Complaint for Custody - Maryland
Circuit Court for
Case No.
Name
Street Address
Apt. #
City State Zip Code
Area
Code
Telephone
City or County
Name
Street Address
Apt. #
City State Zip Code
Area
Code
Telephone
Plaintiff Defendant No. 1
Name
Street Address
Apt. #
City State Zip Code
Area
Code
Telephone
Defendant No. 2
COMPLAINT FOR CUSTODY
(DOM REL 4)
I, , representing myself, state that:
Your name
1. I am the mother father or
of the following minor child(ren):
Relationship (for example, aunt, grandfather, guardian, etc.)
Name of Child
Date of Birth
Name of Child
Date of Birth
Name of Child
Date of Birth
Name of Child
Date of Birth
Name of Child
Date of Birth
Name of Child
Date of Birth
2. is the mother father or
of the child(ren). Defendant No. 2 is the mother father of the child(ren).
Defendant
Relationship
3. The child(ren) live(s) at
with .
Address
Name of person
4. The child(ren) have lived in the following places, with the persons indicated during the last
five years:
(check one)
(check one)
Time Period Place Name(s)/Current Address of Person(s) with whom Child Lived
Page 1 of 3
DR 4 (Rev. 9/2005)
Page 1/3
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