SUPERIOR COURT OF FULTON COUNTY STATE OF GEORGIA FAMILY DIVISION , v. Petitioner, , Respondent. Civil Action Case Number PETITION FOR CITATION OF CONTEMPT My name is , and I am representing myself in this Petition. I am the __Respondent / __Petitioner from the original case. The other party's name is ____________________, and he / she is the __Respondent / __Petitioner from the original case. In support of my case, I state the following: 1. Jurisdiction and Venue: [Check one of the following, either (a), (b) or (c); also, in each section, check the space to show whether the other party was the "Respondent" or the "Petitioner".] __ (a) __Respondent / __Petitioner is a resident of Fulton County, Georgia and is subject to the jurisdiction of this Court as a result of the prior Order entered by this Court. __ (b) __Respondent / __Petitioner is a resident of County, Georgia and is subject to the jurisdiction of this Court as a result of the prior Order entered by this Court. to the jurisdiction of this Court as a result of the prior Order entered by this Court. __ (c) __Respondent / __Petitioner is not a resident of Georgia, but is subject 2. Service of Process: __Respondent / __Petitioner shall be served as provided under OCGA § 9-11-4, in the following manner: [Check only one of the following, either (a) or (b)] __ (a) __Respondent / __Petitioner has acknowledged service of process. I am filing The signed Acknowledgment of Service with this Petition. Petition for Citation of Contempt -- Rev. Nov. 2015 Provided by the Fulton Family Law Information Center American LegalNet, Inc. www.FormsWorkFlow.com __ (b) __Respondent / __Petitioner may be served by the Sheriff's Department at his/her __ home __ work address, which is: __ (b-1) [Check only if the other party resides outside of Fulton County.] __Respondent / __Petitioner resides outside of Fulton County, and shall therefore be served by second original, as provided under OCGA § 9-1072. Service shall be made by the Sheriff's Department in the county where Respondent resides. 3. An Order was entered in the Superior Court of Fulton County, Civil Action File No. on . A copy of that Order is attached. 4. In the prior Order, __Respondent / __Petitioner was ordered [check all that apply]: __ (a) to pay me $ per in child support and, as of the date of the filing of this Petition, owes to the Petitioner the following amount: $ . per in alimony and, as of the date of the filing of this Petition, owes to the Petitioner the following amount: $ . __ (b) to pay me $ __ (c) to allow me to visit with the minor child(ren). __ (d) to give me the following property/possessions: Petition for Citation of Contempt -- Rev. Nov. 2015 Provided by the Fulton Family Law Information Center American LegalNet, Inc. www.FormsWorkFlow.com __ (e) To pay for and have medical insurance for the minor child(ren). __ (f) To pay me back for medical bills in the amount of $ . __ (g) Other: 5. __Respondent / __Petitioner was able to do what the Court ordered. His / Her refusal to do so is willful. __Respondent / __Petitioner should be held in contempt of this Court's Order and incarcerated until such time as he/she purges him/herself of this contempt. __Respondent / __Petitioner should be ordered to reimburse me for payment in filing this action and for the cost of service. 6. 7. WHEREFORE, I request: (a) (b) (c) (d) (e) (f) That process and summons issue as provided by law; That __Respondent / __Petitioner be served with a copy of this Motion; That __Respondent / __Petitioner be held in contempt and incarcerated for failure to comply with the Court's Order; That a Rule Nisi be scheduled by the Court to decide on the relief I have requested; That __Respondent / __Petitioner be required to pay all costs of this action; and That the Court order any and all other relief that the Court finds appropriate. Dated: Pro se (Signature) Name: Email: IF YOU DO NOT HAVE AN EMAIL ADDRESS, YOU MUST COMPLETE A CERTIFICATE OF NO EMAIL ADDRESS Address: ______________________________ ______________________________ ______________________________ Phone: ______________________________ Petition for Citation of Contempt -- Rev. Nov. 2015 Provided by the Fulton Family Law Information Center American LegalNet, Inc. www.FormsWorkFlow.com