Page 1 of 3Plaintiff/Counter-DefendantDefendant/Counter-PlaintiffCOUNTER-COMPLAINT FOR CUSTODY CHILD SUPPORTI, , representing myself, file a Counter-Complaint to filed against me, state: CC-DR-095 (Rev. 06/2018)City, State, ZipTelephoneCity, State, ZipTelephonevs.AddressNameAddress1.I am the mother father orof the following minor child(ren):NameDate of BirthNameDate of BirthNameDate of BirthNameDate of BirthNameDate of BirthNameDate of Birth2.I know of the following related cases concerning the child(ren) or parties (such as domesticviolence, paternity, divorce, custody, visitation, termination of parental rights, adoption orother cases): Court Case No. Kind of Case Year FiledResults or Status (if you know)Name of Complaint, Petition, or Motion That You are CounteringRelationship (for example, aunt, grandfather, guardian, etc.)3.I have been a party, witness, or otherwise involved in the following cases about custody orvisitation of the child(ren):Attach the most recent court order for the above-referenced court cases. State Court Case No. Date of Child Custody Determination CIRCUIT COURT FOR , MARYLANDCase No.City/CountyLocated at4.I know of the following people, not parties to this case, who have physical custody of, or claimrights of legal custody or physical custody of, or visitation with the child(ren):NameNameCurrent AddressCurrent AddressNameCurrent AddressName Attach the most recent court order for the above-referenced court cases. American LegalNet, Inc. www.FormsWorkFlow.com 5.The child(ren) are currently living with:6.The child(ren) have lived in the following places, with the persons indicated during the lastfive (5) years:7.It is in the best interests of the child(ren) that I have (check all that apply):joint sole (check one) physical custody ofjoint sole (check one) legal custody ofvisitation with8.The plaintiff/counter-defendant is the mother father of the child(ren) and (check all that apply):Page 2 of 3CC-DR-095 (Rev. 06/2018)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 SupportGuidelines.is making child support payments, but I need an Earnings Withholding Order. Time Period Place Name(s)/Current Address of Person(s) With Whom Child Lived.Name(s) of Child(ren).(Check One)9.(In the space provided, please provide the court with facts that prove your case and support yourrequest for relief.)Nameand reasonable child support.Name(s) of Child(ren)and reasonable child support.Name(s) of Child(ren) FOR THESE REASONS, I want the court to grant me (check all that apply and attach formsindicated):Grant me sole joint physical custody of the child(ren) and reasonable child support.Grant me sole joint legal custody of the child(ren) and reasonable child support.Allowto visit with the child(ren).Name(s)(Check One)(Check One) American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 3 CC-DR-095 (Rev. 06/2018)Allow no visitation because:Order to pay health insurance for child(ren).Order to pay child support (attach FinancialStatement. Use Financial Statement (Child Support Guidelines) (CC-DR-030) or FinancialStatement (General) (CC-DR-031)).(State other requests relating to the children):Order any other appropriate relief.Name(s)Name(s)DateSignatureCERTIFICATE OF SERVICE I CERTIFY that on this day of , , a copy of this counterclaim and acopy of the forms listed above, were mailed, postage prepaid, to:DateSignatureOpposing Party's or His/Her Attorney's Address Including City/State/ZipOpposing Party or His/Her Attorney XAllow to visit with the child(ren)on the following terms:Name(s) I solemnly affirm under the penalties of perjury, that the contents of this document are true to thebest of my knowledge, information, and belief. American LegalNet, Inc. www.FormsWorkFlow.com