JV-118 (Rev. 06/14/2013) COMPLAINT FORCIVIL CONTEMPT DOCKET NUMBER Trial Court of MassachusettsJuvenile Court Department CASE NAME DIVISION(print or type full name) 1. Plaintiff(s) Information: Name: Address: Name: Address:(street and no.)(city or town)(state)(zip code)(zip code)(state)(city or town)(street and no.)(print or type full name) 2. Defendant(s) Information: Name: Address: Name: Address:(print or type full name)(street and no.)(city or town)(state)(zip code)(zip code)(state)(city or town)(street and no.)(print or type full name)3. Alleged Contempt of Order Judgment of the Court, dated Case Docket No.: Case Name: Check box if copy of Order/Judgment is attached.4. The Defendant(s) failed to comply with the Court's order/judgment by (explain with specificity):WHEREFORE, the Plaintiff(s) request that the Court issue a summons for the Defendant(s) to appear for a hearing for theCourt to determine whether the Defendant(s) should be found in civil contempt.Signature and Verification of ComplaintI/we verify that the statements made in this complaint are true and correct and of my/our own knowledge.Date: (Signature of Plaintiff) Date: (Signature of Plaintiff) (Court Use Only)Issue summons Do not issue summons Date: (Signature of Justice) American LegalNet, Inc. www.FormsWorkFlow.com