NameAddressNameAddressPlaintiffDefendant No. 1NameAddressDefendant No. 2COMPLAINT FOR CUSTODYI, , representing myself, state that:1. I am the mother father or of the following minor child(ren):Relationship (for example, aunt, grandfather, guardian, etc.)2. is the mother father or of the child(ren). Defendant No. 2 is the mother father of the child(ren).DefendantRelationship3. The child(ren) live(s) at with .AddressName of Person4. The child(ren) have lived in the following places, with the persons indicated during the last five (5) years: Time Period Place Name(s)/Current Address of Person(s) With Whom Child LivedPage 1 of 3 CC-DR-004 (Rev. 06/2018)vs. CIRCUIT COURT FOR , MARYLANDCase No.City/CountyLocated atNameDate of BirthNameDate of BirthNameDate of BirthNameDate of BirthNameDate of BirthNameDate of BirthCity, State, ZipTelephoneCity, State, ZipTelephoneCity, State, ZipTelephone American LegalNet, Inc. www.FormsWorkFlow.com 5. I know of the following cases concerning the child(ren) (such as domestic violence (protective order), paternity, divorce of the child(ren)'s parents, custody, visitation, termination of parental rights, adoption or other cases): Court Case No. Kind of Case Year Filed Results or Status (if you know) Attach the most recent court order for the above-referenced court cases.6. I have been a party, witness, or otherwise involved in the following cases about custody or visitation of the child(ren): State Court Case No. Date of Child Custody Determination Attach the most recent court order for the above-referenced court cases.7. I know of the following people, not parties to this case, who have physical custody of, or claim rights of legal custody or physical custody of, or visitation with the child(ren):NameCurrent Address8. It is in the best interests of the child(ren) to be in my custody because:FOR THESE REASONS, I request the court (check all that apply):Grant me sole joint (check one) physical custody of the child(ren).Grant me sole joint (check one) legal custody of the child(ren).Allow to visit with the child(ren).Name(s)Page 2 of 3CC-DR-004 (Rev. 06/2018)NameCurrent AddressNameCurrent AddressAllow to visit with the child(ren) onName(s)the following terms: American LegalNet, Inc. www.FormsWorkFlow.com Allow no visitation becauseOrder to pay health insurance for child(ren).Order to pay child support (attach FinancialStatement. Use Financial Statement (Child Support Guidelines) (CC-DR-030) orFinancial Statement (General) (CC-DR-031)).(State other requests relating to the children.) Order any other appropriate relief. I solemnly affirm under the penalties of perjury, that the contents of this document are true to the best ofmy knowledge, information, and belief.DateSignaturePage 3 of 3 CC-DR-004 (Rev. 06/2018)Name(s)Name(s) X American LegalNet, Inc. www.FormsWorkFlow.com