PHILADELPHIA COURT OF COMMON PLEAS FAMILY DIVISION MOTION COVER SHEET ________________________________ Plaintiff v. ________________________________ Defendant : : : : : : __________ Term, 20 ____, No. __________ DR No: _____________________________ PACSES No: _________________________ Name of Filing Party: Status of Filing Party: Plaintiff Defendant Petitioner Respondent Type of Filing: Support Custody Divorce Domestic Violence State Full Description of Motion: CASE STATUS (Answer all questions) I. Has this case been listed before a Judge for any other Domestic Relations matter? Yes No IF YES, identify the Judge(s) II. If a Decree in Divorce has been entered, identify the Judge who entered the Decree and the date of Decree. III. Has another Motion been decided in this case? Yes No Yes No IF YES, identify the Judge and date of Order. Is another Motion pending? IF YES, identify the type of Motion and hearing date if assigned. IV. List name, address and telephone number of other counsel of record and any unrepresented parties. (Attach a self-addressed stamped envelope for each attorney and any unrepresented party.) I verify that the information listed above is true and correct and I understand that sanctions may be imposed for inaccurate or incomplete answers. _______________________________________ Signature __________________________________________ Printed Name American LegalNet, Inc. www.USCourtForms.com