PA · rules

Chester Cnty. C.P. Family Court Rules 18

Notice and Order to Appear (Custody) C.C.R.C.P

activein force · 2002-01-01 – presentact-effective-date

1915.12.A.(f)

(willful disobedience/contempt of custody) Req’d by C.C.R.C.P. 1915.12(a)

19A. Notice and Order to Appear: Conciliation C.C.R.C.P.1915.15.A(a)

19B. Notice and Order to Appear: Relocation C.C.R.C.P.1915.17.A

20. Order (Divorce) C.C.R.C.P. 1920.73.A(a)

(grounds for divorce) Req’d by C.C.R.C.P. 1920.42(d)(1)

[to be printed on green paper]

21. Cert. of Trial Readiness (Divorce) C.C.R.C.P. 1920.74.A(b)

[to be printed on blue paper]

22. Motion & Order for Cont. C.C.R.C.P. 1930.1.A(a)[(b)(1)]

Req’d by C.C.R.C.P. 1920.72.A(a)

23.. Rule to Show Cause (Supp./Div) C.C.R.C.P. 1930.1.A(c)

Req’d by Pa. R.C.P. 206.6

Form 1 See CCRCP 1901.7.A.(b)(3) as req’d by 23 Pa.C.S. 6108.1 & CCRCP 1901.7.A.

Protection Order Number:

THE COUNTY OF CHESTER, OFFICE OF THE SHERIFF

201 W. Market Street, Suite 1201

P.O. Box 2746

West Chester, PA 19382-0989

FIREARM RELEASE REQUEST

A. REQUESTED INFORMATION:

LAST NAME FIRST NAME MIDDLE INITIAL SUFFIX

ADDRESS CITY STATE ZIP CODE

DATE OF BIRTH (MM/DD/YYYY) SOCIAL SECURITY # RACE SEX

DRIVER LICENSE # STATE OF ISSUANCE

HOME PHONE # MOBILE/CELL PHONE # EMAIL ADDRESS

*Please note that this process may take up to fifteen (15) days to complete. If your Firearms Release

Request is denied, you have the right to petition the Court pursuant to 18 Pa. C.S. § 6105.1.

B. ACKNOWLEDGEMENT OF RETURN (Sign in the presence of Law Enforcement Officer/Designee)

By signing below, I am confirming that if the request is approved, I am taking possession of the

firearm(s), other weapon(s), and/or ammunition referenced in the above Protection Order Number and

that they are in the same condition as when they were relinquished. I agree I will not hold the

Department or Agency identified below liable for any damage or reduction in value of the firearm(s),

other weapon(s), or ammunition.

I also certify that I am not prohibited by state or federal law from possessing of a firearm for any

reason. I understand that no relinquished item will be returned to me unless I successfully pass a

background check via the Pennsylvania Instant Check System (PICS) or National Instant Check

System (NICS) check or comparable check in the state of my residence.

Requestor Signature: Date: _

Returning Officer/Designee signs below:

Officer/Designee Signature: Date: _

See CCRCP 1901.7.A.(b)(3) as req’d by 23 Pa.C.S. 6108.1 & CCRCP 1901.7.A.

C. DEPARTMENT/AGENCY USE ONLY:

CHESTER CO. SHERIFF’s OFFICE PHONE #: ORI:

STREET ADDRESS CITY: STATE: ZIP CODE:

PROCESSING DEPUTY/DESIGNEE NAME: _ DATE:

PROTECTION ORDER NO.: DATE ORDER ISSUED (Attach copy):

DATE ORDER CANCELED/EXPIRED

DATE RELINQUISHED: DEPARTMENT/INCIDENT/CASE NO.:

DEFENDANT OTHERWISE PROHIBITED? YES NO

PICS CHECK CONDUCTED? YES NO PICS NO: _

FIREARM RETURNED? YES NO

If NO, explain in comments*

RECIEPT PROVIDED YES NO

FIREARMS EVIDENCE IN A CRIME? YES NO

PARTIAL RETURN? YES NO

If YES, explain in comments*

PLAINTIFF NOTIFIED? YES NO

If YES, attach copy of Certificate of Service indicating that at least 14 days have passed since request

DATE PLAINTIFF NOTIFIED:

METHOD OF NOTIFICATION:

DISTRICT ATTORNEY NOTIFIED? YES NO

If YES, attach copy of Certificate of Service indicating that at least 14 days have passed since request

DATE DISTRICT ATTORNEY NOTIFIED:

METHOD OF NOTIFICATION:

COMMENTS:

: IN THE COURT OF COMMON PLEAS

Plaintiff

: CHESTER COUNTY, PENNSYLVANIA

v s: N O.

