IN THE COURT OF COMMON PLEAS OF LEHIGH COUNTY, PENNSYLVANIA

CIVIL / FAMILY DIVISION

)	NO. -FC-
)
Plaintiff	)
vs	)	CUSTODY
)	ASSIGNED JUDGE:
)
Defendant	)

Petition to Confirm Relocation and Modify Custody Order

AND NOW, comes
(name of Plaintiff or Defendant)
and in support of this Petition avers as follows:
1.	The Petitioner is	.
2.	The Petitioner seeks to confirm relocation of the following minor child/children:
Child’s Initials	Year of Birth
3.	Petitioner sent a Notice of Proposed Relocation to
(name of other parent)
on
by
(date)
certified mail, return receipt requested, addressee only
personal service
4.	Proof of service was filed on
with the Clerk of Judicial Records.
(date)
5.	Thirty (30) days have passed since Respondent’s receipt of the Notice, and Respondent has not filed a Counter Affidavit with the Court.

WHEREFORE, Petitioner respectfully requests that, pursuant to 23 Pa.C.S. § 5337, this Court enter an order granting Petitioner’s relocation, and modifying the existing custody order.
Respectfully submitted,
Petitioner (Signature)
VERIFICATION
I verify that the statements made in this pleading are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Sec. 4904 relating to unsworn falsification to authorities.
Date	Petitioner

CERTIFICATE OF COMPLIANCE

I certify that this filing complies with the provisions of the Public Access Policy of the Unified Judicial System of Pennsylvania: Case Records of the Appellate and Trial Courts that require filing confidential information and documents differently than non-confidential information and documents.

Submitted by
Signature:
Name:
Attorney No. (if applicable):

Rachel A Wotring

2020-02-14