IN THE COURT OF COMMON PLEAS OF MONTGOMERY COUNTY, PENNSYLVANIA CIVIL ACTION - LAW ___________________________________ VS. : NO. _______________________ : ___________________________________ : PETITION TO MODIFY (CUSTODY) (VISITATION) ORDER 1. The Petitioner is ___________________________________________________________ residing at ____________________________________________________________________ 2. The Respondent is __________________________________________________________ residing at ____________________________________________________________________ 3. Petitioner and Respondent are the natural parents of: Name of Child Date of Birth Present Residence ____________________ _______________ ___________________________________ ____________________ _______________ ___________________________________ ____________________ _______________ ___________________________________ ____________________ _______________ ___________________________________ Since the last custody Order was entered in this case, the child(ren) has/have resided with the following persons and at the following addresses: (List all persons) (List all addresses) (Dates) _____________________ _________________________________ _________________ _____________________ _________________________________ _________________ _____________________ _________________________________ _________________ American LegalNet, Inc. www.FormsWorkFlow.com 4. A custody Order was entered on (date) _____________________ in the Montgomery County Court of Common Pleas. A copy of the Order is attached. 5. Petitioner now seeks to modify the Order because: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com WHEREFORE, Petitioner respectfully requests that this Honorable Court modify the present (custody) (visitation) Order. Respectfully submitted ____________ Date ____________________________________ Petitioner ____________________________________ ____________________________________ (print your address) I verify that the statements made in this Complaint are true and correct as to my personal knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904, relating to unsworn falsification to authorities. ____________ Date ____________________________________ Petitioner American LegalNet, Inc. www.FormsWorkFlow.com