: C I V I L A C T I O N - L A W

Defendant: PROTECTION FROM ABUSE

TO THE POLICE

Under the Pennsylvania Protection from Abuse Act, 23 P.S.§ 6101, et seq. you are authorized to arrest

the Defendant for a violation of the order, without warrant, upon probable cause, whether or not the violation

was committed in your presence. The defendant is to be taken forthwith before a District Justice for preliminary

arraignment. The Defendant can be found at the following address:

_________________________________________________________________________ during the hours

of ____________ a.m./p.m. to ___________ a.m./p.m.

Order effective from ______ _________, 20 _____ to __________________, 20 ____.

Form 2 See CCRCP Rule 1905.A.(a): form req’d by CCRCP 1901.4.A.

Form 3 See CCRCP 1905.A.(b): form req’d by CCRCP 1901.5.A.(a)

: IN THE COURT OF COMMON PLEAS

Plaintiff

: CHESTER COUNTY, PENNSYLVANIA

vs: NO.

: CIVIL ACTION - LAW

Defendant: PROTECTION FROM ABUSE

PROTECTION FROM ABUSE

INDIRECT CRIMINAL CONTEMPT AFFIDAVIT

On _______________________, 20___, _____________________________________

(Name of Defendant)

did commit the following in violation of a protection from abuse order entered by a Judge of the

Court of Common Pleas of Chester County, Pennsylvania on ____________________, 20_____

Docket No. ______________________.

The acts committed were:

____________________________________________________________________________

_______________________________________________________________________________

______________________________________________________________________

I verify that the statements made in this affidavit are true and correct. I understand that false

statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification

to authorities.

_____________________________________ _______________________________________

Witness Affiant

Date: ____________________ Name:_________________________

Address:_______________________

______________________________

Form 4 See CCRCP 1905.A.(c): form req’d by CCRCP 1901.5.A.(a)

IN THE COURT OF COMMON PLEAS OF CHESTER COUNTY, PENNSYLVANIA

Plaintiff: No.

v. : Civil Action

: Indirect Criminal Contempt

Defendant: for Violation of Protection From Abuse Order

COMPLAINT

I, the undersigned, do hereby state under oath:

1. My name is ___________________________________________ and I live/work at

________________________________________________ ;

2. I accuse _________________________________________ , who lives at

____________________________________________________ , with violating a protection from

abuse order entered by Judge ______________ on the______ day of ____________, 20____

(attach copy of order if available);

3. The date (and day of the week) when the accused committed the offense was on or about

__________________________________________________________.

4. The place where the offense was committed was in the County of Chester;

5. The acts committed by the accused were: (place an X before the appropriate statement(s))

_____ attempting to cause or intentionally, knowingly or recklessly causing bodily injury

to_________________________________________

-or-

_____ using physical menace to put _________________________ in fear of imminent serious

bodily injury,

all of which were in violation of the protection from abuse order entered in accordance with the

Protection from Abuse Act, 23 Pa.C.S. §6101 et seq.;

See CCRCP 1905.A.(c): form req’d by CCRCP 1901.5.A.(a)

6. If the defendant has not already been arrested, I ask that a warrant of arrest be issued and that

the accused be required to answer the charges I have made.

I verify that the statements made in the complaint are true and correct to the best of my

knowledge, information and belief. I further understand that any false statements made herein are subject

to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities.

________________________________________

Date __________________ Signature of Affiant

The above subscribed affiant personally appeared before me on this date, signed the complaint in

my presence and asserted that the facts therein are true and correct; and wherefore it appears that there is

probable cause for the issuance of process.

Date __________________ ___________________________________(SEAL)

Issuing Authority

Form 5 See CCRCP 1905.A.(d): form req’d by CCRCP 1901.5.A.(e)

: IN THE COURT OF COMMON PLEAS

Plaintiff

: CHESTER COUNTY, PENNSYLVANIA

vs: NO.

