IN THE COURT OF COMMON PLEAS OF LEHIGH COUNTY, PENNSYLVANIA

CIVIL ACTION

)	NO.
Plaintiff	)
vs	)	CUSTODY
)
Defendant	)
CUSTODY COMPLAINT AND RELATED DOCUMENTS –

AFFIDAVIT OF SERVICE BY PERSONAL SERVICE

Pursuant to Pa. R.C.P. 1930.4

I,	, hereby depose and say that I am 18 years or older,
(print full name)
and am not a party to the case, nor an employee or a relative of a party.
Complete A, B, or C:

A.	On	, at	AM PM I personally served the Defendant at
(fill in date)	(fill in time)
by handing to him or her
(fill in address or location)
filed copies of the Complaint for Custody, scheduling Order of Court, Plaintiff’s completed Criminal Record/Abuse History Verification and a blank Criminal Record/Abuse Verification form for Defendant

to complete and file.
OR

B.	On	, at	AM PM at the Defendant’s residence at,
(fill in date)	(fill in time)
I handed filed copies of
(fill in address or location)
the Complaint for Custody, scheduling Order of Court, Plaintiff’s completed Criminal Record/Abuse History Verification and a blank Criminal Record/Abuse Verification form for Defendant to complete

and file to:
Check One:

i) an adult member of the family identified as Defendant’s
(identify relation)
with whom the Defendant resides at the Defendant’s residence.
ii) an adult identified as	in charge of the residence
(fill in name)
where the Defendant resides since no family member of the Defendant was available.
iii) the clerk or manager identified as	of the
(fill in name and title)
hotel, inn, apartment house, boarding house, or other place of lodging of the Defendant.
iv) the Defendant or the person for the time being in charge of the Defendant’s office or
usual place of business, identified as	.
(fill in name and title)
OR

C.	On	, service was completed pursuant to Special Order of Court (explain)
(fill in date)

I verify that the statements in this document are true and correct to the best of my 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:
Signature:

Rachel A Wotring

2023-02-01