COMPLAINT FOR CIVIL CRIMINAL Docket No. Commonwealth of Massachusetts The Trial Court Probate and Family Court CONTEMPT ,Plaintiff First Name M.I Last Name Division v. ,Defendant First Name M.I Last Name 1. Plaintiff resides at (Address) (Apt, Unit, No. etc.) (Apt, Unit, No. etc.) (City/Town) (City/Town) (State) (State) (Zip) (Zip) 2. Defendant resides at (Address) 3. By judgment to pay order of the Court, dated alimony and/or defendant was ordered weekly monthly support for minor or dependent child(ren) in the sum of to comply with the Court ordered parenting time. not to impose any restraint on the personal liberty of plaintiff to pay health insurance premiums for plaintiff and/or plaintiff child(ren) and/or child(ren) to pay reasonable medical and dental expenses for other and said judgment order is still in force. judgment order and 4. Defendant has not obeyed that is in arrears of court-ordered support payments. there now remains due and unpaid to plaintiff the sum of amounts as may accrue to the date of hearing. plaintiff has been denied parenting time on has violated the order on by: $ plus such further 5. Wherefore, plaintiff requests that defendant be required to appear before this Court to show cause why defendant should not be adjudged in contempt of Court and for such other relief as the Court deems just. Date: Signature of Attorney or Plaintiff, if pro se (Print name) (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) Primary Phone #: B.B.O. # American LegalNet, Inc. www.FormsWorkFlow.com CJ-D 103 (7/15/15) page 1 of 1