: CIVIL ACTION - LAW

Defendant: PROTECTION FROM ABUSE

NOTICE OF HEARING TO DEFENDANT

________________________________________________________________

(Name of Defendant)

You have been charged with Indirect Criminal Contempt for an alleged Violation of a Protection

From Abuse Order. A hearing has been scheduled in the Chester County Justice Center, 201 West Market

Street, West Chester, Pennsylvania, on the_______ day of ______________ , 20_____. The hearing will

be held in Courtroom No. ______ at 10:30 a.m. FAILURE TO APPEAR AT THIS HEARING WILL

RESULT IN THE ISSUANCE OF A WARRANT FOR YOUR ARREST.

If you are found guilty of Indirect Criminal Contempt, you may be sentenced to prison for up to

six (6) months and fined up to $1,000.00 for each offense. You should be represented by a lawyer at this

hearing. If you do not have a lawyer you may call the Chester County Public Defender's Office at the

Justice Center, 201 West Market St, second floor, West Chester, Pennsylvania, (610) 344-6940, any

business day between 8:30 a.m. and 4:30 p.m. IF YOU WANT A PUBLIC DEFENDER,

APPLY IMMEDIATELY UPON RECEIPT OF THIS NOTICE.

VERIFICATION

I, ________________________ , of _________________________ , do hereby verify that the

(Dist. Ct./Police/other)

above notice was served upon _________________________________________________________

(Defendant)

on the ____________ day of ________________ , 20_____ , at ____________ (a.m./p.m.).

This service was made at _____________________________________________________________

(location of service)

_____________________________

(Signature and Title of Server)

Form 6 See CCRCP 1905.A.(e): form req’d by CCRCP 1901.5.A.(e)

: IN THE COURT OF COMMON PLEAS

Plaintiff

: CHESTER COUNTY, PENNSYLVANIA

vs: NO.

: CIVIL ACTION - LAW

Defendant: PROTECTION FROM ABUSE

NOTICE OF HEARING TO PLAINTIFF

________________________________________________________________

(Name of Plaintiff)

________________________________________________________________ has been

(Name of Defendant)

charged with Indirect Criminal Contempt for an alleged violation of a Protection From Abuse Order

wherein you are the Plaintiff. A hearing has been scheduled in the Chester County Justice Center, 201

West Market Street, West Chester, Pennsylvania, on the ______________ day of __________________ ,

20 ____. The hearing will be held in Courtroom No. _______, at 10:30 a.m.

You will be represented by the Chester County District Attorney's Office at this hearing. You may

contact that office at (610) 344-6801 for information as to which Assistant District Attorney will be

representing you at the hearing. It is not required, but would be helpful, if you would list your present

address and telephone number in the space provided so the District Attorney may contact you.

If you do not appear at the hearing, the charges may be dismissed.

Name: ________________________________________________________________

Address: ________________________________________________________________

Phone Number: ________________________________________________________________

VERIFICATION

I, _______________________ , of __________________________________ ,

(Dist. Ct./Police/other)

do hereby verify that the above notice was served upon

____________________________________________________________

(Plaintiff)

On the ________ of _____________ , 20_____ , at _________ (a.m./p.m.).

This service was made at ______________________________________________________

___________________________________________________________________________

(location of service)

__________________________

(Signature and Title of Server)

Form 7 See CCRCP 1905.A.(f)

: IN THE COURT OF COMMON PLEAS

Plaintiff

: CHESTER COUNTY, PENNSYLVANIA

vs: NO.

Defendant: PROTECTION FROM ABUSE

MOTION FOR CONTINUANCE

AND NOW, this _______ day of _______________, 20___, upon motion of

_____________________________________, it is hereby requested that the hearing scheduled for

_______________________________, 20_____, concerning Protection from Abuse be continued for the

following reason(s): ___________________________________________________________

_____________________________________________________________________________________

___________________________________________________________________

The opposing party/counsel __________________________ (name) has been notified and

AGREES/DISAGREES (circle).

________________________________

Party/Counsel for:

________________________________

(Name)

________________________________

(Telephone Number)

TEMPORARY ORDER AND ORDER FOR CONTINUANCE

AND NOW, this _______ day of ________________, 20___, upon motion of

____________________________________, it is hereby ORDERED and DECREED that the continuance

is GRANTED/DENIED and the Protection from Abuse hearing is continued and rescheduled to the

_______ day of ______________________, 20___ at ______ __.m. in Courtroom No. ____, Chester

County Justice Center, 201 West Market Street, West Chester, Pennsylvania.

