody
modification is sought, attendance at such seminars may be ordered by the court.
If a count for custody is included in the initial divorce filing, an extra $39.50 will be charged for this
count. If a count for custody is not included in the divorce complaint, it will be necessary to file a new
complaint and pay another $226.00 filing fee. However, if you file an amended complaint adding a count
for custody, an additional fee may not be charged for filing the amended complaint. After five years have
passed and the custody case has been closed, a new complaint has to be filed if you are requesting a
change in the custody order. If less then five years has passed, you can file a complaint with the
original custody court number and no additional filing fee wil be assessed.
In the event you include a custody count as part of your divorce complaint, no action will occur on the
custody issue unless you deliver a copy of the complaint to Genya Trice, secretary to Sara Goren,
Rev: 08/2006
8-11

Custody Conciliator at 321 Swede Street in Norristown and request a hearing date. Cases are currently
being scheduled for a hearing approximately 4 to 6 weeks from the request for a hearing.
In the case of contempt of a custody order, file the contempt petition with the Prothonotary and then
take the contempt petition to the Court Administrators Office. See section 4 of this manual for further
guidance.
2. Hearing Procedures
Custody cases, other than emergency cases, are handled by a three-step process. The first step is
before Sara L. Goren, Custody Conciliator, who is located at 321 Swede Street in Norristown. A conciliation
conference is scheduled before her in all custody cases unless an emergency exists. The conciliation
conference is very informal; however, counsel must officially enter his or her appearance to represent
a party at the conference. Ms. Goren will usually talk with the attorneys and try to work out a settlement.
No testimony is taken but she will speak with the child or children involved if requested to do so by the
parties. If an agreement is reached, Ms. Goren will hand draft an order reflecting the agreed-upon
terms or will ask counsel to prepare an agreed order. All agreed orders are turned over to the signing
Judge at the end of each day.
In the event that Ms. Goren is unable to resolve the matter, the case is then scheduled for a nonbinding custody mediation in an attempt to resolve the custody issues. See Pa. R.C.P. 1940.1 et seq.
concerning the requirements for mediation. The Cost for the custody mediation is $150.00 which is
split between the parties. The initial mediation meeting can last up to two hours for the previously
stated fee. The mediator is selected by the parties from a list of approved mediators. The list is kept
by Ms. Goren, the Court Administrators Office and the Prothonotarys Office. If the parties wish, they
can continue with the mediation process until a resolution is made or the parties become deadlocked.
The parties will have to share in the mediators fee. The list of mediators gives the mediators address,
telephone number, credentials and the fee charged. The mediation meeting is with the parties only;
counsel is not permitted to participate in the mediation meeting and the mediation process is confidential
and cannot be used in court.
If an agreement is made between the parties, the mediator will draft a non-binding memorandum of
understanding which the parties do not have to sign. The non-binding memorandum of understanding
is then presented to the parties who can take the agreement to their attorneys to finalize and submit to
the court for the entry of a custody order. If the parties are pro se, the non-binding agreement is sent to
the court for the entry of an order after a voir dire of the parties to make sure that the agreement is
satisfactory to the parties. If the parties cannot agree to a custody arrangement at the mediation level,
the matter is then heard by the court.
Montgomery County Local Rule 1915.8 gives the custody conciliator the authority to recommend a
custody evaluation. That recommendation will be entered as an Order of Court. Within ten days of the
receipt of the recommendation, either party may file exceptions thereto. Those exceptions operate as
a stay of the Order. The exceptions would then be heard by the Judge assigned to the case.
In the case of an emergency custody matter, file the complaint with the Prothonotary and request
that the complaint be immediately added to the computer. The adding of the complaint to the computer
assigns a Judge to the case. Without the Judge being assigned, your case cannot proceed. Take the
complaint (with the Family Law Cover Sheet and a Family Law Emergency Cover Sheet) to the court
Administrators Office on the second floor of the Courthouse. The emergency matter will then be sent
to the appropriate judge for review and determination of whether the matter is considered by the court
to be an emergency. If so determined, the Judge will either schedule a hearing or conference the
matter with the counsel.
Rev: 08/2006
8-12

G. PROTECTION FROM ABUSE
The Protection from Abuse Office of the Court Administrators Office is between the elevators on the
second floor of the Courthouse. Obtain the PFA complaint forms from this Office and complete the
complaint. After the complaint has been completed, have the complaint reviewed by the PFA Office.
Once the complaint has been approved, take the complaint to the PFA indexers outside of the
Prothonotarys Office on the first floor and have the complaint typed by the indexers. Once the complaint
has been typed, take the complaint to the Prothonotarys Office and file it. After the complaint has been
filed, take the complaint to the signing Judge for entry of a Temporary Order and then back to the Court
Administrators Office to schedule a final hearing on the PFA complaint. Once the final hearing has
been scheduled, you will be directed to the Sheriffs office for service of the complaint. If the Judge
does not enter a Temporary Order take the complaint to the Court Administrators Office to schedule a
hearing on your PFA complaint.
No fee is charged at the time of filing the PFA complaint. The fee is assessed by the court at the
hearing. The procedure for securing the Temporary Order depends upon the specific judge involved.
Final hearings are held on each Thursday at 9:30 A.M. and are heard by the Family Judge assigned for
that week.
It should be noted that if an attorney wishes to file a PFA complaint for a client, the client should also
appear in court if a temporary order is desired.
Rev: 08/2006
8-13

IN THE COURT OF COMMON PLEAS OF MONTGOMERY COUNTY, PENNSYLVANIA
FAMILY COURT COVER SHEET
________________________________________________________________________________________
NO. ______________________________________
__________________________________ ID: ______

Attorney for Plaintff OR Pro Se Party
VS.
___________________________________________
Phone Number(s)
____________________________ ID: ____________

Attorney for Defendant OR Pro Se Party
___________________________________________
Phone Number(s)
_________________________________________________________________________________________
AVERMENT OF CONSOLIDATION
On the spaces below, please provide the docket number of all other companion cases associated with this
case (including any closed files involving the same party-litigants) that relate to:
1. Divorce/Annulment_____________________
2. Support_______________________
3. Equitable Distribution __________________
4. Paternity _____________________
5. Custody/Visitation _____________________
6. Special Relief __________________
7. Outstanding/Temporary/Final Protection From Abuse Order ______________________

___________________________________________________________________________
I certify that the information provided above is comprehensive and complete to the best of my knowledge and that
I have formally entered my appearance for the case captioned above.
By:_____________________________________
Rev: 08/2006
8-14

EMERGENCY COURT COVER SHEET
__________________________________________________________________________________________
Every emergency petition is sent directly to the Judge assigned to the case by the Court Administrators Office
after service has been made. THE JUDGE WILL DECIDE WHETHER THIS IS AN EMERGENCY OR WHETHER
THE MATTER WILL BE HEARD IN DUE COURSE. If the Judge deems the matter is an emergency, a conference,
hearing or argument will be scheduled. To expedite this process, please complete all requested information,
including telephone numbers, of all parties named in the captions or their attorneys names and phone numbers.
SERVICE: The party initiating the emergency petition must (1) serve the other side with a TIME STAMPED copy
before the petition will go to the Judge, (2) fax a copy of the Certificate of Service to: Phyllis Suriano, Court
Administration, 610-292-2027, and (3) mail the original Certificate of Service to the Prothonotary.
CASE NUMBER:
____________________________ ID: ____________
Attorney for Plaintff OR Pro Se Party
___________________________________________
Phone Number(s)
VS.
____________________________ ID: ____________

Attorney for Defendant OR Pro Se Party
___________________________________________
Phone Number(s)
_________________________________________________________________________________________
THE FILING PARTY HEREBY CERTIFIES THAT HE/SHE HAS MADE A GOOD FAITH EFFORT TO RESOLVE THIS
MATTER PRIOR TO THE FILING OF THE ATTACHED EMERGENCY PETITION.
NOTE - COURT ADMINISTRATOR WILL NOT PROVESS THIS PETITION UNLESS THIS BOX IS CHECKED.
_________________________________________________________________________________________
ORDER
AND NOW, this ______________day of ___________________________________, 20 _____,
Designated Judge __________________________________has deemed this petition:
OR
Designated Judge __________________________________is unavailable until __________.
Judge ___________________________(to whom matter was referred) has deemed this petition:
is an emergency, and has scheduled a conference/hearing/argument for _______________;
is not an emergency and ________ Court Administration is directed to schedule this in due course;
or
___________________________________________________________________________
is to be scheduled for an expedited Custody Conciliation Conference.
can wait the return of the Designated Judge.
BY THE COURT:
__________________________________
J.
Rev: 08/2006
8-15

_______________________________
By:
_______________________________
Attorney I.D. _______________________________
_______________________________
Attorney for ____________________

CIVIL ACTION - DIVORCE
__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
___________________________________
___________________________________
Soc. Sec. No. ______________________
No. ____________________
NOTICE TO DEFEND AND CLAIM RIGHTS

You have been sued in Court. If you wish to defend against the claims set forth in the following pages, you
must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree
of divorce or annulment may be entered against you by the Court. A judgment may also be entered against you for
any other claim or relief requested in these papers filed by the Plaintiff. You may lose money or property or other
rights important to you, including custody or visitation of your child(ren).
When the ground for divorce is indignities or irretrievable breakdown of the marriage, you may request
marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary at the Montgomery
County Court House, P.O. Box 311, Norristown, PA.
IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYERS FEES OR
EXPENSES BEFORE THE DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM
ANY OF THEM.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER
OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE
YOU CAN GET LEGAL HELP.
LAWYER REFERENCE SERVICE
100 West Airy Street (Rear)
NORRISTOWN, PA 19401
(610) 279-9660, X201
TOLL FREE (800) 560-LAW1 (5291)
Rev: 08/2006
8-16

_______________________________
By:
_______________________________
Attorney I.D. _______________________________
_______________________________
Attorney for ____________________

__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
___________________________________
___________________________________
Soc. Sec. No. ______________________
No. ____________________
COMPLAINT
COUNT I
UNDER SECTION 3301 (c) & (d) OF THE DIVORCE CODE
1.
Plaintiff is __________________________________________________, who currently resides at
____________________________________ , ________________________________,
________________ County, _________________________.
2.
Defendant is _______________________________________________, who currently resides at
____________________________________ , ________________________________,
________________ County, ________________________.
3.
Plaintiff and/or Defendant have been bona fide residents in the Commonwealth for at least six
months immediately previous to the filing of this Complaint.
4.
The Plaintiff and Defendant were married on___________________, at ________________ County,
_______________.
5.
There have been no prior actions of divorce or for annulment between the parties except
_________________________________________.
6.
The marriage is irretrievably broken.
7.
Plaintiff has been advised that counseling is available and that Plaintiff may have the right to
request that the court require the parties to participate in counseling.
8.
Plaintiff requests the court to enter a decree of divorce.
COUNT ____
Request for a Fault Divorce under Section 3301(a)(1)
9.
The prior paragraphs are incorporated by reference.
10.
Defendant has willfully and/or maliciously deserted the Plaintiff, having not lived with the Plaintiff
for more than one year.
11.
This action is not collusive as that term is defined by Section 3309 of the Divorce Code.
WHEREFORE, Plaintiff requests that this Court enter a decree in divorce pursuant to Section 3301(a)(1) of
the Divorce Code.
Rev: 08/2006
8-17

COUNT ____
12.
13.
Defendant has committed adultery.
14.
This action is not collusive as that term is defined by Sectin 3309 of the Divorce Code.
the Divorce Code.
COUNT____
15.
16.
The Defendant has, over a period of time from _______ to ______, by cruel and barbarous treatment,
endangered the life of Plaintiff, the injured and innocent spouse.
17.
the Divorce Code.
COUNT____
18.
19.
Defendant married Plaintiff when Defendant knew Plaintiff was still married.
20.
WHEREFORE, Plaintiff requests that this Court enter a decree in divorce pursuant to Sectin 3301(a)(4) of
the Divorce Code.
COUNT____
21.
22.
Defendant has been convicted of committing a crime and sentenced to imprisonment for a term of
more than two years.
the Divorce Code.
COUNT____
23.
24.
Defendant has offered such indignities to Plaintiff, the innocent and injured spouse, as to render
his/her life condition intolerable and life burdensome.
25.
the Divorce Code.
COUNT ____
EQUITABLE DISTRIBUTION
26.
27.
Plaintiff and Defendant have acquired property, both real and personal, during their marriage from
___________until__________, the date of separation.
28.
Plaintiff and Defendant have acquired, prior to their marriage or subsequent thereto, non-marital
property which has increased in value since the date of the marriage, and/or subsequent to its acquisition during
the marriage, which increase in value is marital property.
29.
Plaintiff and Defendant have been unable to agree as to an equitable division of said property.
WHEREFORE, Plaintiff requests this Honorable Court to equitably divide all marital property.
COUNT ____
ALIMONY/SPOUSAL SUPPORT
30.
31.
Plaintiff lacks sufficient property to provide for his/her reasonable needs and is unable to support
himself/herself through appropriate employment.
32.
Plaintiff requires reasonable support to adequately maintain himself/herself in accordance with the
standard of living established during the marriage.
WHEREFORE, Plaintiff requests this Honorable Court to enter an award of temporary alimony/spousal
support until final hearing and thereupon award such additional alimony/spousal support as is deemed appropriate.
COUNT ____
CHILD SUPPORT
Rev: 08/2006
8-18

