IN THE SUPERIOR COURT OF FULTON COUNTY STATE OF GEORGIA FAMILY DIVISION Petitioner: _____________________________ Civil Action File No: ____________________ and Respondent: ___________________________ PETITION FOR CITATION OF CONTEMPT NOW COMES ____________________________ (your full name), Petitioner in the above-styled action, and files this Petition for Citation of Contempt and shows the Court as follows: 1. An Order was entered in the Superior Court of ___________________________ County as follows: Civil Action File Number (use the letters and numbers from that case):__________________________ The case name as it appeared in the prior action: ________________________________________ The date the Order was filed in the Court: _______________________________________________ A copy of that Order is attached. 2. □ Respondent is subject to the jurisdiction of this Court (where Respondent lives in Georgia or can be personally served in Georgia) and may be personally served with a copy of this Petition and Rule Nisi at ___________________________________________________. □ Respondent is not a resident of Fulton County. Respondent lives in ___________________ County, Georgia and shall be served with a copy of this Petition and Rule Nisi by second original. □ Respondent is subject to the jurisdiction of this Court pursuant to the Georgia Domestic Relations Long Arm Statute (where Respondent is a non-resident of Georgia and you are seeking a contempt action against the opposing party for failure to pay child support/alimony, to obtain health/life insurance coverage, to pay medical expenses, to turn over property, or to pay other expenses) and may be personally served with a copy of this Petition and Rule Nisi at _______________________ _______________________________________________________ by second original. 3. In the prior Order, Respondent was ordered: (check all that apply) □ to pay the Petitioner the amount of $ ______ per week/bi-weekly/semi-monthly/monthly in child support, and owes $______ to Petitioner as of the date of the filing of this Petition □ to allow Petitioner to visit with the minor child(ren) but has refused to do so □ to give to Petitioner the following possessions but has refused to do so: ______________________ □ to pay for and have medical insurance for the minor child(ren) □ to pay me back for medical bills, in the amount of $ ______________________ □ other ____________________________________________________________________________ Petition for Citation of Contempt © 2006 Fulton County Superior Court Family Division Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com 4. Respondent was able to do what the Court ordered. Respondent's refusal to do so is willful. 5. Respondent should be held in contempt of this Court's Order and confined to the common jail of Fulton County until he/she purges him/herself of said contempt. 6. Respondent should be ordered to reimburse Petitioner for costs incurred in this action. WHEREFORE, Petitioner demands: (a) (b) (c) (d) (e) (f) That process and summons issue as provided by law; That Respondent be served with a copy of Petitioner's Petition for Citation of Contempt; That Respondent be held in contempt for failure to obey the terms of the Court's Order; That a Rule Nisi hearing be set ordering Respondent to come to Court and tell the Judge why Petitioner's Petition should not be granted; That Respondent be ordered to reimburse Petitioner for the cost of this action; and That Petitioner be awarded any other relief this Court finds right and proper. This the ____________________ day of ___________________________ , _____. [date] [month] [year] (Sign your name here) Pro Se Petitioner’s name (print or type): ___________________________ Petitioner’s address: ____________________________________ ____________________________________________________ Petitioner’s telephone number: (_____)_____________________ Petition for Citation of Contempt © 2006 Fulton County Superior Court Family Division Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com