See CCRCP 1905.A.(f)

The Temporary Order for Protection from Abused dated ___________________, 20__ shall remain

in full force and effect until further Order of this Court.

[Failure of the Plaintiff to appear for hearing may result in dismissal of the Protection From

Abuse Petition and the entry of an Order requiring the costs of the proceeding to be paid by the

Plaintiff.]

Failure of the Defendant to appear for hearing may result in the issuance of a final Protection From

Abuse Order and an Order to pay costs.

BY THE COURT:

___________________________________

Note: All counsel seeking a continuance of a Protection from Abuse matter shall file an entry of appearance.

Form 8 See CCCRP Rule 1910.12.A.(i)(1)

: IN THE COURT OF COMMON PLEAS

Plaintiff

: CHESTER COUNTY, PENNSYLVANIA

vs: NO.

: CIVIL ACTION - LAW

Defendant: IN SUPPORT

MOTION FOR A SEPARATE LISTING

AND NOW, this ______ day of ________________, 20 _____, Plaintiff/Defendant moves the

Court for a separate listing and in support thereof avers the following:

(1) The hearing will be protracted in nature and requires more than two (2) hours for hearing; or

(2) There are complex questions of law, fact, or both.

(3) Issues for resolution: (state if case entails a determination of income or if incomes exceed the

guidelines, whether or not it is a self-employment case, whether or not valuations are at issue)

(4) Estimated duration of hearing:

(5) Number of witnesses: (state whether or not witnesses are experts).

Respectfully submitted,

___________________________________

Counsel for:

cc: _______________________________, Esquire - Attorney for __________________________

N.B. Failure to complete this form in its entirety will result in its rejection by the Family Court

Administrator and the case will not be placed on the Long Day Hearing List.

Form 9 See CCRCP Rule 1910.12.a.(i)(iv)(d)

Form to be printed on blue paper

IN THE COURT OF COMMON PLEAS CHESTER COUNTY, PENNSYLVANIA

: IN THE COURT OF COMMON PLEAS

Plaintiff

: CHESTER COUNTY, PENNSYLVANIA

vs: NO.

: PACSES:

: CIVIL ACTION – DOMESTIC RELATIONS

Defendant: IN SUPPORT

CERTIFICATION OF TRIAL READINESS - SUPPORT

Please place the above-captioned case on the trial list of _________________, Esquire, Hearing

Officer and schedule it for a hearing. NO CONTINUANCES SHALL BE GRANTED WITHOUT GOOD

CAUSE SHOWN. FAILURE TO BE READY AT THE TIME THE CASE IS CALLED MAY RESULT

IN THE REASSIGNMENT OF THE CASE ON THE TRIAL LIST.

If after fifteen (15) days the adverse party fails to execute this certificate, the moving party may

certify the matter as an active case.

I hereby certify that:

1. Discovery is complete;

2. On ________________, I notified all interested parties.

Estimated trial time for the presentation of the entire case: ________________________.

________________________________ __________ ____________________________

Signature of Attorney for Plaintiff Signature of Attorney for Defendant

________________________________ __________________________________

Type Name & Attorney ID # Type Name & Attorney

_____________________________ __________________________________

Address of Attorney for Plaintiff Address of Attorney for Defendant

_____________________________ __________________________________

Telephone # of Attorney for Plaintiff Telephone # of Attorney for Defendant

________________________________________________________________________

Unrepresented party (signature), name and address (typed)

(This form is printed on blue paper)

Form 10 C.C.R.C.P. Rule 1910.20.A

: IN THE COURT OF COMMON PLEAS

Plaintiff

: CHESTER COUNTY, PENNSYLVANIA

vs: NO.

: CIVIL ACTION - LAW

Defendant: IN SUPPORT

NOTICE

Pursuant to § 4303 of Act 1985-66, a Consumer Credit Bureau Organization has requested the

amount of arrearages owed by you under your existing support order. Domestic Relations must provide

this information to the Consumer Credit Bureau Organization on any arrearage in excess of $1,000.00

Our records show an arrearage of $ ________ on the above order.

You may contest the accuracy of this information by contacting the Domestic Relations Office at

the Chester County Justice Center, 201 West Market Street, West Chester, PA, (610) 344-6215

no later than _________________________, 20_____. If you fail to contact Domestic Relations by said

date, the figure stated above will be reported to the Consumer Credit Bureau Organization.