33.
34.
Plaintiff and Defendant are the parents of the following child(ren):
(a)
Born of marriage:
Name
Birth date
Age
Residence
______________________
_______
___
_____________________________
______________________
_______
___
_____________________________
______________________
_______
___
_____________________________
(b)
Born out of wedlock:
Name
Birth date
Age
Residence
______________________
_______
___
_____________________________
______________________
_______
___
_____________________________
______________________
_______
___
_____________________________
35.
Plaintiff seeks support for the following persons:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
36.
(a)
Plaintiff __ (is) __ (is not) receiving public assistance in the amount of $___ per
____ for the support of _____________________.
(b)
Plaintiff is receiving additional income in the amount of $____ from
___________________________.
37.
A previous support order was entered against the Defendant on _________________
in an action at _________________________________________________________
(Court, term and docket number)
in the amount of $______ for the support of _______________________________.
38.
Plaintiff last received support from the Defendant in the amount of $_______ on ____________.
WHEREFORE, Plaintiff requests that an order be entered against Defendant and in favor of the Plaintiff and
the aforementioned child(ren) for reasonable support and medical coverage.
COUNT____
CUSTODY
39.
40.
Plaintiff seeks____custody____ partial custody ____ visitation of the following child(ren):
Name
Present Residence
Age
________________________ ________________________________________ ____
________________________ ________________________________________ ____
________________________ ________________________________________ ____
41.
The child(ren) ____ was/were ____ was/were not born out of wedlock.
42
The child(ren) is/are presently in the custody of________________________________, who resides
at ________________________________.
43.
During the past five years, the child(ren) has/have resided with the following persons and at the
following addresses:
Name
Present Residence
From
To
________________________ _____________________________ _________ _______
______
________________________ _____________________________ _________ _______
______
________________________ _____________________________ _________ _______
______
44.
The mother of the child(ren) is __________________________________________ , currently residing
at _______________________________________________________________. She is ____ married ____ divorced
_____ single.
45.
The father of the child(ren) is _____________________________________, currently residing at
____________________________________________________________________. He is ____ married ____
divorced _____single.
Rev: 08/2006
8-19

46.
The relationship of Plaintiff to the child(ren) is that of ___________________. The Plaintiff currently
resides with the following persons:
Name
Relationship
________________________ _____________________________
________________________ _____________________________
________________________ _____________________________
47.
The relationship of Defendant to the child(ren) is that of___________________.
The Defendant currently resides with the following persons:
Name
Relationship
________________________ _____________________________
________________________ _____________________________
________________________ _____________________________
48.
Plaintiff____ has ____ has not participated as a party or witness, or in another capacity, in other
litigation concerning the custody of the child(ren) in this or another court. The court, term and number, and its
relationship to this action is ___________________________________.
.
49.
Plaintiff ____ has ____ has no information of a custody proceeding concerning the child(ren)
pending in a court of this Commonwealth. The court, term and number, and its relationship to this action is
_________________________________________.
.
50.
Plaintiff ____ knows ____ does not know of a person not a party to the proceedings who has
physical custody of the child(ren) and claims to have custody or visitation rights with respect to the child(ren). The
name and address of such person is______________________________.
51.
The best interest and permanent welfare of the child(ren) will be served by granting the relief
requested because ____________________________________.
.
52.
Each parent whose parental rights to the child(ren) have not been terminated and the person who
has physical custody of the child(ren) have been named as parties to this action. All other persons, named below,
who are known to have or claim a right to custody or visitation of the child(ren) have been given notice of the
pendency of this action and the right to intervene:
Name
Address
Basis of Claim
________________________ _____________________________
___________________
________________________ _____________________________
___________________
________________________ _____________________________
___________________
WHEREFORE, Plaintiff requests this Honorable Court to grant physical and legal custody to Plaintiff.
COUNT__
ATTORNEYS FEES, COSTS AND EXPENSES
46.
47.
Plaintiff has employed ___________________________ , Esquire as counsel, but is unable to
pay the necessary and reasonable attorneys fees for said counsel.
WHEREFORE, Plaintiff requests Your Honorable Court to enter an award of temporary counsel fees, costs
and expenses until final hearing and thereupon award such additional counsel fees, costs and expenses as are
deemed appropriate.
________________________________
Attorney for Plaintiff
VERIFICATION
Plaintiff verifies that the statements made in this Complaint are true and correct. Plaintiff understands that
false statements herein are made subject to the penalties of 18 Pa. C.S. 4904, relating to unsworn falsification to
authorities.
_____________________
Date
Rev: 08/2006
________________________________
Plaintiff
8-20

_______________________________
By:
_______________________________
Attorney I.D. _______________________________
_______________________________
Attorney for ____________________

__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
___________________________________
___________________________________
Soc. Sec. No. ______________________
No. ____________________
ACCEPTANCE OF SERVICE BY ATTORNEY FOR DEFENDANT

To the Prothonotary:
I accept service of the Complaint on behalf of the Defendant and certify that I am authorized to do so.
My relationship to Defendant is that of Attorney.
Dated:____________________________
Rev: 08/2006
By:__________________________
8-21

_______________________________
By:
_______________________________
Attorney I.D. _______________________________
_______________________________
Attorney for ____________________

__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
___________________________________
___________________________________
Soc. Sec. No. ______________________
No. ____________________
ACCEPTANCE OF SERVICE BY DEFENDANT

I, __________________________________________ , Defendant in the above referenced matter, accept
service of the Divorce Complaint on the date set forth below.
This Affidavit is made subject to the penalties of 18 Pa. C.S. 4904 relating to unsworn falsification to
authorities.
Dated: _________________________
By: _____________________________
(Defendant)
Rev: 08/2006
8-22

_______________________________
By:
_______________________________
Attorney I.D. _________________________
_______________________________
Attorney for ____________________

__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
___________________________________
___________________________________
Soc. Sec. No. ______________________
No. ____________________
AFFIDAVIT OF SERVICE OF DIVORCE COMPLAINT

I, ____________________________________________ , Esquire, attorney for Plaintiff in the above captioned
matter, hereby certify that a Complaint in Divorce was served on the Defendant on ____________________________
in the above captioned action. Said Complaint was served by certified mail, return receipt requested at Defendants
residence of __________________________.
The original return receipt is attached as exhibit A.
This Affidavit is made subject to the penalties of 18 Pa. C.S. 4904 relating to unsworn falsification to
authorities.
Dated:_______________________________
Rev: 08/2006
________________________________
8-23

_______________________________
By:
_______________________________
Attorney I.D. _______________________________
_______________________________
Attorney for ____________________

__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
__________________________________
__________________________________
Soc. Sec. No. ______________________
No. ____________________
ANSWER AND COUNTERCLAIM TO COMPLAINT IN DIVORCE

ANSWER
1. - 8.
Pursuant to Pennsylvania Rule of Civil Procedure 1920.14(a), the allegations in a Complaint for
Divorce are deemed denied.
COUNTERCLAIM
COUNT I
UNDER SECTION 3301 (c) & (d) OF THE DIVORCE CODE

9.
Counterclaim-Plaintiff is _____________________________________________, who currently
resides at______________________________, ___________________________, _____________________ County,
Pennsylvania.
10.
Counterclaim-Defendant is ________________________________________ , who currently resides
at ______________________________, _______________________________ , _____________________ County,
Pennsylvania.
11.
Counterclaim-Plaintiff and/or Counterclaim-Defendant have been bona fide residents in the
Commonwealth for at least six months immediately previous to the filing of this Counterclaim.
12.
The Counterclaim-Plaintiff and Counterclaim-Defendant were married on _____________________,
at _____________________ County,______________________ .
13.
There have been no prior actions of divorce or for annulment between the parties
except_____________________________________.
14.
15.
Counterclaim-Plaintiff has been advised that counseling is available and that Counterclaim-Plaintiff
may have the right to request that the court require the parties to participate in counseling.
16.
Counterclaim-Plaintiff requests the court to enter a decree of divorce.
(NOTE: Add additional counts from the form complaint as required.)
___________________________________________
Attorney for Counterclaim-Plaintiff
Rev: 08/2006
8-24

VERIFICATION
Counterclaim-Plaintiff verifies that the statements made in this Counterclaim are true and correct. CounterclaimPlaintiff understands that false statements herein are made subject to the penalties of 18 Pa. C.S. A. 4904,
relating to unsworn falsification to authorities.
________________________
Date
Rev: 08/2006
__________________________________
Counterclaim-Plaintiff
8-25

_______________________________
By:
_______________________________
Attorney I.D. _______________________________
_______________________________
Attorney for ____________________

__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
__________________________________
__________________________________
Soc. Sec. No. ______________________
No. ____________________
AFFIDAVIT OF CONSENT UNDER SECTION 3301(c)

1.
A Complaint in Divorce under Section 3301 (c) of the Divorce Code was filed on ______________.
2.
The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed
from the date of the filing and service of the Complaint.

3.
I consent to the entry of a final Decree of Divorce after service of notice of intention to request entry
of the decree.
I verify that the statements made in this Affidavit are true and correct. I understand that false statements
herein are made subject to the penalties of 18 Pa.C.S.A. 4904, relating to unsworn falsification to authorities.
Dated: _____________________
Rev: 08/2006
________________________________
8-26

_______________________________
By:
_______________________________
Attorney I.D. _________________________
_______________________________
Attorney for ____________________

__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
__________________________________
__________________________________
Soc. Sec. No. ______________________
No. ____________________
NOTICE TO DEFENDANT UNDER SECTION 3301(d)

If you wish to deny any of the statements set forth in this affidavit, you must file a counteraffidavit within twenty
days after the affidavit has been served on you or the statements will be admitted.
PLAINTIFFS AFFIDAVIT UNDER SECTION 3301(d) OF THE DIVORCE CODE

1.
The parties to this action separated on ____________ and have continued to live separate and
apart for a period of at least two years.

2.
3.
I understand that I may lose rights concerning alimony, division of property, lawyers fees or
expenses if I do not claim them before a divorce is granted.

I verify that the statements made in this affidavit are true and correct. I understand that false statements
herein are made subject to the penalties of 18 Pa.C.S.A. 4904 relating to unsworn falsification to authorities.
Dated: ______________________
Rev: 08/2006
_______________________________
8-27

_______________________________
By:
_______________________________
Attorney I.D. _________________________
_______________________________
Attorney for ____________________

__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
__________________________________
__________________________________
Soc. Sec. No. ______________________
No. ____________________
COUNTER-AFFIDAVIT UNDER SECTION 3301(c)

I wish to claim economic relief which may include alimony, division of property, lawyers fees or expenses,
or other important rights.
I understand that I must file my economic claims with the Prothonotary in writing and serve them on the
other party. If I fail to do so before the date set forth on the Notice of Intention to Request Divorce Decree, the
divorce decree may be entered without further notice to me, and I shall be unable thereafter to file any economic
claims.
I verify that the statements made in this counter-affidavit are true and correct. I understand that false
statements herein are made subject to the penalties of 18 Pa.C.S.A. 4904 relating to unsworn falsification to
authorities.
Date: _________________
__________________________________
Plaintiff
Defendant
__________________________________
Print/Type Name
(Notice: If you do not wish to claim economic relief, you should not file this counter-affidavit.)
Rev: 08/2006
8-28

_______________________________
By:
_______________________________
Attorney I.D. _________________________
_______________________________
Attorney for ____________________

__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
___________________________________
___________________________________
Soc. Sec. No. ______________________
No. ____________________
DEFENDANTS COUNTER-AFFIDAVIT UNDER SECTION 3301(d) OF THE

DIVORCE CODE
(1)
Check either (a) or (b)

(a)___ I do not oppose the entry of a divorce decree.
(b)___ I oppose the entry of a divorce decree because
(check (i), (ii), or both)
(i) ____ The parties to this action have not lived separate and apart for a period
of two years.
(ii)____ The marriage is not irretrievably broken.
(2) Check either (a) or (b)
(a)____ I do not wish to make any claims for economic relief. I understand that I may lose rights
concerning alimony, division of property, lawyers fees or expenses if I do not claim them before a divorce is granted.
(b)____ I wish to claim economic relief which may include alimony, division of property, lawyers
fees or expenses, or other important rights.
I understand that in addition to checking (b) above, I must also file all of my economic claims with the Prothonotary
in writing and serve them on the other party. If I fail to do so before the date set forth on the Notice of Intention to
Request Divorce Decree, the divorce decree may be entered without further notice to me and I shall be unable
thereafter to file any economic claims.
I verify that the statements made in this counter-affidavit are true and correct. I understand that false statements
herein are made subject to the penalties of 18 Pa.C.S.A. 4904 relating to unsworn falsification to authorities.
Date: _____________________
______________________________
Plaintiff
Defendant
______________________________
Print/Type Name
(Notice: If you do not wish to oppose the entry of a divorce decree and you do not wish to make any claim for
economic relief, you should not file this counter-affidavit.)
Rev: 12/98
8-29

_______________________________
By:
_______________________________
Attorney I.D. _________________________
_______________________________
Attorney for ____________________

__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
___________________________________
___________________________________
Soc. Sec. No. ______________________
No. ____________________
WAIVER OF NOTICE OF INTENTION TO

REQUEST ENTRY OF A DIVORCE DECREE
1.
I consent to the entry of a final Decree of Divorce without notice.
2.
I understand that I may lose rights concerning alimony, division of property, lawyers fees or
expenses if I do not claim them before a divorce is granted.

