In the Court of Common Pleas of Butler County Commonwealth of Pennsylvania Civil Division Versus No I. Notice You are hereby notified that the attached matter will be: Filed on 20. Presented to the Unassigned Motion Judge Presented to Assigned Judge on at am/pm. II. Certificate of Notice/Service I gave reasonable prior notice of filing and a copy of this document o at on 20 by: III. Information for Court Administrator Is this an original filing in this case? No Yes Has any Judge been assigned to this matter? No If yes, please check your assigned Judge. Thomas J. Doerr (Courtroom 1) S. Michael Yeager (Courtroom 3) Marilyn J. Horan Estimated court time required if the matter is granted: Minutes Hours Day(s) None Adverse party position? Opposes Consents Unopposed IV. Information for Domestic Relations Plaintiff Date of Birth Defendant Date of Birth To your knowledge, is there currently an action pending in any of these areas? AbuseIf there was a prior custody action, who was the conciliator? I certify all the above statements are true and correct. Date20 Signature Counsel for: