Circuit Court for Case No. City or County Name Name VS. Street Address City Apt. # State Zip Code Petitioner ( ) Area Code PO Box Street Address Telephone City Apt. # PO Box State Zip Code Respondent ( ) Area Code Telephone APPLICATION FOR THE ISSUANCE OF A WARRANT (DOM REL 80) Based on the information provided in the accompanying Petition for Enforcement of a Foreign Child Custody Determination (DR 78), I request that the court issue a warrant to take physical custody of the following child(ren): Name Date of Birth Name Date of Birth Name Date of Birth Name Date of Birth It is necessary for the court to take physical custody of the child(ren) for at least one of the following reasons: ‘ The child(ren) is/are likely to suffer serious physical harm for the following reasons:____________________________________________________. ‘ The child(ren) is/are likely to be removed from Maryland:______________ _____________________________________________________________. I solemnly affirm and verify under the penalties of perjury that the contents of the foregoing application are true to the best of my knowledge, information and belief. Date Signature Page 1 of 1 DR 80 (4/2006)