Form 11 See CCRCP 1915.15A.I. (c): req’d in Pa. R.C.P. 1915.4.A.I.(c)

: IN THE COURT OF COMMON PLEAS

Plaintiff

: CHESTER COUNTY, PENNSYLVANIA

vs: NO.

: CIVIL ACTION - LAW

Defendant

: IN CUSTODY

NOTICE AND ORDER TO APPEAR

You ______________________, plaintiff/defendant, have been sued in court to obtain/modify

custody of the child(ren):

_______________________________________________________________________

You are hereby notified of the following:

1. Court Ordered Mediation: You are ordered to contact the Mediator assigned to your case within

three (3) days of receiving these papers to schedule mediation orientation.

Mediator: _________________________________ Phone __________________________

Failure to contact the mediator and attend mediation orientation may result in sanctions, including, but

not limited to, a fine of up to $100, delay in your custody proceedings or other appropriate sanction.

2. Custody Conciliation Conference: You are ordered to appear in person at the Chester County

Justice Center, 5th Floor, Conciliation Room, 201 West Market Street, West Chester, PA for a

Custody Conciliation Conference on __________________________________, 20____ at

___________, ___.m. at which time a recommendation for a custody Order may be entered.

If you fail to appear, an order for custody may be entered against you or the court may

issue a warrant for your arrest.

3. Online Parenting Class:

All parties are required to attend by remote means the following:

Chester County, PA Parenting Class

Center for Divorce Education’s Children In Between

See CCRCP 1915.15.4.A.II.(c): req’d in Pa. R.C.P. 1915.4.A.II.(c)

All parties are directed to enroll online at Center for Divorce Education’s website:

online.divorce-education.com

Failure to attend may affect your rights to custody, partial custody or visitation.

4. You must file with the Court verification as required by Pa.R.Civ.P. 1915.3-1 in the form attached

regarding any criminal record or abuse history regarding you and anyone living in your household

within thirty days of the service of the within complaint or petition on you, but not later than the

custody conciliation conference scheduled in Paragraph 2, above.

No party may make any change in the residence of any child which significantly impairs the ability of the

other party to exercise custodial rights without first complying with all the applicable provisions of 23

Pa.C.S. § 5337 and Pa.R.Civ.P. 1915.17 regarding relocation.

YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A

LAWYER, PLEASE CONTACT THE OFFICE SET FORTH BELOW:

Lawyer Referral Service

15 West Gay Street

West Chester, PA 19380

610-429-1500

IF YOU CANNOT AFFORD A LAWYER, PLEASE CONTACT THE OFFICE SET FORTH BELOW:

Legal Aid of Southeastern Pennsylvania

Chester County Division

222 North Walnut Street, 2nd Floor

West Chester, PA 19380

610-436-4510

AMERICAN WITH DISABILITIES ACT OF 1990

The Court of Common Pleas of Chester County is required by law to comply with the Americans with

Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to

disabled individuals having business before the court, please contact Family Court Administration at 610-344-

6405. All arrangements must be made at least 72 hours prior to any hearing or business before the court. You

must attend the scheduled conference.

BY THE COURT:

Date: _____________ _____________________________________

Form 12 See CCRCP Rule 1915.4.A.III. (c)

Form to be printed on blue paper

: IN THE COURT OF COMMON PLEAS

Plaintiff

: CHESTER COUNTY, PENNSYLVANIA

vs: NO.

: ACTION - LAW

Defendant: IN CUSTODY

CERTIFICATE OF TRIAL READINESS

TO THE FAMILY COURT ADMINISTRATOR:

The undersigned counsel certify this matter to be trial ready.

Estimated time of trial for both sides: __________________ (An estimated time of hearing must be

entered or the demand will be rejected by the Family Court Administrator and the case will not be listed for

trial.)

______________________________ ______________________________

Attorney for I.D. # Attorney for I.D. #

______________________________ ______________________________

Address Address

______________________________ ______________________________

Date: ____________________ Date: ____________________

CHOOSE ONE: Evaluations ARE/ARE NOT pending.

SEE PA.R.C.P. RULE 1915.4.4 AND CHESTER COUNTY FORM #12

See 23 Pa.C.S.§5331 for the contents of the proposed Parenting Plan.

(This form is printed on blue paper)

Form 13 See CCRCP 1915.4.A.II.(d), Req’d by Pa. R.C.P. 1915.4.II(d)

: IN THE COURT OF COMMON PLEAS

Plaintiff

: CHESTER COUNTY, PENNSYLVANIA

vs: NO.