3.
I understand that I will not be divorced until a divorce decree is entered by the Court and that a
copy of the decree will be sent to me immediately after it is filed with the Prothonotary.
I verify that the statements made in this Waiver are true and correct. I understand that false statements
herein are made subject to the penalties of 18 Pa. C.S. A. 4904 relating to unsworn falsification to authorities.
Date: ______________________
Rev: 08/2006
_______________________________
8-30

_______________________________
By:
_______________________________
Attorney I.D. _________________________
_______________________________
Attorney for ____________________

__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
___________________________________
___________________________________
Soc. Sec. No. _______________________
No. ____________________
PRAECIPE TO TRANSMIT RECORD

Transmit the record together with the following information to the court for entry of a divorce decree or approval of
grounds for divorce and disposition of unresolved claims:
1.
Ground for divorce: irretrievable breakdown under Section (3301(c)) (3301(d)(1)) of the Divorce Code. (Strike
out inapplicable section).
2.
Date and manner of service of the complaint:

________________________________________________________________
3.
(Complete either paragraph (a) or (b)).

(a)
Date of execution of the affidavit of consent required by Section 3301(c) of the Divorce Code:
By plaintiff:
_________________
By defendant: _________________
(b)
(1)
Date of execution of the plaintiffs affidavit required by Section 3301(d) of the Divorce Code
__________________
(2)
Date of service of the plaintiffs affidavit upon the defendant:______________________
4.
Related claims pending:

______________________________________________________________________________________
5.
(Complete either (a) or (b)).

(a)
Date and manner of service of the Notice of Intention to File Praecipe to Transmit Record, a copy
which is attached: ___________________________________________________________
(b)
Date plaintiffs Waiver of Notice was filed with the Prothonotary:
_____________
Date defendants Waiver of Notice was filed with the Prothonotary:
_____________
6.
The following is requested:

_____ Decree in divorce with property settlement attached.
_____ Bifurcated Decree in divorce with the court to retain jurisdiction over unresolved claims which
shall be listed for a hearing. Stipulation or order to bifurcate required.
_____ Decree in divorce with no other relief granted.
_____ Order approving ground for divorce and referring matters for a hearing on unresolved claims.
Decree in divorce deferred.
7.
Pennsylvania vital statistics form is attached.
of
______________________________
Signature of Attorney
____________________________
Print Name and ID Number
____________________________
Telephone Number
Rev: 12/98
8-31

_______________________________
By:
_______________________________
Attorney I.D. _________________________
_______________________________
Attorney for ____________________

__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
__________________________________
__________________________________
Soc. Sec. No. ______________________
No. ____________________
AFFIDAVIT OF NON-MILITARY SERVICE

______________________________, attorney for Plaintiff, makes this affidavit on behalf of the above named
Plaintiff, being authorized so to do and knows of his own personal knowledge, and therefore avers that:
1.
_________________________________ is the Plaintiff in the above captioned divorce.
2.
That the Defendant is _____ years of age.
3.
That the Defendant lives at __________________________________________________.
4.
Defendant is employed as ____________________________________.
5.
That Defendant is not in the military or naval services of the United States or its allies, or is otherwise within
the provisions of the Soldiers and Sailors Civil Relief Act of Congress of 1940 and its amendments.
I understand that the statements made herein are subject to the penalties of 18 Pa. C.S.A. 4904, relating
to unsworn falsification to authorities.
_____________________________
Rev: 12/98
8-32

_______________________________
By:
_______________________________
Attorney I.D. _________________________
_______________________________
Attorney for ____________________

__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
__________________________________
__________________________________
Soc. Sec. No. ______________________
No. ____________________
NOTICE OF INTENTION TO REQUEST

ENTRY OF SECTION 3301(C) DIVORCE DECREE
To: _________________________________
(Plaintiff)(Defendant)
You have signed a Section 3301(c) affidavit consenting to the entry of a divorce decree. Therefore, on or
after ______________, 20___, the other party can request the court to enter a final decree in divorce.
Unless you have already filed with the Court a written claim for economic relief, you must do so by the date
in the paragraph above, or the Court may grant the divorce and you will lose forever the right to ask for economic
relief. The filing of the form counter-affidavit alone does not protect your economic claims.
(610) 279-9660, X201
TOLL FREE (800) 560-LAW1 (5291)
Rev: 08/2006
8-33

_______________________________
By:
_______________________________
Attorney I.D. _______________________________
_______________________________
Attorney for ____________________

__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
__________________________________
__________________________________
Soc. Sec. No. ______________________
No. ____________________

ENTRY OF SECTION 3301(d) DIVORCE DECREE
To: _______________________________
(Plaintiff)(Defendant)
You have been sued in an action for divorce. You have failed to answer the Complaint or file a Counteraffidavit
to the Section 3301(d) Affidavit. Therefore, on or after _______________, 20__ , the other party can request the
Court to enter a final Decree in Divorce.
If you do not file with the Prothonotary of the Court an Answer with your signature notarized or verified or a
Counter-affidavit by the above date, the Court can enter a final Decree in Divorce.
A Counter-affidavit which you may file with the Prothonotary of the Court is attached to this notice.
Unless you have already filed with the Court a written claim for economic relief, you must do so by the
above date or the Court may grant the divorce and you will lose forever the right to ask for economic relief. The filing
of the form Counter-affidavit alone does not protect your economic claims.
(610) 279-9660, X201
TOLL FREE (800) 560-LAW1 (5291)
(Note: Use this form when an attorney does not represent the Defendant.)
Rev: 08/2006
8-34

_______________________________
By:
_______________________________
Attorney I.D. _________________________
_______________________________
Attorney for ____________________

__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
__________________________________
__________________________________
Soc. Sec. No. ______________________
No. ____________________

ENTRY OF DIVORCE DECREE
To:
_______________________________
(Plaintiff/Defendant)
_____________________________ (Plaintiff/Defendant) intends to file with the court the attached Praecipe
to Transmit Record on or after ______________, 20___ requesting that a final decree in divorce be entered.
_____________________________________
Attorney for Plaintiff/Defendant
(Note: Use this form when an attorney represents the Defendant)
Rev: 08/2006
8-35

DEPARTMENT OF HEALTH - VITAL RECORDS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH
VITAL RECORDS
105.157 REV. 6/02
COUNTY
DIVORCE
RECORD OF
OR
(CHECK ONE)
STATE FILE NUMBER
ANNULMENT
STATE FILE DATE
HUSBAND
1. Name
(First)
(Middle)
3. RESIDENCE
Street or R.D.
City, Born. Or Twp.
5. NUMBER OF THIS MARRIAGE
6. RACE
WHITE
2. Date of Birth
(Last)
County
State
(Month)
4. PLACE OF BIRTH
(Year)
(Day)
(State or Foreign Country)
7. USUAL OCCUPATION
BLACK
OTHER (Specify)
WIFE
8. MAIDEN Name
10. RESIDENCE
(First)
(Middle)
City, Boro. Or Twp.
Street or R.D.
12. NUMBER OF THIS MARRIAGE
15. PLACE OF THIS MARRIAGE
County
State
(State or Foreign County)
(County)
(Month)
(Day)
(Year)
9. Date of Birth
(Month)
11. PLACE OF BIRTH
(State or Foreign Country)
(Day)
(Year)
14. USUAL OCCUPATION
13. RACE
WHITE BLACK OTHER (Specify)
18. PLAINTIFF
17A. NUMBER OF
17 B. NUMBER OF
HUSBAND WIFE
DEPENDENT CHILDREN
CHILDREN THIS
UNDER 18
MARRIAGE
20. NUMBER OF CHILDREN TO CUSTODY OF
SPLIT CUSTODY
OTHER (Specify)
HUSBAND WIFE
22. DATE OF DECREE
(Last)
(Month)
16. DATE OF THIS MARRIAGE
OTHER (Specify)
(Year)
(Day)
19. DECREE GRANTED TO

HUSBAND WIFE
OTHER (Specify)
21. LEGAL GROUNDS FOR DIVORCE OR ANNULMENT
23. DATE REPORT SENT TO VITAL RECORDS
(Month)
(Day)
(Year)
24. SIGNATURE OF TRANSCRIBING CLERK
Rev: 08/2006
8-36

_______________________________
By:
_______________________________
Attorney I.D. _________________________
_______________________________
Attorney for ____________________

__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
__________________________________
__________________________________
Soc. Sec. No. ______________________
No. ____________________
ORDER TO SCHEDULE HEARING

AND NOW, this _____ day of ___________________, 20___ , the grounds for divorce having been
established, ________________________________________________.
IT IS ORDERED AND DECREED that the grounds for divorce are approved and the issuance of a divorce
decree is deferred.
A hearing is to be scheduled to resolve any claims of either party to equitable distribution of marital
property, alimony, counsel fees, costs and expenses, and related claims.
By the Court:
_____________________________
J.
Copy of the above Order
mailed to the following on:
_______________________________
Secretary
Rev: 08/2006
8-37

_______________________________
By:
_______________________________
Attorney I.D. _________________________
_______________________________
Attorney for ____________________

__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
__________________________________
__________________________________
Soc. Sec. No. ______________________
No. ____________________
DIVORCE DECREE
AND NOW, this ________ day of _____________________, 20____, IT IS DECREED that
______________________________ and _______________________________ are hereby DIVORCED FROM THE
BONDS OF MATRIMONY.
IT IS FURTHER ORDERED that:
____
The property settlement agreement between the parties, dated ________________ and attached
to this Decree is hereby incorporated by reference as though the same were set forth herein at length. Said
agreement shall not merge with, but shall survive, this Decree.
____
No other relief is granted.

By the Court:
______________________________
J.
Copy of the above Decree

_______________________________
Secretary
Rev: 08/2006
8-38

_______________________________
By:
_______________________________
Attorney I.D. _________________________
_______________________________
Attorney for ____________________

__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
__________________________________
__________________________________
Soc. Sec. No. ______________________
No. ____________________
PETITION FOR BIFURCATION

Petitioner, _______________________________________________, by and through his attorney,
____________________________________ , Esquire, files this Petition for Bifurcation and respectfully represents
in support thereof:
1.
Petitioner, Plaintiff in this action, currently resides at _______________________________.
2.
Respondent, Defendant in this action, currently resides at ______________________________.
3.
On or about _______________ Petitioner filed a Complaint in Divorce, averring therein that the
marriage is irretrievably broken. A true and correct copy of said Complaint is attached hereto, as Exhibit A.
4.
Respondent does not deny this averment.
5.
The Complaint in Divorce also averred that the parties have lived separate and apart for a period of
at least two years.
6.
The Respondent does not deny this averment.
7.
Respondent requested, in her Answer and Counterclaim, ancillary relief in the form of a claim for
equitable distribution, spousal support, alimony, alimony pendente lite and counsel fees, costs and expenses. A
true and correct copy of said Answer and Counterclaim is attached hereto as Exhibit B.
8.
On or about ______________, Petitioner filed his 3301(d) Affidavit. A true and correct copy of said
Affidavit is attached hereto as Exhibit C.
9.
On or about_____________, Plaintiff forwarded to Defendant a Notice of Intention to Request
Entry of Divorce Decree and a copy of the Praecipe to Transmit the Record. A true and correct copy of said Notice
and Request are collectively attached hereto as Exhibit D.
10.
On or about______________, Plaintiff filed a Praecipe to Transmit the Record. A true and correct
copy of said Praecipe is attached hereto as Exhibit E.
11.
Respondent is presently residing in the marital residence and Petitioner is continuing to make all
mortgage payments towards said residence.
Rev: 08/2006
8-39

12.
Because the divorce complaint is not at issue, and Respondents ancillary causes of action are
preserved by the pleadings, no prejudice will occur if the divorce is granted prior to the adjudication of those claims.
13.
Pursuant to the Divorce Code, 23 Pa. C.S.A. 3101 et seq., this Court is empowered to grant a
divorce and to reserve jurisdiction over the remaining ancillary issues.
WHEREFORE, Petitioner respectfully requests this Honorable Court:
(a)
order bifurcation of this action;
(b)
grant the requested divorce in the Complaint and Counterclaim; and
(c)
reserve jurisdiction over all other remaining ancillary issues before the court.
Respectfully submitted,
By: _____________________________
(Note: Since Montgomery County does not regurlaly grant a bifurcated case, add additional
paragraphs to pursuade the Court to grant your request for a bifurcated case).
Rev: 08/2006
8-40

_______________________________
By:
_______________________________
Attorney I.D. _______________________________
_______________________________
Attorney for ____________________

__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
__________________________________
__________________________________
Soc. Sec. No. ______________________
No. ____________________
BIFURCATED DIVORCE DECREE

AND NOW, this____ day of ______________________, 20__ , IT IS DECREED that
____________________________________and _________________________________are hereby DIVORCED
FROM THE BONDS OF MATRIMONY.
IT IS FURTHER ORDERED that this Court retains continuing jurisdiction to resolve the claims of either
party to equitable distribution, alimony, counsel fees, costs, expenses, or related claims which shall be listed for
hearing.
Any existing spousal support order shall hereafter be deemed an order for alimony pendente lite if any
economic claims remain pending.
By the Court:
__________________________________
J.
Copy of the above Decree
_______________________________
Secretary
Rev: 08/2006
8-41

_______________________________
By:
_______________________________
Attorney I.D. _______________________________
_______________________________
Attorney for ____________________

__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
__________________________________
__________________________________
Soc. Sec. No. ______________________
No. ____________________
NOTICE TO RETAKE PRIOR SURNAME

