Rule 1915.15. Form of Complaint. Caption. Order. Petition to Modify a Custody Order. *** (b) A petition to modify a custody order shall be in substantially the following form: (Caption) PETITION FOR MODIFICATION OF A CUSTODY ORDER 1. Petitioner is _____________________ and resides at ____________________________.

2. Respondent is ___________________ and resides at ____________________________.

[1. The petition of __________________]3. Petitioner respectfully represents that on ____________, 20__ an Order of Court was entered for (shared legal custody) (sole legal custody) (partial physical custody) (primary physical custody) (shared physical custody) (sole physical custody) (supervised physical custody)[, a]. A true and correct copy of [which]the Order is attached.

[2]4. This Order should be modified because: _____________________________________________________________________ _____________________________________________________________________ [3]5. Petitioner has attached the Criminal Record/Abuse History Verification form required pursuant to Pa.R.C.P. No. 1915.3-2.

WHEREFORE, Petitioner requests that the Court modify the existing Order because it will be in the best interest of the child(ren).

______________________________ (Attorney for Petitioner) (Petitioner) I verify that the statements made in this petition 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. _________________________________ _________________________________ Date Petitioner ***