: ACTION - LAW

Defendant: IN CUSTODY

THE PRETRIAL STATEMENT OF PLAINTIFF/DEFENDANT

PURSUANT TO C.C.R.C.P. 1915.4.A.II.(d)

Plaintiff/Defendant, _____________, files the instant Pretrial Statement pursuant to C.C.R.C.P.

1915.4.A(c).

A. Brief Statement of the Claims by moving party or defense by responding party:

_____________________________________________________________________________

B. Concise Statement of the Facts:

_____________________________________________________________________________

C. Concise Statement of the Factual and Legal Issues, if any, including citations to applicable

statutes and case law, if applicable:

_____________________________________________________________________________

Page 1 of 2/3

D. Witnesses to be Called at Trial (names and addresses):

E. Schedule of Exhibits to be offered at trial:

F. Estimated length of time for trial:

G. Proposed Custody Order and Parenting Plan:

See attached proposed Custody Order.

H. Criminal Record/Abuse History Verification:

To be updated prior to trial.

I. Attach any reports of experts to be called at trial.

Respectfully submitted,

____________________________

Plaintiff/Defendant

NOTICE

All pretrial statements shall not exceed three (3) pages in length. A time-stamped copy of the filed pretrial

statement shall be served on Family Court and opposing counsel/pro se litigant. Failure to comply with the

timely filing of a pretrial statement may result in the imposition of sanctions including but not limited to

the exclusion of evidence at trial, fines and costs.

Page 2/3 of 2/3

Form 14 See CCRCP 1915.4.A.III.(a), 1915.13.A and 1930.1.A(c) Req’d by Pa. R.C.P. 206.6

: IN THE COURT OF COMMON PLEAS

Plaintiff

: CHESTER COUNTY, PENNSYLVANIA

vs: NO.

: ACTION - LAW

Defendant: IN CUSTODY

RULE RETURNABLE

AND NOW, this day of ,20__, upon consideration of the Petition for

________________________, a Rule is issued upon the Respondent, ______________, to show cause, if

any he/she may have, why the prayer of the Petition should not be granted.

Rule Returnable due the day of, 20__, with hearing on

day of, 20__, at a.m./p.m. in Courtroom No. , Chester

County Justice Center, West Chester, PA.

The respondent is advised the well-pled facts of the Petition shall be deemed admitted unless a

response specifically denying same is filed by the close of court on or before the rule returnable date set

for above.

Petitioner makes a good faith estimate of the total time for this hearing to be: ______________.

BY THE COURT:

_________________________

Form 15 See CCRCP 1915.11.A(b)(2)(ii)(a): form req’d by CCRCP 1915.11.A.(b)(2)

: IN THE COURT OF COMMON PLEAS

Plaintiff

: CHESTER COUNTY, PENNSYLVANIA

vs: NO.

: ACTION - LAW

Defendant: IN CUSTODY

ORDER FOR APPEARANCE

WHEREAS, a Custody Conciliation Conference in this matter has been scheduled for the _________

day of __________________, 20 ___ at ___________ ____m. before a Chester County Custody Conciliator

in the Custody Conciliation Room at the Justice Center, 201 West Market Street,

5th floor, West Chester, Pennsylvania, and,

WHEREAS, ________________________________, who is a party to these proceedings has

requested the presence at the Conciliation Conference of the children named below who are the subject of these

proceedings and are ten (10) years of age or older,

IT IS HEREBY ORDERED that the following minor children shall attend the aforesaid Conciliation

Conference:

Name ___________________________ Date of Birth ____________________

BY THE COURT:

Date: _______________ ____________________________

See CCRCP 1915.11.A(b)(2)(ii)(a): form req’d by CCRCP 1915.11.A.(b)(2)

1. Has the child or children been interviewed by a conciliator or Judge? If yes, please provide all of

the dates.

2. Have the parties/children participated in any court ordered evaluations or therapy within the last

six months. If yes, when was it ordered? Will a report from the therapist/evaluator be provided at the

conciliation conference?

3. Please provide a statement as to why the child’s appearance is necessary. If the request is for

more than one child to appear, please highlight why each child is necessary.