Notice is given that the ____ Plaintiff ____ Defendant, having been granted a Final Decree in Divorce on the____
day of___________________, 20___, elects to retake and use her prior surname, _______________________.
_____________________________
Signature (Married Name)
___________________________
Print (Married Name)
TO BE KNOWN AS:
_____________________________
Signature (Prior Surname)
___________________________
Print (Prior Surname)
Rev: 08/2006
8-42

__________________________________
__________________________________
v.
__________________________________
__________________________________
No. _________________________
MOTION FOR APPOINTMENT OF A MASTER IN DIVORCE

_____________________________________ , Plaintiff/Defendant, moves the Court to appoint a master with
respect to the following claims:
(__ ) Divorce
(__ ) Annulment
(__ ) Alimony
(__ ) Alimony Pendente Lite
(__ ) Distribution of Property
(__ ) Support
(__ ) Counsel Fees
(__ ) Costs and Expenses
and in support of the motion states:
1. Discovery (is) (is not) complete as to the claim(s) for which the appointment of a master is requested.
2. The (defendant) non-moving party (has) (has not) appeared in the action (personally) (by his attorney,
____________________________________, Esquire).
3. The statutory groud(s) for divorce (is) (are) _____________________________________________.
4. Delete the inapplicable paragraphs(s):
(a) The action is not contested
(b) An Agreement has been reached with respect to the following claims:
____________________________________________________________________________
5. The action (involves) (does not involve) complex issues of law or fact.
6. The hearing is expected to take __________________________(hours) (days).
7. Additional information, if any relevant to the motion:
___________________________________________________________________________________
Date: __________________________________
__________________________________________
Attorney for (Plaintiff)(Defendant)
ORDER APPOINTING MASTER

AND NOW, __________________20,_____, ______________________________, Esquire, is appointed master
with respect to the following claims: _______________________________________________________________
BY THE COURT:
________________________________
J.
Rev: 08/2006
8-43

MOVING PARTY
NON-MOVING PARTY
Name: ________________________________
Name: _________________________________
Attorneys Name: ________________________
Attorneys Name: _________________________
Attorneys Address: ______________________
Attorneys Address: ________________________
__________________________
_________________________________
Attorneys Telephone #: ___________________
Attorneys Telephone #: ____________________
Attorneys E-Mail: ________________________
Attorneys E-Mail: _________________________
Partys Address and Telephone # if

not represented by counsel:
Partys Address and Telephone # if

not represented by Counsel
______________________________________
_______________________________________
______________________________________
_______________________________________
Rev: 08/2006
8-44

_______________________________
By:
_______________________________
Attorney I.D. _______________________________
_______________________________
Attorney for ____________________

CIVIL ACTION - LAW
__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
__________________________________
__________________________________
Soc. Sec. No. ______________________
No. ____________________
INVENTORY
OF
_____________________________
(Plaintiff) (Defendant) files the following inventory of all property owned or possessed by either party at the
time this action was commenced and all property transferred within the preceding three (3) years.
(Plaintiff) (Defendant) verifies that the statements made in this inventory are true and correct. (Plaintiff)
(Defendant) understands that false statements herein are subject to the penalties of
18 Pa. C.S. 4904 relating to unsworn falsification to authorities.
_______________________________
(Plaintiff) (Defendant)
Rev: 08/2006
8-45

ASSETS OF PARTIES
(Plaintiff) (Defendant) marks on the list below those items applicable to the case at bar and itemizes the
assets on the following pages.
(__) 1.
Real Property
(__) 2.
Motor Vehicles
(__) 3.
Stocks, Bonds, Securities and Options
(__) 4.
Certificates of Deposit
(__) 5.
Checking Accounts, Cash
(__) 6.
Savings Accounts, Money Market and Savings Certificates
(__) 7.
Contents of Safe Deposit Box
(__) 8.
Trusts
(__) 9.
Life Insurance Policies (indicate face value, cash surrender value and current
beneficiaries)
(__) 10.
Annuities
(__) 11.
Gifts
(__) 12.
Inheritances
(__) 13.
Patents, Copyrights, Inventions, Royalties
(__) 14.
Personal Property Outside the Home
(__) 15.
Business (list all owners, including percentage of ownership and officer/director positions
held by a party with company)
(__) 16.
Employment Termination Benefits - Severance Pay, Workers Compensation Claim/Award
(__) 17.
Profit Sharing Plans
(__) 18.
Pension Plans (indicate employee contribution and date plan vests)
(__) 19.
Retirement Plans, Individual Retirement Accounts
(__) 20.
Disability Payments
(__) 21.
Litigation Claims (Mature and Unmatured)
(__) 22.
Military/V.A. Benefits
(__) 23.
Education Benefits
(__) 24.
Debts Due, including Loans, Mortgages Held
(__) 25.
Household Furnishings and Personalty (include as a total category and attach itemized
list if distribution of such assets is in dispute.)
(__) 26.
Other
Rev: 08/2006
8-46

MARITAL PROPERTY
(Plaintiff) (Defendant) lists all marital property in which either or both spouses have a legal or equitable interest
individually or with any other person as of the date this action was commenced:
Item
Number
Description
of Property
Names of
All Owners
_____________
________________________________
___________________________
_____________
________________________________
___________________________
_____________
________________________________
___________________________
_____________
________________________________
___________________________
_____________
________________________________
___________________________
_____________
________________________________
___________________________
_____________
________________________________
___________________________
_____________
________________________________
___________________________
_____________
________________________________
___________________________
_____________
________________________________
___________________________
_____________
________________________________
___________________________
_____________
________________________________
___________________________
_____________
________________________________
___________________________
_____________
________________________________
___________________________
_____________
________________________________
___________________________
_____________
________________________________
___________________________
_____________
_________________________________
___________________________
_____________
_________________________________
___________________________
_____________
_________________________________
___________________________
_____________
_________________________________
___________________________
Rev: 08/2006
8-47

NON-MARITAL PROPERTY
(Plaintiff) (Defendant) lists all property in which a spouse has a legal or equitable interest which is
claimed to be excluded from marital property:
Item
Number
Description
of Property
Reason for
Exclusion
_____________
_______________________________
___________________________
_____________
_______________________________
___________________________
_____________
_______________________________
___________________________
_____________
_______________________________
___________________________
_____________
_______________________________
___________________________
_____________
_______________________________
___________________________
_____________
_______________________________
___________________________
_____________
_______________________________
___________________________
_____________
_______________________________
___________________________
_____________
_______________________________
___________________________
_____________
_______________________________
___________________________
_____________
_______________________________
___________________________
_____________
_______________________________
___________________________
_____________
_______________________________
___________________________
_____________
_______________________________
___________________________
_____________
_______________________________
___________________________
_____________
_______________________________
___________________________
_____________
_______________________________
___________________________
_____________
_______________________________
___________________________
_____________
_______________________________
___________________________
Rev: 08/2006
8-48

PROPERTY TRANSFERRED
Description
of Property
_____________
______________ ______________ __________ _____________________
_____________
______________ ______________ __________ _____________________
_____________
______________ ______________ __________ _____________________
_____________
______________ ______________ __________ _____________________
_____________
______________ ______________ __________ _____________________
_____________
______________ ______________ __________ _____________________
_____________
______________ ______________ __________ _____________________
_____________
______________ ______________ __________ _____________________
_____________
______________ ______________ __________ _____________________
_____________
______________ ______________ __________ _____________________
_____________
______________ ______________ __________ _____________________
_____________
______________ ______________ __________ _____________________
_____________
______________ ______________ __________ _____________________
_____________
______________ ______________ __________ _____________________
_____________
______________ ______________ __________ _____________________
_____________
______________ ______________ __________ _____________________
_____________
______________ ______________ __________ _____________________
_____________
______________ ______________ __________ _____________________
Rev: 08/2006
Date of
Transfer
Consideration
Person
to Whom
Transferred
Item
Number
8-49

LIABILITIES
Item
Number
Description
of Property
__________
_______________________ ______________________ ______________________
__________
_______________________ _______________________ ______________________
__________
_______________________ _______________________ _____________________
__________
_______________________ _______________________ _____________________
__________
_______________________ _______________________ _____________________
__________
_______________________ _______________________ _____________________
__________
_______________________ _______________________ _____________________
__________
_______________________ _______________________ _____________________
__________
_______________________ _______________________ _____________________
__________
_______________________ _______________________ _____________________
__________
_______________________ _______________________ _____________________
__________
_______________________ _______________________ _____________________
__________
_______________________ _______________________ _____________________
__________
_______________________ _______________________ _____________________
__________
_______________________ _______________________ _____________________
__________
_______________________ _______________________ _____________________
__________
_______________________ _______________________ _____________________
__________
_______________________ _______________________ _____________________
__________
_______________________ _______________________ _____________________
__________
_______________________ _______________________ _____________________
__________
_______________________ _______________________ _____________________
__________
_______________________ _______________________ _____________________
__________
_______________________ _______________________ _____________________
Rev:
Names of
All Owners
Names of
All Debtors
8-50

Check List for Liabilities
Secured
(__)
1.
Mortgages
(__)
2.
Judgments
(__)
3.
Liens
(__)
4.
Other Secured Liabilities
Unsecured
(__)
5.
Credit Card Balances
(__)
6.
Purchasers
(__)
7.
Loan Payments
(__)
8.
Notes Payable
(__)
9.
Other Unsecured Liabilities
Contingent or Deferred
(__) 10.
Contracts or Agreements
(__) 11.
Promissory Notes
(__) 12.
Lawsuits
(__) 13.
Options
(__) 14.
Taxes
(__) 15.
Other Contingent or Deferred Liabilities
Rev:
8-51

_______________________________
By:
_______________________________
Attorney I.D. _________________________
_______________________________
Attorney for ____________________

CIVIL ACTION - LAW
__________________________________
__________________________________
Soc. Sec. No. ______________________
Docket No.____________________
PACES Case No. ______________
__________________________________
Other State ID No. ______________
__________________________________
Soc. Sec. No. ______________________
v.
COMPLAINT FOR SUPPORT

1.
Plaintiff resides at __________________________________________________________,

Street
City
Zip Code
____________________ County. Plaintiffs Social Security Number is __________________ and

date of birth is __________________.
2.
Defendant resides at ________________________________________________________,

Street
City
Zip Code
____________________ County. Defendants Social Security Number is ________________ and

date of birth is __________________.
3. (a)
Plaintiff and the Defendant were married on_____________________________ at
________________________________________.
Date
City and State
(b)
Plaintiff and the Defendant were separated on ___________________.

Date
(c)
Plaintiff and the Defendant were divorced on ____________________________ at
________________________________________.
Date
City and State
Rev: 08/2006
8-52

4.
Plaintiff and Defendant are the parents of the following child(ren):
(a)
Born of Marriage:
Name
Birth Date
____________________
__________
____________________
__________
____________________
__________
Age
_______
_______
_______
Residence
_______________________________
_______________________________
_______________________________
(b)
Born out of Wedlock:
Name
Birth Date
____________________
__________
____________________
__________
____________________
__________
Age
_______
_______
_______
Residence
_______________________________
_______________________________
_______________________________
5. Plaintiff seeks support for the following persons:

____________________
__________
_______
____________________
__________
_______
____________________
__________
_______
_______________________________
_______________________________
_______________________________
6.
(a)
Plaintiff ___(is) ____ (is not) receiving public assistance in the amount of $___________ per
________ for the support of _________________________________________.
(Name(s))
(b)
Plaintiff is receiving additional income in the amount of $ __________________ from
_____________________________________________.
(Name(s))
7.
A previous support order was entered against the defendant on ________________ in an action at
Date
___________________________________________________________________ in
the
amount
of
(Court, term and docket number)
$____________ for the support of _________________________________.
(Name(s))
There ___ (are) ___ (are no) arrearages in the amount of $ _____________. The order ____ (has) ____(has not)
been terminated.
8.
Plaintiff last received support from the Defendant in the amount of $ _______________ on ______________.
Date
WHEREFORE, Plaintiff requests that an order be entered against Defendant and in favor of the Plaintiff and
the aforementioned child(ren) for reasonable support and medical coverage.
I verify that the statements made in this Complaint are true and correct. I understand that false statements
_____________________________
Plaintiff
Guidelines for child and spousal support and alimony pendente lite have been prepared by the Court of
Common Pleas and are available for inspection in the office of Domestic Relations Section, Montgomery
County, One Montgomery Plaza, Norristown, PA 19401.
Rev: 08/2006
8-53

_______________________________
By:
_______________________________
Attorney I.D. _______________________________
_______________________________
Attorney for ____________________

__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
__________________________________
__________________________________
Soc. Sec. No. ______________________
No. ____________________
PETITION FOR MODIFICATION OF AN EXISTING SUPPORT ORDER

1.
The Petition of_________________________________________________ respectfully represents that on

______________________ ___,an Order of Court was entered for the support of
__________________________________________ . A true and correct copy of the order is attached to
this petition.
2.
Petitioner is entitled to _________________________________________* of this Order because of the

following material and substantial change(s) in circumstance:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
*
Fill in the relief sought, e.g. increase, decrease, modification, termination, suspension, vacation.
WHEREFORE, Petitioner requests that the Court modify the existing order for support.
________________________________
(Attorney for Petitioner)
I verify that the statements made in this complaint are true and correct. I understand that false statements
herein are made subject to the penalties of 18 Pa. C.S.A. 4904 relating to unsworn falsification to authorities.
_________________________
Date
Rev: 08/2006
________________________________
Petitioner
8-54

CIVIL ACTION - LAW
__________________________________
__________________________________
v.
___________________________________
___________________________________
No. ____________________
ORDER OF COURT (SUPPORT HEARING)

