Circuit Court for Name Street Address City State Zip Code Apt. # City or County Name Case No. VS. Telephone Street Address City State Zip Code Apt. # Area Code ( Area Code ) ( ) Telephone Plaintiff (DR 1) Defendant COMPLAINT FOR CHILD SUPPORT I, 1. I am the My name , representing myself, state that: father or Relationship (for example, aunt, grandfather, guardian, etc.) mother of the following minor child(ren) or adult disabled child(ren): Name Name Date of Birth Date of Birth Name Name Date of Birth Date of Birth 2. The child(ren) lives(s) at with Name The Opposing Party . is the mother Address 3. father of the child(ren) and (check all that apply): " " " " " " " is not making child support payments. is not making regular child support payments. is not making child support payments in an amount required by the Maryland Child Support Guidelines. is making child support payments, but I need an Earnings Withholding Order. FOR THESE REASONS, I request the Court (check all that apply): Order to pay child support in an amount required by the Maryland Child Support Guidelines. Order child support to be paid by earnings withholding order through the local support enforcement agency. Order to provide health insurance for the child(ren). Name Name : Order any other appropriate relief, including support arrearages, if appropriate, from the date of filing. Date Signature IMPORTANT: YOU MUST COMPLETE AND FILE A FINANCIAL STATEMENT WITH THIS FORM (Use Form DR 30 or DR 31) Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com DR 1 - Revised 10/2015