Form 16 See CCRCP 1915.11-1.A.(b)(4)(i): form req’d by CCRCP 1915.11-1.A(b)

AFFIDAVIT – ATTORNEY

I, ________________________ , the undersigned applicant, hereby certify that I possess the minimum

qualifications to serve as a Parenting Coordinator as established by Pa.R.Civ.P. 1915.11-1.(b)(1),(2), as

follows:

1. ______ I am licensed to practice in the Commonwealth of

Pennsylvania. My Attorney ID number is _____________.

_______ My license is in good standing.

________ I have never been subject to attorney discipline. (If Applicant has been subject to

discipline, provide details on separate sheet).

________ I have practiced Family Law for ______ years, as follows (or attach CV):

__________________________________________________________

2. ________ I have obtained the special training required by the Rule and have attached

verification for each training:

______ hours in the Parenting Coordination process, of which 2 or more hours were

specific to Pennsylvania PC practice.

Date of training: _________________________

Provider: ______________________________

______ hours of Family mediation (or hours of non-specific mediation training and hours

of Family Mediation conducted).

Date of training: ________________________

Provider: ______________________________

______ hours of Domestic Violence training.

Date of training: ________________________

Provider: ______________________________

3. _________ I understand that to remain qualified as a Parenting Coordinator in each 2-year

period after March 1, 2019, I must take a minimum of 10 additional continuing education credits,

of which at least 2 must be on domestic violence.

4. _________ I maintain Professional Liability insurance of $___________, which coverage

expressly covers me for serving as a Parenting Coordinator. The Declaration page showing the

foregoing is attached.

1. I acknowledge that I may not charge more than $350 per hour (although I may charge less), nor

require more than a $1,500 initial retainer. My hourly rate for Parenting Coordination is:

$____________.

2. ________ I acknowledge I must accept one pro bono PC appointment for every 2 fee-generating

appointments in this judicial district/county, up to 12 hours per pro bono case. I understand that it

is my responsibility to advise the court upon acceptance of the second appointment. I further

understand that failing to accept a pro bono assignment or to notify the Court is grounds for

removal from the roster maintained by this county. My obligation to provide pro bono work is

ongoing and does not expire in the event I do not receive a pro bono case.

3. ________ I have read Pa.R.Civ.P. 1915.11-1 and understand the scope (and) limits of my

authority and the procedures which I must follow when appointed as a Parenting Coordinator.

4. ________ I acknowledge that I have read the Guidelines for Parenting Coordination

promulgated by the American Psychological Association and Association of Family and

Conciliation Court.

https://www.apa.org/practice/guidelines/parenting-coordination

https://www.afccnet.org/Resource-Center/Practice-Guidelines

I swear or affirm that the foregoing statements are true and correct.

APPLICANT:

Name (printed) _______________________

Signature ___________________________

Date: ___________________

FOR OFFICIAL USE ONLY

Qualifications Reviewed by: ______________ (initials)

Place application on Roster: __________ _____________

Yes No

If No, state reasons:

______________________________________________________________

_________________________

Form 17 See Rule 1915.11-1.A.(b)(4)(ii): form req’d by CCRCP 1915.11-1.A(b)(1)

AFFIDAVIT – MENTAL HEALTH PROFESSIONAL

I, ________________________ , the undersigned applicant, hereby certify that I possess the minimum

qualifications to serve as a Parenting Coordinator as established by Pa.R.Civ.P. 1915.11-1(b)(1),(2), as

follows:

1. _______ I have the following professional degree: _______________ from (Institution and date

granted): _____________________________

2. ______ I am licensed to practice in the Commonwealth of

Pennsylvania as a _______________________. My license number is _______________.

_______ My license is in good standing.

________ I have never been subject to professional discipline. (If Applicant has been subject to

discipline, provide details on separate sheet).

________ I have ______ years of experience in dealing with families involved in child custody

matters, as follows: (or attach CV):

__________________________________________________________

______________________________________________________

__________________________________________________________

3. ________ I have obtained the special training required by the Rule and have attached

verification for each training:

______ hours in the Parenting Coordination process, of which 2 or more hours were

specific to Pennsylvania PC practice.

Date of training: _________________________

Provider: ______________________________

______ hours of Family mediation (or hours of non-specific mediation training and hours

of Family Mediation conducted).

Date of training: ________________________

Provider: ______________________________

______ hours of Domestic Violence training.

Date of training: ________________________

Provider: ______________________________

4. _________ I understand that to remain qualified as a Parenting Coordinator in each 2 year

period after March 1, 2019, I must take a minimum of 10 additional continuing education credits,

of which at least 2 must be on domestic violence.

