DATE: _________________, ______ HEARING REQUIRED: YES NO MOTIONS JUDGE: ________________________ HEARING JUDGE: ________________________ CAPTION: DOCKET NO: ________________________ VS. _________________________ ________________________ FAMILY / ORPHANS' DIVISION MOTION COVER SHEET AND NOTICE You are hereby notified that the attached motion/petition will be presented by me on: _________________________, ______: to the Court Administrator as a contested matter 9:00 a.m. ­ 11:00 a.m. and 1:30 p.m. ­ 3:00 p.m. Monday through Friday: to Motion Court at 9:00 a.m. Monday through Thursday CERTIFICATION OF NOTICE AND SERVICE (To be completed for Motion Court presentation) The undersigned represents that a copy of this motion and proposed order have been served upon all parties or their counsel of record on _______________, _____ in accordance with: A. Local Rule No. 440, hereby providing: Two full business days prior notice by hand delivery, fax, Five full business days prior notice by mail; or B. Local Orphans' Court Rule 12 for Special Petitions, thereby providing: Ten full business days written notice. UNCONTESTED MOTION CERTIFICATE The undersigned represents that: All parties or counsel have consented and consents are attached. The Order seeks only a return hearing or argument date and no other relief. INFORMATION FOR COURT ADMINISTRATOR If a Judge has heard previously, please identify: Trucilla Domitrovich Cunningham Kelly Brabender Sambroak Mead Walsh Estimated court time required Is this motion/petition opposed? ___minutes ___hours ___ days yes no unknown A. B. C. (OVER) American LegalNet, Inc. www.FormsWorkFlow.com FAMILY COURT MOTIONS CUSTODY: Petition/Motion relating to: Temporary custody Approval of custody agreement Waive attendance at seminar Custody Other:______________________________ In Forma Pauperis Special relief (Cust) Cust Contempt Continuance (Cust) Counsel fees & expenses(Cust) In Forma Pauperis Approve QDRO Divorce Contempt Divorce, Special Relief Amend pleadings divorce Counsel fees & expenses(Div) DIVORCE: Petition/Motion relating to: Exclusive possession of property Bifurcation Filing Inven/Pre-Trial Stmt Waive Attendance at seminar Alimony Pende Lite Divorce Other:_______________________________ SUPPORT: Petition/Motion relating to: Cont conf/de novo hrg (support) Support Other:_______________________________ In Forma Pauperis Paternity/Blood tests Support Contempt ORPHANS' COURT MOTIONS DECEDENTS' ESTATES: Petition/Motion relating to: ADOPTIONS: Petition for: Inheritance Tax Return Family Exemption Settlement of Small Estate Approval of sale of property App settlement/Wrongful Death, et Decedents' Estates Other:____________________ Adoption Voluntary Relinquishment Involuntary Termination Confirm Consent Adoption Adoption Other:_____________ MINOR'S ESTATES: Petition for: Appr Set of Minor's Claim Auth to Release Funds from Minor's Account Minor's Estates Other:____________________ GUARDIANSHIPS: Petition for: Minor guardianship Alleged Incapacitated Emergency Intervention Discharge/Sub/Guardian Guardianship Other:________________ I hereby certify all of the above statements are true and correct. Name(s) of opposing counsel or pro se litigants By ______________________________________ ______________________________________________ Attorney for Plaintiff Defendant ______________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com