You, _____________________________, Defendant, are ordered to appear in person at the Domestic Relations
Office, One Montgomery Plaza, First Floor, Swede and Airy Streets, Norristown, Pennsylvania, on
__________________ at _____ .M. for a conference/hearing after which the conference officer may recommend
that an order for support be entered against you.
BOTH PARTIES ARE ORDERED TO BRING TO THE CONFERENCE AN ORIGINAL AND TWO COPIES OF
THE FOLLOWING:
(1) A true copy of your most recent Federal Income Tax Return, INCLUDING W-2s, as filed;
(2) Your pay stubs for the preceding six months;
(3) Completed History Sheet & the Income and Expense Statement attached to this order, completed as
required by Rule 1910.11(c);
(4) Verification of child care expenses;
(5) Proof of medical coverage which you may have, or may have available to you;
(6) Students written consent and verification of the following; enrollment, all educational expenses and
receipt or denial of grants, loans and scholarships if requesting secondary education expenses;
(7) Doctors report if your ability to work is impaired; and
(8) Drivers License, Social Security Card, and the childrens Social Security Numbers.
IF YOU FAIL TO APPEAR OR TO BRING THE REQUIRED DOCUMENTS, THE COURT MAY
ISSUE A WARRANT FOR YOUR ARREST.
Date of Order: ____________
______________________________
GARY KLINE, DIRECTOR,
DOMESTIC RELATIONS SECTION
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR
TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING
A LAWYER.
IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION
ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR AT NO FEE.
100 West Airy Street, Norristown, PA. 19401
(610) 279-9660, X201
TOLL FREE (800) 560-LAW1 (5291)
AMERICANS WITH DISABILITIES ACT OF 1990

The Court of Common Pleas of Montgomery County is required by law to comply with the Americans with Disabilities Act of 1990. For
information about accessible facilities and reasonable accommodations available to disabled individuals having business before the court,
please contact our office at 610-278-3891. All arrangements must be made at least 72 hours prior to any hearing or business before the
court. You must attend the scheduled conference or hearing.
If you have questions regarding the attached order, please contact the Domestic Relations Office at 610-278-3646. Please appear for the
conference 15 minutes before scheduled time.
Rev: 08/2006
8-55

MONTGOMERY COUNTY DOMESTIC RELATIONS SECTION
SUITE 102 ONE MONTGOMERY PLAZA NORRISTOWN, PA 19401
HISTORY / FACE SHEET (SUPPORT)

NOTE: INFORMATION TO BE COMPLETED BY __ DEFENDANT OR __ PLAINTIFF (Check One)
Date:___________________
Case No:
_____________________
Docket No:_______________
Name:
______________________________
Confidential
Address:
______________________________
Yes __ No__
Telephone Number(s) Home: ________________
Business: _________________
Social Security Number:
__________________________
Date of Birth:_______________________ Glasses Yes __ No __
Race ___________
Height ___
Weight ____ Hair ___ Eyes ___ Sex M __ F___
Date of Marriage: ________________Place of Marriage: ___________________________
Date of Divorce: ________________Date of Separation: __________________________
Gross
Net Amount
Employer:________________________________
Wage Per Hr
________ __________
Address: _________________________________
Per Wk
________ __________
________________________________
Per Mo
________ __________
Per Annum
________ __________
Occupation: ___________________________________
Receiving Unemployment Compensation? Yes____ No____ How Much?_________________
Other Source of Income: ____________________________________
Parents Name:________________________ Mothers Maiden Name:___________________
Parents Address: ____________________________________
DEPENDENT INFORMATION
Names of Children
(Last, First, M.I.)
___________________________
___________________________
___________________________
___________________________
Sex
___
___
___
___
Date of
Birth
___________
___________
___________
___________
Race
__________
__________
__________
__________
Soc. Sec.
Numbers
____________________
____________________
____________________
____________________
HEALTH INSURANCE INFORMATION

Name & Address of Insurance Carrier:
Policy No:
_____________________________________ ___________________________________
_____________________________________
Insurance Codes/ Group Number: _________________________
Beginning Coverage Date:__________________ End Coverage Date: __________________
Attorneys Name: __________________________________ ID#_______________________
Rev: 08/2006
8-56

MONTGOMERY COUNTY DOMESTIC RELATIONS SECTION
THIS FORM MUST BE FILLED OUT
(If you are self-employed or if you are salaried by a business of which you are owner in whole or in part, you must also
fill out the Supplemental Income Statement which appears on the last page of this Income and Expense Statement.)
Docket #_____________
INCOME AND EXPENSE STATEMENT (SUPPORT)

Case # ______________
INCOME
Employer:
_______________________________________
Address:
_______________________________________
Type of Work:
_______________________________________
Payroll Number: _______________________________________
Pay Period (Weekly, Biweekly, etc.): __________________
Gross Pay per Pay Period:
Itemized Payroll Deductions:
Federal Withholding
Social Security
Local Wage Tax
State Income Tax
Retirement
Savings Bonds
Credit Union
Life Insurance
Health Insurance
Other (specify)
___________________________________
___________________________________
Net Pay per Pay Period:
$_____________
$_____________
______________
______________
______________
______________
______________
______________
______________
______________
______________
______________
______________
$_____________
Other Income:
Week
Interest
Dividends
Pension
Annuity
Social Security
Rents
Royalties
Expense Account
Gifts
Unemployment Comp.
Workers Comp.
_____________________________
_____________________________
Total
Month
Year
(Fill in appropriate column)
$__________
$__________
$________
__________
__________
________
__________
__________
________
__________
__________
________
__________
__________
________
__________
__________
________
__________
__________
________
__________
__________
________
__________
__________
________
__________
__________
________
__________
__________
________
__________
__________
________
__________
__________
________
$__________
$__________
$________
TOTAL INCOME
Weekly
EXPENSES (Fill in appropriate column)
Home
Mortgage/Rent
Maintenance
Utilities
Electric
Gas
Oil
Telephone
Water
Sewer
Employment
Public Transportation
Lunch
Rev: 08/2006
$ ______________
Monthly
Yearly
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
________
________
________
________
________
________
________
________
________
$__________
__________
$__________
__________
$________
________
8-57

EXPENSES (Fill in appropriate column)
Weekly
Monthly
Yearly
$__________
__________
__________
$__________
__________
__________
$________
________
________
$__________
__________
__________
__________
__________
__________
$__________
__________
__________
__________
__________
__________
$________
________
________
________
________
________
$__________
__________
__________
$__________
__________
__________
$________
________
________
$__________
__________
__________
__________
__________
__________
$__________
__________
__________
__________
__________
__________
$________
________
________
________
________
________
$__________
__________
__________
__________
$__________
__________
__________
__________
$________
________
________
________
$__________
__________
__________
__________
__________
__________
$__________
__________
__________
__________
__________
__________
__________
$________
________
________
________
________
________
________
$__________
__________
__________
$__________
__________
__________
$________
________
________
Taxes
Real Estate
Personal Property
Income
Insurance
Homeowners
Automobile
Life
Accident
Health
Other
Automobile
Payments
Fuel
Repairs
Medical
Doctor
Dentist
Orthodontist
Hospital
Medicine
Special needs (glasses, braces, orthopedic devices)
Education
Private School
Parochial School
College
Religious
Personal
Clothing
Food
Barber/Hairdresser
Credit payments
Credit Card
Charge Accounts
Memberships
Loans
Credit Union
___________________
___________________
Miscellaneous
Household Help
Papers/Books/Magazines
Entertainment
Pay TV
Vacation
Gifts
Legal Fees
Charitable Contributions
Other Child Support
Alimony Payments
Other
___________________
___________________
$__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
$__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
$________
________
________
________
________
________
________
________
________
________
$__________
__________
$__________
__________
$________
________
TOTAL EXPENSES
$ __________
$__________
$________
Rev: 08/2006
8-58

PROPERTY OWNED
Checking Accounts
Savings Accounts
Credit Union
Stocks/Bonds
Real Estate
Other
TOTAL
Description
Value
__________________________ $ __________
__________________________
__________
__________________________
__________
__________________________
__________
__________________________
__________
__________________________
__________
$__________
Ownership
H
W
__
__
__
__
__
__
__
__
__
__
__
__
Policy
Coverage
INSURANCE
Company
No.
H
W
Hospital
Blue Cross
__________________________ ___________
__
__
Other
__________________________ ___________
__
__
Medical
Blue Shield
__________________________ ___________
__
__
Other
__________________________ ___________
__
__
Health/Accident
__________________________ ___________
__
__
Disability Income
__________________________ ___________
__
__
Dental
__________________________ ___________
__
__
Other
__________________________ ___________
__
__
_____________________________________________________________________
* H=Husband, W=Wife, J=Joint, C=Child
J
__
__
__
__
__
__
C
__
__
__
__
__
__
__
__
SUPPLEMENTAL INCOME STATEMENT

a)This form is to be filled out by a person (check one):
___ (1)
who operates a business or practices a profession, or
___ (2)
who is a member of a partnership or joint venture, or
___ (3)
who is a shareholder in and is salaried by a closed corporation or similar entity.
b)
Attach to this statement a copy of the following documents relating to the partnership, joint venture, business
profession, corporation or similar entity:
(1)
the most recent Federal Income Tax Return, and
(2)
the most recent Profit and Loss Statement.
c)
Name of Business:
________________________________________
Telephone Number:
________________________________________
d)
___
___
___
___
___
Nature
(check
(1)
(2)
(3)
(4)
(5)
of Business
one)
Partnership
Joint Venture
Profession
Closed Corporation
Other
(1)
e)
Name of Accountant, Controller or other person in charge of financial records:
f)
Annual income from business:
_________________________
g)
How often is income received?
_________________________
h)
Gross income per pay period:
_________________________
i)
Net income per pay period:
_________________________
j)
Specified deductions, if any:
________________________
I verify that the statements made in this Income and Expense Statement are true and correct. I understand that false
statements herein are made subject to the penalties of Pa. C.S. 4904 relating to unsworn falsification to authorities.
Date: _____________________
Rev: 08/2006
___________________________________
Signature of Plaintiff or Defendant
8-59

COURT OF COMMON PLEAS, MONTGOMERY COUNTY, PENNSYLVANIA
DOMESTIC RELATIONS OFFICE
APPLICATION FOR CONTINUANCE
Case Caption:
______________________________________
______ Conciliation Conference
______________________________________
______ Enforcement
______________________________________
______ Other
Case No: ____________________
Reason for Continuance:

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Continuance Requested by:
______ Plaintiffs Attorney
______ Court
______ Defendants Attorney
______ Other
______ We the undersigned, do hereby request the Court to grant a continuance in the above referenced case and
do hereby agree to the new date.
______ This continuance is opposed by ______ Plaintiffs ______ Defendants Attorney
_______________________________________
/ /
_____________________________
_______________________________________
/ /
_____________________________
Print Name
Date
Signature
The Domestic Relations Office recommends

_______ Approval ________ Disapproval of this application because:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Application for Continuance is ______ Approved _______ Disapproved
______________________________________
Judge
__________________
Date
NOTE: THIS FORM IS TO BE FILED IN OR FAXED (610-239-9637 OR 610-278-3959) TO THE DOMESTIC

RELATIONS OFFICE NOT LESS THAN 48 HOURS IN ADVANCE OF THE SCHEDULED HEARING UNLESS
WAIVED BY DRO OR THE COURT.
Rev: 08/2006
8-60

_______________________________
By:
_______________________________
Attorney I.D. _______________________________
_______________________________
Attorney for ____________________

CIVIL ACTION - LAW
__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
__________________________________
__________________________________
Soc. Sec. No. ______________________
No. ____________________
COMPLAINT FOR CUSTODY, PARTIAL CUSTODY AND VISITATION

1.
Plaintiff is____________________________________________________, residing at
___________________________________________________________.
2.
Defendant is________________________________________________, residing at
___________________________________________________________.
3.
Plaintiff seeks ____ custody ____ partial custody ____ visitation of the following
child(ren):
Name
Present Residence
Age
_________________________ ______________________________________________ ____
_________________________ ______________________________________________ ____
_________________________ ______________________________________________ ____
4.
5.
The child(ren) ____ was/were _____was/were not born out of wedlock.

The child(ren) is/are presently in the custody of________________________________________,
who resides at ___________________________________________________.
6.
During the past five years, the child(ren) has/have resided with the following persons and at the
following addresses:
List All Names
List All Addresses
Dates
_________________________ ____________________________________
___________
_________________________ ____________________________________
___________
_________________________ ___________________________________
___________
7.
Rev: 08/2006
The mother of the child(ren) is _______________________________________, currently residing

at
_______________________________________________________. She is ___
married____ divorced ____ single.
8-61

8.
The father of the child(ren) is ________________________________________ , currently residing
at_________________________________________________________. He is ____ married ____
divorced ____ single.
9.
The relationship of Plaintiff to the child(ren) is that of __________ . The Plaintiff currently resides
with the following persons:
Names
Relationship
_________________________ __________________________________
_________________________ __________________________________
_________________________ __________________________________
10.
The relationship of Defendant to the child(ren) is that of ______________________ .
The Defendant currently resides with the following persons:
Name
Present Residence
_________________________ __________________________________
_________________________ __________________________________
_________________________ __________________________________
11.
Plaintiff ___ has ____ has not participated as a party or witness, or in another capacity, in other
litigation concerning the custody of the child(ren) in this or another court. The court, term and number, and its
relationship to this action is________________________________________.
12.
Plaintiff ___ has ____ has no information of a custody proceeding concerning the child(ren) pending
in a court of this Commonwealth. The court, term and number, and its relationship to this action is
_______________________________________ .
13.
Plaintiff____ knows ____ does not know of a person not a party to the proceedings who has
physical custody of the child(ren) and claims to have custody or visitation rights with respect to the child(ren).
The name and address of such person is __________________________________.
14.
The best interest and permanent welfare of the child(ren) will be served by granting the relief
requested because ________________________________.
15.
Each parent whose parental rights to the child(ren) have not been terminated and the person who
has physical custody of the child(ren) have been named as parties to this action. All other persons, named
below, who are known to have or claim a right to custody or visitation of the child(ren) have been given notice of
the pendency of this action and the right to intervene:
Name
Address
Basis of Claim
_________________________ ______________________________________________ _____________
_________________________ ______________________________________________ _____________
_________________________ ______________________________________________ _____________
WHEREFORE, Plaintiff requests that this Honorable Court grant physical and legal custody of the child(ren)
to Plaintiff.
______________________________
VERIFICATION
I,______________________________, Plaintiff, do hereby verify that the statements made in the foregoing
Complaint for Custody are true and correct to the best of my knowledge, information and belief and that these
statements are made subject to the penalties of 18 Pa. C.S.A. 4904 relating to unsworn falsification to authorities.
Rev: 08/2006
8-62

Montgomery County
Domestic Relations
Montgomery County
Domestic Relations
P.O. Box 311
Norristown, PA 19404
Phone: 610-278-3646
Fax: 610-239-9637
UN-REIMBURSED EXPENSE
PROCEDURES
Domestic Relations Enforcement Unit
Un-Reimbursed Expense Instruction Sheet
This instruction sheet details what steps must be taken prior to the Enforcement Conference scheduling. The
outlined process must be followed by both plaintiff and/or defendant, whichever party is requesting enforcement.
Points to specifically note:
1)
2)
3)
4)
Expenses must be a condition of an order filed in Domestic Relations.

Copies of expense bills, documentation of insurance reimbursement & proof of payment
must be sent to the opposite party certified mail with 30 days elapsed for payment
arrangements.
What enforcement requests must have:
Copies of expense bills; copies of payment; proof of certified mail; copies of insurance
reimbursement statements; completed summary sheets in organized manner.
What enforcement requests should have to expedite conference:
Documentation that first annual $250.00 per person covered under order has been paid
by plaintiff prior to enforcement.
3 copies of all paperwork submitted.
Please note that no expenses older than 24 months will be enforced.
REQUEST FOR TELEPHONE CONFERENCE

Both parties are required to attend un-reimbursed expense or conditions conferences. These conferences are
scheduled as needed one daily at 1:30 P.M. Monday thru Thursday. This time allows officers more freedom to
investigate bills and guide parties to agreeable resolution for all.
If petitioning party lives more than 100 miles from Montgomery County Domestic Relations, then a Request for
Telephone Conference will be provided. If the petitioning party does not appear and does not request a phone
conference, then the conference will be continued one time only. If no appearance at the second conference, then
those particular bills will be dismissed and not addressed in Domestic Relations again.
If the party in contempt does not appear, Judge Daniele has approved 2 options:
1)
2)
Rev: 08/2006
Officer will review bills and decide if all bills appropriate. Party in contempt will have
their portion added to the arrears balance by administrative order. Both parties will be
given or sent copy of that order with 10 days to appeal. Appeals will be heard first in
Domestic Relations and then will be referred to the courts.
Officer will review bills and decide if all bills appropriate. Matter will be forwarded to
8-63

contempt court with recommendation that portion be added to arrears balance or offset
from arrears balance.
DOMESTIC RELATIONS RULES SHEETS
Revised Rules Sheets pending approval

Please note section with Rules for both parties, specifically numbers 12 and 13 generally explaining un-reimbursed
expense procedures.
THE CONFERENCE
Please be aware that any amount due for un-reimbursed expenses will be offset from
balance due or credit in place on case arrears. Note that this action is contingent on
whichever party is in contempt.
Please be aware that cases which may need to be sent to court will be sent on dates
with accommodation to both parties and attorneys schedules.
There is a $50.00 contempt petition fee. This fee will be assessed upon determination
of contempt.
If an attorney chooses to represent client without their presence, knowledge of the bills
and issues is required. Also, the attorney should be aware that they will be expected to
sign any order entered on behalf of their client.
Rev: 08/2006
8-64

_______________________________
By:
_______________________________
Attorney I.D. _________________________
_______________________________
Attorney for ____________________

CIVIL ACTION - LAW
__________________________________
__________________________________
v.
__________________________________
__________________________________
No. ____________________
PETITION TO MODIFY (CUSTODY) (VISITATION) ORDER

1.
The Petitioner is _____________________________________________________________________,

residing at __________________________________________________________________________
___________________________________________________________________________________.
2.
The Respondent is ___________________________________________________________________,

residing at __________________________________________________________________________
___________________________________________________________________________________.
3.
Petitioner and Respondent are the natural parents of:

Name of Child
4.
Date of Birth
Present Residence
________________________________
__________________
______________________________
________________________________
__________________
______________________________
________________________________
__________________
______________________________
________________________________
__________________
______________________________
A custody Order was entered on ______________in the Montgomery County Court of Common Pleas.
A copy of the Order is attached.
Rev: 08/2006
8-65

5. Petitioner now seeks to modify the Order because:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Wherefore, Petitioner respectfully requests that this Honorable Court modify the present (custody) (visitation)
Order.
Date: _____________________________________
Respectfully Submitted:
_____________________________________
_____________________________________
Petitioner
_____________________________________
Address
_____________________________________
I verify that the statements made in this Petition are true and correct as to my personal knowledge, information,
and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. 4904,
relating to unsworn falsification to authorities.
Date: _____________________________________
Rev: 08/2006
_____________________________________
Petitioner
8-66

_______________________________
By:
_______________________________
Attorney I.D. _______________________________
_______________________________
Attorney for ____________________

CIVIL ACTION - LAW
__________________________________
__________________________________
v.
__________________________________
__________________________________
No. ____________________
AGREEMENT FOR CUSTODY

The parties hereto, _______________________________________________ (hereinafter referred to as Mother)
and ______________________________________ (hereinafter referred to as Father), hereby stipulate and agree
that:
1.
The parties are the natural parents of one (1) child(ren):_________________________, born
____________________,20__.
2.
The parties shall have shared legal custody of their son/daughter,__________________.
____ Mother ____ Father shall have primary physical custody of _______________________, and
3.
____ Mother ____ Father shall have partial physical custody of _____________________ , as
may be mutually arranged by Father and Mother. The parties will cooperate in transporting and delivering the child
to and from residence.
4.
The parties agree that Mother shall have Mothers Day with _________________ and Father shall
have Fathers Day with_______________________ . The parties agree to alternate custody of the child/children on
all major secular and religious holidays.
5.
Each party shall have a minimum of two (2) weeks vacation with ___________________ and shall
provide the other party with thirty (30) days notice.
6.
Any modification of the above terms of shared custody may be provided from time to time with
mutual consent of the parties. The parties agree that they are to use intelligence and reason to work out whatever
difficulties which may arise with respect to shared custody. Neither party shall attempt to alienate the affections of
the child and that the best interest of the child will always be the first consideration when the terms of shared
custody are being discussed and considered.
7.
The parties agree that they shall discuss any of the major decisions regarding the health, welfare,
education, religious training and upbringing of the child/children with a view toward obtaining and following a harmonious
plan in the childs/childrens best interest. The parties further agree that the personal lives of the parents are not to
be discussed with or in front of the child.
Rev: 08/2006
8-67

IN WITNESS WHEREOF, intending to be legally bound hereby, the parties have set their hands and seals.
Witnesses:
______________________________
(Witness)
______________________________
(Mother)
______________________________
(Witness)
______________________________
(Father)
Approved by: _______________________________

Custody Conciliator
ORDER
AND NOW, this_____ day of ___________________ , 20___ , the foregoing Stipulation of the parties as to
Custody is made an Order of this Court.
By the Court:
______________________________
J.
Rev: 08/2006
8-68

_______________________________
By:
_______________________________
Attorney I.D. _________________________
_______________________________
Attorney for ____________________

CIVIL ACTION - LAW
__________________________________
__________________________________
v.
__________________________________
__________________________________
No. ____________________
PROTECTION FROM ABUSE (HEARING NOTICE)

Filing Fee
____ Paid
____ I am requesting that the filing fee and costs be waived at the present time. I understand that
the Court will determine which party will pay the filing fee and costs.
NOTICE OF HEARING AND ORDER
YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the
following pages, you must appear at the hearing scheduled herein. If you fail to do so, the case may
proceed against you and a FINAL Order may be entered against you granting the relief requested in the
Petition. In particular, you may be evicted from your residence and lose other important rights.
A hearing on the matter is scheduled for the ____ day of_____________, 20___ at____.m. in
Courtroom ___ at the Courthouse, Norristown, Pennsylvania.
You MUST obey the Order that is attached until it is modified or terminated by the Court after
notice and hearing. If you disobey this Order, the police may arrest you. Violation of this Order may
subject you to a charge of indirect criminal contempt, which is punishable by a fine of up to $1,000.00
and/or up to six months in jail under 23 Pa.C.S. 6114. Violation may also subject you to prosecution
and criminal penalties under the Pennsylvania Crimes Code. Under federal law, 18 U.S.C. 2265, this
Order is enforceable anywhere in the United States, tribal lands, U.S. Territories and the Commonwealth
of Puerto Rico. If you travel outside of the state and intentionally violate this Order, you may be subject
to federal criminal proceedings under the Violence Against Women Act, 18 U.S.C. 2261 - 2262.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR
TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING
A LAWYER.
IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION
ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR AT NO FEE.
100 West Airy Street, Norristown, PA. 19401
(610) 279-9660, X201
Rev: 08/2006
8-69

_______________________________
By:
_______________________________
Attorney I.D. _______________________________
_______________________________
Attorney for ____________________

CIVIL ACTION - LAW
__________________________________
__________________________________
v.
__________________________________
__________________________________
No. ____________________
PETITION FOR PROTECTION FROM ABUSE

1.
Plaintiffs name is _____________________________________
2.
I am filing this Petition on behalf of:

___ Myself and/or ____ Another Person
If you have checked myself, please answer all questions referring to yourself as Plaintiff. If you checked
Another Person, please answer all questions referring to that person as the Plaintiff and provide your address
here, unless confidential:
__________________________________________________________________________________________
If you checked Another Person, also indicate your relationship with Plaintiff:
___
___
___
___
3.
Parent of minor Plaintiff(s)

Parent for appointment as guardian ad litem of minor Plaintiff(s)
Adult household member with minor Plaintiff(s)
Court-appointed guardian of incompetent Plaintiff(s)
Name(s) of ALL person(s), including Plaintiff and minor children, who seek protection from abuse:
Person 1. (seeking protection from abuse)
Name: __________________________________________________________________________
______ This is a child of BOTH the Plaintiff and the Defendant.
______ This is a minor child living with the Plaintiff, but whose parents are NOT BOTH the Plaintiff and
Defendant.
______ Neither of the above
______ This is a minor child, and the Plaintiff is requesting custody.
Name: __________________________________________________________________________
Defendant.
Rev: 08/2006
8-70

Name: __________________________________________________________________________
Defendant.
Name: __________________________________________________________________________
Defendant.
4.
Plaintiffs Address
______ Plaintiffs address is confidential or
______ Plaintiffs address is: _____________________________________________________________
5.
Defendants information:
Name: ________________________________________________
_____ Defendants address is unknown, or
_____ Defendant is believed to live at the following address:
______________________________________________________________________________
______________________________________________________________________________
Defendants Social Security Number (if known) is:__________________
Defendants date of birth is: ____________________________________
Defendants place of employment is:_______________________________________________________
_____ Check here if the Defendant is 17 years old or younger.
6.
Indicate the relationship between Plaintiff and Defendant: __________________

_____
_____
_____
_____
_____
_____
7.
Spouse ___ Ex-spouse

Current or former sexual/intimate partner
Parent/Child ____ Brother/Sister
Parents of the same child/ren
Persons who live or have lived like spouses
Other relationship by blood or marriage:
Have Plaintiff and Defendant been involved or are you currently involved, in any of the following court actions?
____ Divorce ____ Custody ____ Support ____ Protection from Abuse
If you checked any of the above, briefly indicate when and where the case was filed and the case number, if
known:
__________________________________________________________________________________________
__________________________________________________________________________________________
Rev: 08/2006
8-71

8.
Has the Defendant been involved in any criminal court action? ____
If you answered YES, is the Defendant currently on probation? ____
If you answered YES, is it County and/or State probation/parole:
______ County probation/parole. List counties/states of probation/parole:
_______________________________________________________
______ State probation/parole. List states of probation/parole:
_______________________________________________________
9.
Plaintiff and Defendant are the parents of the following child/ren:
10.
Name
Age
Residence (list address unless confidential)
_______________________
_______________________
_______________________
_______________________
__________
__________
__________
__________
___________________________________
___________________________________
___________________________________
___________________________________
If Plaintiff and Defendant are parents of any minor child/ren together, is there an existing Court
Order regarding Custody? ____
If you answered Yes, describe the terms of the Order (e.g. primary, shared, legal and/or physical
custody):
___________________________________________________________________________________
___________________________________________________________________________________
If you answered Yes, in what county and state was the Order issued?__________________
If you are now seeking an Order of child custody as part of this petition, list the following information:
(a)
Where has each child resided during the past five years?
____________________ _________________________________ ______________________
Childs Name
Person(s) lived with
When this child lived there
_______________________________________________________________________________
Address (unless confidential)
____________________ _________________________________ ______________________
Childs Name
_______________________________________________________________________________
____________________ _________________________________ ______________________
Childs Name
_______________________________________________________________________________
____________________ _________________________________ ______________________
Childs Name
_______________________________________________________________________________
(b)
List any other persons who are known to have or claim a right to custody of each child
listed above.
Name
Address
Basis of Claim
____________________ ______________________________________ ______________
____________________ ______________________________________ ______________
____________________ ______________________________________ ______________
Rev: 08/2006
8-72