5. _________ I maintain Professional Liability insurance of $___________, which coverage

expressly covers me for serving as a Parenting Coordinator. The Declaration page showing the

foregoing is attached.

6. _________ I acknowledge that I may not charge more than $350 per hour (although I may

charge less), nor require more than a $1,500 initial retainer. My hourly rate for Parenting

Coordination is: $____________.

7. ________ I acknowledge I must accept one pro bono PC appointment for every 2 fee-generating

appointments in this judicial district/county, up to 12 hours per pro bono case. I understand that it

is my responsibility to advise the court upon acceptance of the second appointment. I further

understand that failing to accept a pro bono assignment or to notify the Court is grounds for

removal from the roster maintained by this county. My obligation to provide pro bono work is

ongoing and does not expire in the event I do not receive a pro bono case.

8. ________ I have read Pa.R.Civ.P. 1915.11-1 and understand the scope (and) limits of my

authority and the procedures which I must follow when appointed as a Parenting Coordinator.

9. ________ I acknowledge that I have read the Guidelines for Parenting Coordination

promulgated by the American Psychological Association and Association of Family and

Conciliation Court.

https://www.apa.org/practice/guidelines/parenting-coordination

https://afccnet.org/Resource-Center/Practice-Guidelines

I swear or affirm that the foregoing statements are true and correct.

APPLICANT:

Name (printed) _______________________

Signature ___________________________

Date: ___________________

FOR OFFICIAL USE ONLY

Qualifications Reviewed by: ______________ (initials)

Place application on Roster: __________ _____________

Yes No

If No, state reasons:

______________________________________________________________

BY THE COURT:

_________________________

Form 18 See CCRCP 1915.12.A.(f): form req’d in Pa.R.Civ.P. 1915.12(a)

: IN THE COURT OF COMMON PLEAS

Plaintiff

: CHESTER COUNTY, PENNSYLVANIA

vs: NO.

: CIVIL ACTION - LAW

Defendant: IN CUSTODY

NOTICE AND ORDER TO APPEAR

Legal proceedings have been brought against you alleging you have willfully disobeyed an order

of court for custody. If you wish to defend against the claim set forth in the following pages, you may but

are not required to file, in writing, with the court your defenses or objections.

An evidentiary hearing has been scheduled for ________________________________, 20______

at _____________________ ____ m. in the Chester County Justice Center, 201 West Market Street, Fifth

(5th) Floor, Hearing Room: A, West Chester, PA.

Whether or not you file in writing with the court your defenses or objections, you must appear in

person for this hearing.

IF YOU DO NOT APPEAR IN PERSON, THE COURT MAY ISSUE A WARRANT FOR

YOUR ARREST.

If the court finds that you have willfully failed to comply with its order for custody, you may be

found to be in contempt of court and committed to jail, fined or both.

YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE

A LAWYER, PLEASE CONTACT THE OFFICE SET FORTH BELOW:

Lawyer Referral Service

15 West Gay Street

West Chester, PA 19380

610-429-1500

See CCRCP 1915.12.A.(f): form req’d in Pa.R.Civ.P. 1915.12(a)

IF YOU CANNOT AFFORD A LAWYER, PLEASE CONTACT THE OFFICE

SET FORTH BELOW:

Legal Aid of Southeastern Pennsylvania

Chester County Division

222 North Walnut Street, 2nd floor

West Chester, PA 19380

610-436-4510

AMERICANS WITH DISABILITIES ACT OF 1990

The Court of Common Pleas of Chester County is required by law to comply with the Americans

with Disabilities Act of 1990. For information about accessible facilities and reasonable

accommodations available to disabled individuals having business before the court, please contact

our office. All arrangements must be made at least 72 hours prior to any hearing or business before

the court. You must attend the scheduled conference.

BY THE COURT:

Date: _________________ __________________________________

Form 19A See CCRCP 1915.15A(a): req’d in Pa. R.C.P. 1915.3(a)

: IN THE COURT OF COMMON PLEAS

Plaintiff

: CHESTER COUNTY, PENNSYLVANIA

vs: NO.

: CIVIL ACTION - LAW

Defendant

: IN CUSTODY

NOTICE AND ORDER TO APPEAR

You ______________________, defendant, have been sued in court to obtain/modify custody of

the child(ren):