STATE OF NORTH CAROLINA IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION ______-CVD-__________ ( ) COUNTY OF UNION __________________________, Plaintiff, v. __________________________, Defendant. ) ) ) ) ) ) ) ) COMPLAINT FOR CHILD CUSTODY OR VISITATION AND/OR CHILD SUPPORT Plaintiff, complaining of defendant, alleges and says: PARTIES, JURISDICTION AND VENUE 1. Plaintiff is a citizen and resident of ______________________________________. 2. Plaintiff’s address is __________________________________________________. 3. Defendant is a citizen and resident of ____________________________________. 4. Defendant’s address is ________________________________________________. 5. Defendant’s relationship to child: ________________________________________. (County and State) (County and State) (Mother, Father, etc.) 6. The name(s), age(s) and birth date(s) of the child or children at issue in this case is/are as follows: _________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 7. Explain your standing to bring this civil action (e.g., I am the mother/father/other relative of the child/children): ___________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 8. That during the past five years (or since birth if the child is less than five years old), the (child) (children) have lived with: Name of child _____________, birthdate _____________, birthplace _______________. PERIOD _____to present _____to _____ _____to _____ ADDRESS _________________ _________________ ________________ PERSON LIVED WITH PRESENT ADDRESS _________________ _________________ _________________ ____________________ ____________________ ____________________ American LegalNet, Inc. www.USCourtForms.com Name of child________________, birthdate_________________, birthplace____________. PERIOD ADDRESS PERSON LIVED WITH ______to _____ _______________ ______to _____ _______________ ______to _____ _______________ __________________ __________________ __________________ PRESENT ADDRESS ____________________ ____________________ ____________________ (If there are more than two children, insert additional sheets.) 9. That I (have) (have not) participated as a (party) (witness) (other capacity) in litigation concerning the custody of the minor child in (this) (another) State, viz.___________________________________________________________________on , ___ (if answer is affirmative, give details, stating capacity, name and address of court.) ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 10. That I (have) (do not have) information of any custody proceeding concerning a child mentioned above pending in a Court of this or any other State. (If answer is affirmative, give details) _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ 11. That I (know) (do not know) of a person who has physical custody of the child viz. ______________________________________________________________________, or (Name) (Address) claims to have custody or visitation rights with respect to the child, viz.: ______________________________________________________________________ (Name) (Address) 12. The District Court of Union County has personal jurisdiction over the parties and subject matter jurisdiction (including jurisdiction under the Uniform Child Custody Jurisdiction Act) to decide the claim(s) and render a custody determination in this action. 13. Venue of this action is pro in Union County, North Carolina. CUSTODY OR VISITATION CLAIM 14. Plaintiff is a fit and proper person to have primary custody/visitation of the aforesaid minor child/children and an award of custody/visitation to her/him would best promote the interests and welfare of the aforesaid minor child/children. CHILD SUPPORT CLAIMS 15. The aforesaid minor child/children is/are in need of support and maintenance for his/her/their health, education and welfare. 16. Defendant is an able-bodied man/woman regularly and gainfully employed, or capable of gainful employment, and is capable of providing support for the aforesaid minor child/children. American LegalNet, Inc. www.USCourtForms.com 17. Plaintiff is entitled to have and recover child support from and of the defendant. 18. Attached hereto as Exhibit B, and incorporated by reference as if fully set forth herein, is Plaintiff's Affidavit of Financial Standing setting forth his/her needs and the needs of the child/children as required by the Local Rules of Court. PRAYER FOR RELIEF WHEREFORE, plaintiff prays the Court for relief as follows: 1. _____ That custody/visitation of the minor child/children be awarded to plaintiff. 2. _____ That defendant be ordered to pay reasonable child support. 3. _____ That defendant be taxed with the costs of this action. 4. _____ That plaintiff have and recover such other and further relief as the court may deem just and proper. This ____ day of ______________________, _____. ____________________________________________________________ (Signature of Plaintiff) ADDRESS AND TELEPHONE NUMBER OF PLAINTIFF: _____________________________________________ _____________________________________________ _____________________________________________ American LegalNet, Inc. www.USCourtForms.com STATE OF NORTH CAROLINA COUNTY OF UNION ) ) ) VERIFICATION ______________________, being first duly sworn, deposes and says that he/she is the plaintiff in the foregoing action, that he/she has read the foregoing COMPLAINT and knows the contents thereof to be true of his/her own personal knowledge except for those matters and things alleged therein upon information and belief, and as to those matters and things, he/she believes same to be true. ____________________________________ Sworn to and subscribed before me this ____ day of ________________, ______. ____________________________________ Notary Public My Commission expires________________ American LegalNet, Inc. www.USCourtForms.com