11.
The following other minor child/ren presently live with Plaintiff:
Name
__________________________
__________________________
__________________________
__________________________
12.
Age
____
____
____
____
Plaintiffs relationship to child/ren

___________________________________________
___________________________________________
___________________________________________
___________________________________________
The facts of the most recent incident of abuse are as follows:
Approximate Date:_________________________ Approximate Time: ___________________

Place: _______________________________
Describe in detail what happened, including any physical or sexual abuse, threat, injury, incidents of stalking,
medical treatment sought and/or calls to law enforcement (attach additional sheets of paper if necessary):
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
13. If the Defendant has committed prior acts of abuse against Plaintiff or the minor child/ren, describe these
prior incidents, including any threats, injuries or incidents of stalking, and indicate approximately when such acts
of abuse occurred (attach additional sheets of paper if necessary):
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
14. List the weapon(s) that the Defendant has used or threatened to use against Plaintiff or the minor child/ren:
Weapon:
Description of the Weapon:
___________________________________________ ____________________________________________
___________________________________________ ____________________________________________
___________________________________________ ____________________________________________
15. Identify the police department or law enforcement agency in the area in which Plaintiff lives that should be
provided with a copy of the protection order:
__________________________________________________________________________________________
16.
Is there an immediate and present danger of further abuse from the Defendant?
____ Yes
Rev: 08/2006
____ No
8-73

CHECK THE FOLLOWING BOXES ONLY IF THEY APPLY TO YOUR CASE AND PROVIDE THE
REQUESTED INFORMATION
___ Plaintiff is asking the Court to evict and exclude the Defendant from the following residence:
_____________________________________________________________________________
___
owned by (list owners, if known): ______________________________________________
___
rented by (list all names, if known): ____________________________________________
___ Defendant owes a duty of support Plaintiff and/or the minor child/ren.
___ Plaintiff has suffered out-of-pocket financial losses as a result of the abuse described above.
___ These losses are: _____________________________________________________________________
____________________________________________________________________________________
FOR THE REASONS SET FORTH ABOVE, I REQUEST THAT THE COURT ENTER A TEMPORARY
ORDER, AFTER HEARING, A FINAL ORDER THAT WOULD DO THE FOLLOWING (CHECK ALL FORMS OF
RELIEF REQUESTED):
___ A.
Restrain Defendant from abusing, threatening or harassing Plaintiff and/or minor child/ren in any
place where Plaintiff may be found.
___ B.
Evict/exclude Defendant from Plaintiffs residence and prohibit Defendant from attempting to enter
any temporary or permanent residence of the Plaintiff.
___ C.
Require Defendant to provide Plaintiff and/or minor child/ren with other suitable housing.
___ D.
Award Plaintiff temporary custody of the minor child/ren and place the following restrictions on
contact between Defendant and the child/ren:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
___ E.
Prohibit Defendant from having any contact with Plaintiff and/or the minor child/ren in person, by
telephone, or in writing, personally or through third persons, including but not limited to any contact
at Plaintiffs school, business, or place of employment except as the Court may find necessary
with respect to partial custody and/or visitation with the minor child/ren.
___ F.
Prohibit Defendant from having any contact with Plaintiffs relatives and Plaintiffs child/ren listed in
this Petition except as the Court may find necessary with respect to partial custody and/or
visitation with the minor child/ren.
___ G.
Order Defendant to temporarily turn over weapons to the Sheriff of this County and prohibit Defendant
from transferring, acquiring or possessing any such weapons for the duration of the Order.
___ H.
Order Defendant to pay temporary support for Plaintiff and/or the minor child/ren, including medical
support and ______ payment of the rent or mortgage on the residence.
___ I.
Direct Defendant to pay Plaintiff for the reasonable financial losses suffered as the result of the
abuse to be determined at the hearing.
___ J.
Order Defendant to pay the costs of this action, including filing and service fees.
___ K.
Order Defendant to pay Plaintiffs reasonable attorney fees.
Rev: 08/2006
8-74

___ L.
Order the following additional relief, not listed above:

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
___ M.
Grant such other relief as the Court deems appropriate.
___ N.
Order the police or other law enforcement agency to serve Defendant with a copy of this Petition,
any Order issued and the Order for Hearing. The Petitioner will inform the designated authority of
any addresses, other than Defendants residence, where Defendant can be served.
VERIFICATION
I verify that I am the Petitioner as designated in the present action and that the facts and statements
contained in the above petition are true and correct to the best of my knowledge. I understand that false statements
______________________________
Signature
__________________________
Date
Rev: 08/2006
8-75

_______________________________
By:
_______________________________
Attorney I.D. _________________________
_______________________________
Attorney for ____________________

CIVIL ACTION - LAW
__________________________________
__________________________________
Soc. Sec. No. ______________________
v.
__________________________________
__________________________________
Soc. Sec. No. ______________________
No. ____________________
TEMPORARY PROTECTION FROM ABUSE ORDER

Defendants Name: __________________________________________
Defendants Date of Birth:_____________________________________
Defendants Social Security Number:____________________________
Names of ALL Protected Persons, including Plaintiff and minor child/ren:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
AND NOW, this ______ day of _______________, 20__, upon consideration of the attached Petition for
Protection from Abuse, the Court hereby enters the following Temporary Order:
___ 1.
Defendant shall not abuse, harass or threaten any of the above persons in any place
where they might be found.
___ 2.
Defendant is evicted and excluded from the residence at:

___________________________________________________________________
___________________________________________________________________
or any other permanent or temporary residence where Plaintiff may live. Plaintiff is granted exclusive
possession of the residence. Defendant shall have no right or privilege to enter or be present on
the premises.
Rev: 08/2006
8-76

___ 3.
Except for such contact with the minor child/ren as may be permitted under Paragraph
5 of this Order, Defendant is prohibited from having ANY CONTACT with Plaintiff at
any location, including but not limited to any contact at Plaintiffs school, business, or
place of employment. Defendant is specifically ordered to stay away from the following
locations for the duration of this Order:
___________________________________________________________________
___________________________________________________________________
___ 4.
Except for such contact with the minor child/ren as may be permitted under Paragraph
5 of this Order, Defendant shall not contact Plaintiff by telephone or by any other means,
including through third persons.
___ 5.
Pending the outcome of the final hearing in this matter, Plaintiff is awarded temporary
custody of the following minor child/ren:
___________________________________________________________________
___________________________________________________________________
Until the final hearing, all contact between Defendant and the child/ren shall be limited to the following:
___________________________________________________________________
___________________________________________________________________
The local law enforcement agency in the jurisdiction where the child/ren are located shall ensure
that the child/ren are placed in the care and control of the Plaintiff in accordance with the terms of
this Order.
___ 6.
Defendant shall immediately relinquish the following weapons to the Sheriffs Office or
a designated local law enforcement agency for delivery to the Sheriffs office:
___________________________________________________________________
___________________________________________________________________
Defendant is prohibited from possessing, transferring or acquiring any other weapons for the duration
of this Order.
___ 7.
The following additional relief is granted:

___________________________________________________________________
___ 8.
A certified copy of this Order shall be provided to the police department where Plaintiff
resides and any other agency specified hereafter:
___________________________________________________________________
___
THIS ORDER SUPERSEDES ANY PRIOR PFA ORDER AND ANY PRIOR ORDER
RELATING TO CHILD CUSTODY.
9.
___ 10.
Rev: 08/2006
THIS ORDER APPLIES IMMEDIATELY TO DEFENDANT AND SHALL REMAIN IN

EFFECT UNTIL MODIFIED OR TERMINATED BY THIS COURT AFTER NOTICE AND
HEARING.
8-77

NOTICE TO THE DEFENDANT
Defendant is hereby notified that violation of this Order may result in arrest for indirect criminal contempt,
which is punishable by a fine of up to $1,000.00 and/or up to six months in jail under 23 Pa.C.S. 6114. Consent
of the Plaintiff to Defendants return to the residence shall not invalidate this Order, which can only be changed or
modified through the filing of appropriate court papers for that purpose under 23 Pa.C.S. 6113. Defendant is
further notified that violation of this Order may subject him/her to state charges and penalties under the Pennsylvania
Crimes Code and to federal charges and penalties under the Violence Against Women Act, 18 U.S.C. 2261 - 2262.
NOTICE TO LAW ENFORCEMENT OFFICIALS

This Order shall be enforced by the police who have jurisdiction over the Plaintiffs residence OR any
location where a violation of this Order occurs OR where the Defendant may be located. If Defendant violates
Paragraphs 1 through 6 of this Order, Defendant may be arrested on the charge of Indirect Criminal Contempt. An
arrest for violation of this Order may be made without warrant based solely on probable cause whether or not the
violation is committed in the presence of law enforcement.
Subsequent to an arrest, the law enforcement officer shall seize all weapons used or threatened to be used
during the violation of this Order OR during prior incidents of abuse. Weapons must forthwith be delivered to the
Sheriffs Office of the county which issued this Order, which office shall maintain possession of the weapons until
further Order of this Court unless the weapon/s are evidence of a crime, in which case they shall remain with the law
enforcement agency whose officer made the arrest.
By the Court:
_____________________________
J.
Rev:08/2006
8-78

CIVIL ACTION LAW
____________________________________________ : No. _________________________
-vs-
___________________________________________
PROTECTION FROM ABUSE
FINAL ORDER OF COURT (PROTECTION FROM ABUSE)

Defendants Name:_________________________________________________________
Defendants Date of Birth:___________________________________________________
Defendants Social Security Number (if known):_________________________________
Names and Dates of Birth of All Protected Persons, including Plaintiff and minor children:
Names
__________________________________
Dates of Birth
____________________________
__________________________________
____________________________
__________________________________
____________________________
__________________________________
____________________________
Plaintiff or Protected Person(s) are:
spouse or former spouse of Defendant

parent of a common child with Defendant
current or former sexual or intimate partner with Defendant
child of Plaintiff
child of Defendant
family member related by blood (consanguinity) to Defendant
family member related by marriage or affinity to Defendant
sibling (person who shares biological parenthood) of Defendant
current or former cohabitant (person who lives with) Defendant
Defendant was served in accordance with Pa. R.C.P. 1930.4 and provided notice of the time, date
and location of the hearing scheduled in this matter.
Rev:08/2006
8-79

AND NOW, this __________ day of _________________________, 20____, the Court
having jurisdiction over the parties and the subject-matter:
after hearing
after hearing at which Defendant, though properly served, failed to appear;
by agreement of the parties in open court and without prejudice or findings of fact;
IT IS ORDERED, ADJUDGED AND DECREED as follows:
Plaintiffs request for a final protection order is denied, OR

Plaintiffs request for a final protection order is granted, OR
Plaintiffs request for a protection order is withdrawn.
1. Defendant shall not abuse, stalk, harass, threaten or attempt to use physical force that
would reasonably be expected to cause bodily injury to the Plaintiff or any other protected person in
any place where they might be found.

