Complaint For Custody-Support-Parenting Time {CJ-D 109}

COMPLAINT FOR CUSTODY-SUPPORT-PARENTING TIME PURSUANT TO G. L. c. 209C First Name M.I Last Name Docket No. Commonwealth of Massachusetts The Trial Court Probate and Family Court ,Plaintiff Division v. First Name M.I Last Name ,Defendant , is 1. Plaintiff, who resides at the the the Plaintiff is: mother guardian parent father (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) of a child born out of wedlock. a child born out of wedlock. custodian of a child born out of wedlock. personal representative of the mother father of a child born out of wedlock. Department of Revenue Department of Children and Families an agency licensed under G. L. c. 28A 2. The child who is the subject of this complaint is: First Name (Address) M.I. (Apt, Unit, No. etc.) (Address) Last Name (City/Town) (Apt, Unit, No. etc.) Current age (State) (City/Town) (State) Date of Birth (Zip) (Zip) 3. Defendant, who resides at is the mother father of the above-named child who was born out of wedlock. 4. The plaintiff and defendant are not married. 5. The mother of the child was not married at the time of the child's birth and was not married within three hundred days before the birth of the child. 6. The on plaintiff (date) defendant signed a voluntary acknowledgement of paternity , a copy of which is attached to this complaint. was adjudicated the father 7. Wherefore, plaintiff requests that the Court: order a suitable amount of support for the child. order the grant the grant the plaintiff plaintiff plaintiff defendant to maintain provide health insurance for the benefit of the child. plaintiff and/or the child. prohibit the defendant from imposing any restraint on the personal liberty of the defendant custody of the child. defendant parenting time with the child. Date: Signature of Attorney or Plaintiff, if pro se (Print name) (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) Primary Phone #: B.B.O. # CJ-D 109 (7/15/15) page of