Commonwealth of Massachusetts The Trial Court Probate and Family Court Department Division Docket No. COMPLAINT FOR SEPARATE SUPPORT , Plaintiff 1. , Defendant is the V. Plaintiff, who resides at (Street address) (City/Town) (State) (Zip) spouse of the defendant, who resides at (Street address) 2. (City/Town) The parties were married at (State) (Zip) on (Date) and last lived together at on (Date) 3. The minor or dependent child(ren) of this marriage is/are: (name of child and date of birth) (name of child and date of birth) (name of child and date of birth) (name of child and date of birth) 4. Plaintiff alleges: Defendant is not providing suitable support, without justifiable cause. He/she has been deserted by the defendant. He/she is actually living apart from defendant for justifiable cause. Please explain: He/she has justifiable cause for living apart. Please explain: 5. Wherefore, plaintiff requests that the Court: establish that such living apart from the defendant is for justifiable cause. prohibit defendant from imposing any restraint on plaintiff's personal liberty. grant plaintiff defendant custody of the above-named child(ren). order a suitable amount for support of insurance. plaintiff and/or above-named child(ren) with suitable provision for health order conveyance of the real estate located at standing in the name of as recorded with the Registry of Deeds, Book Page . Date (Signature of attorney or plaintiff, if pro se) (Print name) (Street address) (City/Town) (State) (Zip) Tel. No. CJ-D 102 (4/07) B.B.O. # C.G.F American LegalNet, Inc. www.FormsWorkflow.com