2. Defendant is completely evicted and excluded from the residence at ______________

______________________________________________________________________________
(Nonconfidential address from which Defendant is excluded)
or any other residence where Plaintiff or any other person protected under this Order may live.
Exclusive possession of the residence is granted to Plaintiff. Defendant shall have no right or
privilege to enter or be present on the premises of Plaintiff or any other person protected under
this Order.
On _________________________, Defendant may enter the residence to retrieve his/her

clothing and other personal effects, provided that Defendant shall be in the company of a law
enforcement officer when such retrieval is made and (insert other conditions) __________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
3. Except as provided in Paragraph 5 of this Order, Defendant is prohibited from having ANY
CONTACT with the Plaintiff or any other person protected under this Order at any location, including
but not limited to any contact at the Plaintiffs school, business, or place of employment. Defendant is
specifically ordered to stay away from the following locations for the duration of this Order:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
4. Except as Provided in Paragraph 5 of this Order, Defendant shall not contact the Plaintiff, or
any other person protected under this Order, by telephone or by any other means, including third
persons.
Rev: 08/2006
8-80
5. Custody of the minor children, namely:______________________________________

______________________________________________________________________________
shall be as follows: ______________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
6. Defendant shall immediately turn over to the Sheriffs Office, or to a local law enforcement
agency for delivery to the Sheriffs Office, the following weapons used or threatened to be used by
Defendant in an act of abuse against Plaintiff and/or the minor child/ren:
______________________________________________________________________________
______________________________________________________________________________
7. Defendant is prohibited from possessing, transferring or acquiring any other weapons for
the duration of this Order. Any weapons delivered to the Sheriff under Paragraph 6 of this Order or
under the Temporary Order shall not be returned until further order of Court.
8. The following additional relief is granted as authorized by 6108 of the Act:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
9. Defendant is directed to pay temporary support for: ___________________________

_________________________________________________________________________________
as follows:____________________________________________________________________
_____________________________________________________________________________
This Order for support shall remain in effect until a final support order is entered by this Court.
However, this Order shall lapse automatically if the Plaintiff does not file a complaint for support with
the Domestic Relations Section of the Court within two weeks of the date of this Order. The amount
of this Temporary Order does not necessarily reflect Defendants correct support obligation, which
shall be determined in accordance with the Guidelines at the support hearing. Any adjustments in the
final amount of support shall be credited, retroactive to this date, to the appropriate party.
10. COSTS TO BE PAID [ ] WITHIN (30)(60)(90)(120) DAYS [ ] FORTHWITH
______ Assessed against Defendant (address)_______________________________________

______ Assessed against Plaintiff (address)_________________________________________
Please make all checks and money orders payable to OFFICE OF THE PROTHONOTARY and
indicate your case number on the check or money order.
Rev: 08/2006
8-81

OFFICE OF THE PROTHONOTARY
MONTGOMERY COUNTY COURT HOUSE, P.O. BOX 311
NORRISTOWN, PA 19404-0311
ATTENTION: BOOKKEEPER
COSTS WAIVED
11. Defendant shall pay $____________ to Plaintiff as compensation for Plaintiffs out-ofpocket losses, which are as follows:
______________________________________________________________________________
______________________________________________________________________________
OR
Plaintiff is granted leave to present a petition, with appropriate notice to Defendant, requesting
recovery of out-of-pocket losses. The petition shall include an exhibit itemizing all claimed out-ofpocket losses, copies of all bills and estimates of repair, and an order scheduling a hearing. No fee
shall be required by the Prothonotarys Office for the filing of this petition.
12. THIS ORDER SUPERCEDES

RELATING TO CHILD CUSTODY
ANY PRIOR PFA ORDER AND ANY PRIOR ORDER
13. All provisions of this order shall expire in eighteen (18) months, on __________________,
OR _____________________________.
NOTICE TO THE DEFENDANT

VIOLATION OF THIS ORDER MAY RESULT IN YOUR ARREST ON THE CHARGE OF
INDIRECT CRIMINAL CONTEMPT WHICH IS PUNISHABLE BY A FINE OF UP TO $1,000 AND/
OR A JAIL SENTENCE OF UP TO SIX MONTHS. 23 PA. C.S. 6114. VIOLATION MAY ALSO
SUBJECT YOU TO PROSECUTION AND CRIMINAL PENALTIES UNDER THE PENNSYLVANIA
CRIMES CODE.
THIS ORDER IS ENFORCEABLE IN ALL FIFTY (50) STATES, THE DISTRICT OF COLUMBIA,
TRIBAL LANDS, U.S. TERRITORIES AND THE COMMONWEALTH OF PUERTO RICO UNDER
THE VIOLENCE AGAINST WOMEN ACT, 18 U.S.C. 2265. IF YOU TRAVEL OUTSIDE OF THE
STATE AND INTENTIONALLY VIOLATE THIS ORDER, YOU MAY BE SUBJECT TO FEDERAL
CRIMINAL PROCEEDINGS UNDER THAT ACT, 18 U.S.C. 2261-2262. IF YOU POSSESS A
FIREARM OR ANY AMMUNITION WHILE THIS ORDER IS IN EFFECT, YOU MAY BE CHARGED
WITH A FEDERAL OFFENSE EVEN IF THIS PENNSYLVANIA ORDER DOES NOT EXPRESSLY
PROHIBIT YOU FROM POSSESSING FIREARMS OR AMMUNITION. 18 U.S.C. 922(G)(8).
Rev:08/2006
8-82

NOTICE TO LAW ENFORCEMENT OFFICIALS
The police who have jurisdiction over the Plaintiffs residence OR any location where a violation
of this Order occurs OR where the Defendant may be located, shall enforce this order. An arrest for
violation of Paragraphs 1 through 7 of this order may be made without warrant based solely on probably
cause whether or not the violation is committed in the presence of the police. 23 Pa. C.S. 6113.
Subsequent to an arrest, the police officer shall seize all weapons used or threatened to be
used during the violation of the Order or during prior incidents of abuse. The Sheriffs Office shall
maintain possession of the weapons until further order of this Court.
When the Defendant is placed under arrest for violation of the Order the Defendant shall be taken to
the appropriate authority or authorities before whom Defendant is to be arraigned. A Complaint for
Indirect Criminal Contempt shall then be completed and signed by the police officer OR the Plaintiff.
Plaintiffs presence and signature are not required to file this complaint.
If sufficient grounds for violation of this order are alleged, the Defendant shall be arraigned,
bond set and both parties given notice of the date of hearing.
BY THE COURT:
__________________________________
J.
If entered pursuant to the consent of plaintiff and defendant:
__________________________________
(Plaintiffs signature)
____________________________________
(Defendants signature)
cc: Plaintiff (2 copies)

Defendant
Rev: 08/2006
8-83

CIVIL ACTION - LAW
________________________________:
-vs-
No. ___________________
________________________________:
PROTECTION FROM ABUSE ORDER

VACATING/EXTENDING/AMENDING
FINAL ORDER
AND NOW, this _________ day of ______________________, 20_____, upon consideration
of the Petition to Withdraw/Extend/Amend the Final Protection from Abuse Order entered at the above
captioned number,
After hearing
By agreement of parties in open Court and without prejudice or findings of fact

It is hereby ORDERED and DECREED that:
_____ The Petition for Protection from Abuse is withdrawn and the Final Order of Court entered
___________, 20____, is hereby VACATED. Petitioners request for withdrawal and acknowledgment
is set forth below. If costs of Final Order remain unpaid, Plaintiff/Defendant to pay remaining cost
within _____ days.
_____ The Final Order of Court entered on _____________, 20____, is extended and all
provisions thereof shall now expire on _____________, 20____,
_____ The Final Order of Court entered on _____________, 20____, is amended as follows:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
BY THE COURT:
I, ______________________ , hereby
(Printed Name of Plaintiff)
withdraw my Protection from Abuse Petition and

acknowledge that the Order will be vacated.
________________________________________
J.
______________________________________
Signature
If entered pursuant to the consent and agreement of Plaintiff and Defendant:
______________________________________
(Signature of Plaintiff)
Rev: 08/2006
___________________________________
(Signature of Defendant)
8-84

CIVIL ACTION - LAW
_______________________________________
-vs-
No.________________________
_______________________________________
EXTENDED FINAL PROTECTION FROM ABUSE ORDER

AND NOW, this __________ day of ___________________ , 20_____ , upon consideration
of the Petition to Extend the Protection from Abuse Order entered at the above captioned number,
After hearing

The Protection from Abuse Order entered on _______________________ , 20_____,
is extended and all provisions thereof shall now expire on ____________________________ .
BY THE COURT:
_________________________________________
J.

________________________________
Rev: 08/2006
__________________________________
8-85

CIVIL ACTION - LAW
________________________________
-vs-
________________________________
No.___________________
AMENDED FINAL PROTECTION FROM ABUSE ORDER

AND NOW, this _________ day of _________________, 20____, upon consideration of the
Petition to Amend the Protection from Abuse Order entered at the above captioned number,
After hearing

The Protection from Abuse Order entered on ____________________, 20____, is amended
as follows:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
BY THE COURT:
______________________________________
J.
____________________________________
Rev: 08/2006
____________________________________
8-86

CIVIL ACTION - LAW
_________________________________________
-vs-
No._____________________
_________________________________________
PROTECTION FROM ABUSE ORDER

(NO HEARING HELD)
AND NOW, this _____________ day of _________________, 20____, the Petition in the above
captioned matter is:
CONTINUED
______ By Plaintiff/Defendant/Court upon application and for good cause.
Reason: _____________________________________________________________
______ Until personal service has been made upon the Respondent.
______ Special Order for Service by mail pursuant to Pa. R.C.P. 1930.4(b) and (c) is GRANTED.
UNTIL _______________________, 20____, in Court Room ______ at 9:00 A.M.
NOTICE: THE PREVIOUS TEMPORARY ORDER REMAINS IN FULL FORCE AND EFFECT PENDING
FURTHER ORDER OF THE COURT.
STRICKEN
_________Petitioner, having requested leave to withdraw the Petition for Protection from Abuse, so
evidenced by his/her signature below, the Court hereby grants said request and Orders that the Petition
is STRICKEN and any Temporary Order is VACATED.
_________No one appearing or otherwise notifying the Court of cause for their failure to appear, the
Petition is STRICKEN for failure to prosecute. The Temporary Order is VACATED.
COSTS TO BE PAID within (30) (60) (90) (120) DAYS FORTHWITH
_________ Assessed against Defendant (address) ____________________________________________
_________ Assessed against Plaintiff (address) ______________________________________________
COSTS WAIVED
BY THE COURT:
I hereby withdraw my Petition for Protection from
Abuse Order. I acknowledge that any Temporary
Order entered in this case will be VACATED.
___________________________________________
J.
______________________________________
Signature
Please make all checks and money orders payable to OFFICE OF THE PROTHONOTARY
and indicate your case number on the check or money order.
OFFICE OF THE PROTHONOTARY
MONTGOMERY COUNTY COURT HOUSE,
P.O. BOX 311, NORRISTOWN, PA 19404-0311
ATTENTION: BOOKKEEPER
Rev: 08/2006
8-87

CIVIL ACTION - LAW
_________________________________________
-vs-
No._____________________
_________________________________________
ORDER VACATING FINAL PROTECTION FROM ABUSE ORDER

AND NOW, this _______________day of ___________________, 20____, upon consideration of
the Plaintiffs Petition to Withdraw the Protection from Abuse Order entered at the above captioned
number, and the Acknowledgement of Withdrawal set forth below, it is hereby ORDERED and
DECREED that:
The Petition for Protection from Abuse is withdrawn and the Final Order of Court entered on
________________________, 20____, is hereby VACATED.
If costs of Final Order remain unpaid, Plaintiff/Defendant to pay remaining costs within ______days.
BY THE COURT:
______________________________________
J.
I, ________________________hereby withdraw my Protection from Abuse Petition
(Printed Name of Plaintiff)
and request that the Court vacate the Final Order of Court entered in this case.
I acknowledge that I give up all protections provided to me under any existing
Final or Temporary Protection from Abuse Order.
___________________________________________________________
Signature of Plaintiff
Rev: 08/2006
8-88

Civil Practice Manual CH 8

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MONTGOMERY COUNTY CIVIL PRACTICE MANUAL

Index continued on Page 2

Published by the Montgomery Bar Association

MONTGOMERY COUNTY CIVIL PRACTICE MANUAL

Published by the Montgomery Bar Association

MONTGOMERY COUNTY CIVIL PRACTICE MANUAL

B. INTRODUCTION TO FAMILY PRACTICE IN MONTGOMERY COUNTY

Published by the Montgomery Bar Association

MONTGOMERY COUNTY CIVIL PRACTICE MANUAL

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MONTGOMERY COUNTY CIVIL PRACTICE MANUAL

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MONTGOMERY COUNTY CIVIL PRACTICE MANUAL

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MONTGOMERY COUNTY CIVIL PRACTICE MANUAL

verification of counsel fees, costs and expenses, if claimed.

Published by the Montgomery Bar Association

MONTGOMERY COUNTY CIVIL PRACTICE MANUAL

Published by the Montgomery Bar Association

MONTGOMERY COUNTY CIVIL PRACTICE MANUAL

Published by the Montgomery Bar Association

MONTGOMERY COUNTY CIVIL PRACTICE MANUAL

Published by the Montgomery Bar Association

MONTGOMERY COUNTY CIVIL PRACTICE MANUAL

Published by the Montgomery Bar Association

MONTGOMERY COUNTY CIVIL PRACTICE MANUAL

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MONTGOMERY COUNTY CIVIL PRACTICE MANUAL

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MONTGOMERY COUNTY CIVIL PRACTICE MANUAL

__________________________________ ID: ______

____________________________ ID: ____________

3. Equitable Distribution __________________

6. Special Relief __________________

7. Outstanding/Temporary/Final Protection From Abuse Order ______________________

Published by the Montgomery Bar Association

MONTGOMERY COUNTY CIVIL PRACTICE MANUAL

____________________________ ID: ____________

Published by the Montgomery Bar Association

MONTGOMERY COUNTY CIVIL PRACTICE MANUAL

Attorney for ____________________

IN THE COURT OF COMMON PLEAS OF MONTGOMERY COUNTY, PENNSYLVANIA

Soc. Sec. No. ______________________

Soc. Sec. No. ______________________

NOTICE TO DEFEND AND CLAIM RIGHTS

Published by the Montgomery Bar Association

MONTGOMERY COUNTY CIVIL PRACTICE MANUAL

Attorney for ____________________

IN THE COURT OF COMMON PLEAS OF MONTGOMERY COUNTY, PENNSYLVANIA

Soc. Sec. No. ______________________

Soc. Sec. No. ______________________

Published by the Montgomery Bar Association

MONTGOMERY COUNTY CIVIL PRACTICE MANUAL

Published by the Montgomery Bar Association

MONTGOMERY COUNTY CIVIL PRACTICE MANUAL

A previous support order was entered against the Defendant on _________________

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MONTGOMERY COUNTY CIVIL PRACTICE MANUAL

Published by the Montgomery Bar Association

MONTGOMERY COUNTY CIVIL PRACTICE MANUAL

Attorney for ____________________

IN THE COURT OF COMMON PLEAS OF MONTGOMERY COUNTY, PENNSYLVANIA

Soc. Sec. No. ______________________

____________________________ ID:

________________ ID:

________________ ID: