IN THE SUPERIOR COURT OF FULTON COUNTY STATE OF GEORGIA FAMILY DIVISION Petitioner: ________________________________, and Civil Action File No.:_____________ Respondent: ______________________________. PETITION FOR CHANGE OF CUSTODY AND CHILD SUPPORT I,______________________________, representing myself, state my claim for a change of custody and child support against ____________________, the Respondent, as follows: 1. Subject Matter Jurisdiction: Georgia has subject matter jurisdiction over the issue of Change of Custody as follows: (a) There is a Georgia Superior Court Order concerning custody as set forth in paragraph 3 and; (b) The minor child(ren): Full Name Male/Female Year of birth _________________ _________________ _________________ _________________ ______________________________________ ___________ _______________________________________ ___________ _______________________________________ ___________ _______________________________________ ___________ have been residents of Georgia for at least six months prior to filing this Petition for Change of Custody such that Georgia is the home state of the minor child(ren). 2. Venue and Service: The Respondent is subject to the jurisdiction of this court as follows: (Check a, b, c, or d) a) Personal Service: The Respondent is a resident of Fulton County and is subject to the jurisdiction of this Court and may be served with a copy of this petition and summons at the following address: ____________________________________________________________________. b) The Respondent has signed the following documents attached to the Petition: ___ Acknowledgment of Service ___ Waiver of Venue (where the Respondent is not a resident of Fulton County) ___ Waiver of Jurisdiction (where the Respondent is not a resident of Georgia) Change of Custody Petition-7/2014 Fulton County Superior Court Family Division 1 f 5 American LegalNet, Inc. www.FormsWorkFlow.com ___ Consent to Custody c) Personal Service by Second Original: I am a resident of Fulton County. I have had physical custody of the minor child/ren for at least six months prior to filing this Petition. The Respondent left the minor child(ren) with me on ___________________________________ and has abandoned the chid(ren). The Respondent is a former resident of Georgia but now resides in ___________________________ (State) and shall be personally served by second original pursuant to the Domestic Relations Long Arm Statute O.C.G.A. � 9-10-91(5) at his/her address at _________________________________________________________ ________________________________________________________________________ _______________________________________________________________________ . "Service by Publication": I am a resident of Fulton County. I have had physical custody of the minor children for at least six months prior to filing this Petition. The Respondent left the minor children with me on __________________and has abandoned them. I do not know where the Respondent is living now. The Respondent shall be served by Publication. d) 3. Original Custody Order: Pursuant to ____________________________________(Name of order awarding custody) in Civil Action, File No.: ___________________ entered on _______________, _______ in the Superior Court of _______________ County, Georgia, hereinafter referred to as "Order" a copy of which is attached to the Petition, the Respondent was awarded the following type of custody of the minor child(ren): (Check all that apply): a) b) c) d) sole legal and physical custody of the minor child(ren); joint legal custody and Respondent/Petitioner is the primary physical custodian of the minor child(ren); joint physical custody other: _____________________________________________________________ __________________________________________________________________ 4. Children's Place of Residence: The minor child(ren) currently reside at ________________________________________________ with __________________. During the past five years, the minor child(ren) have lived at the addresses below with the following persons: Address: Resided with: ______________________________________________ _______________________________ ______________________________________________ _______________________________ ______________________________________________ _______________________________ ______________________________________________ _______________________________ Change of Custody Petition-7/2014 Fulton County Superior Court Family Division 2 f 5 American LegalNet, Inc. www.FormsWorkFlow.com 5. Other Custody Actions: (Check a or b) a) I have not participated as a party, or witness, or in any capacity in any other litigation concerning the custody of the minor child(ren) in this or any other state except for the initial custody action as described in the Order set forth in paragraph (3) above. I do not know of any custody proceeding concerning the minor child(ren) which may be pending in a Court in this or any other state. The minor child(ren) have been involved in the following custody actions. County:_________________________ State: _________________________ Court:___________________________ Type of Action:____________________ Date Filed:_______________________ Status: __________________________ b) County: _____________________________ State: _____________________________ Court: _____________________________ Type of Action: ________________________ Date Filed: ___________________________ Status: ___________________________ 6. Other Persons with Claims to Children: (Check a or b) a) b) I know of no other person, not a party to this proceeding, who has physical custody of the child(ren) or claims to have custody or visitation rights with respect to the minor child(ren). The following persons who are not a party to this proceeding have custody or visitation rights with the minor child(ren): Claim ______________________________________ ______________________________________ ______________________________________ Full Name ________________________________________ ________________________________________ ________________________________________ 7. Material Change in Circumstance: Since the date of the Order, there has been a change in circumstances materially affecting the welfare of the minor child(ren) as follows: _____________________________________________________________________________________ _____________________________________________________________________________________ __________