DR4 Complaint For Custody Petition is a form intended to request the custody of a child due to various reasons not favorable to the child/ren. The petitioner must specify his/her relationship with the child and seek custody of the child based on the options provided in DR4 form.
Attaching the most recent orders by the court/s is indispensable as an evidentiary proof of the cases mentioned in section 5 and 6 of DR4 form. You have to be very specific in mentioning the cause of the petition for the custody of the child/ren along with your choices of interactions of the child/ren with the other parties involved in some or the other way. The document DR4 also has the provision for seeking insurance and financial support for the child/ren through the court order. File form DR4, Complaint for Custody before the honorable judge of the Circuit Court in your county.
Before You Proceed
- Duly complete DR4 form for its legal standing
- Attach recent court orders as required in section 5 and 6
- Specify the reason/s for seeking the custody of the child as needed in form DR4
- Mark your choice in the boxes provided in the section seeking your preference for custody and visitation by other parties involved
- You must sign form DR4 duly to undertake the responsibility of the custody of the child under penalties of perjury
Begin by entering the county name and the case number followed by the name, street address, apt#, city, state, zip code along with telephone number and area code. Proceed with entering the same information for defendant 1 and defendant 2 if any.
Continue by entering your name followed by your relation to the child. Specify if you are a mother or father and describe the relation if anyone else. The next space in this section is reserved for specifying the names and date of birth of child/ren. Use a separate line for each child.
Mention the name of the defendant and his/her relation with the child/ren on the next line of form DR4. Write residential address of the child and the name of the person accompanying in section 3. The next section requires the input of details of the residency status of the child/ren along with the name and address of the person/s.
Enter the name of the court, case number, type of case, year of filing the case, and the status in the spaces provided in section 5. Specify the state, court, case number, and the date of the determination of child custody in the respective spaces in section 6. Continue by entering the names of the parties that have vested interests with the child like custody or visitation in section 7 of form DR4. Enter the reason why you seek the custody of child/ren in section 8 in detail.
Mark all that apply from the following portion of form DR4. Select options on the type of custody and mode of visitation followed by reason for no visitation. The form has space to request the support for insurance and financial support for child/ren. You can attach Form Dom. Rel. 30 or Dom. Rel. 31 in support of your request. The next space needs input of other requests if any.
Complete the form by writing your name and then date in the subsequent lines. Sign in the space reserved for the same.
Maryland Child Custody DR 4 Form
Text version of this Form
———————– Page 1———————–
Circuit Court for Case No.
City or County
Name Name
Street Address Apt. # Street Address Apt. #
City State Zip Code Area Telephone City State Zip Code Area Telephone
Code Code
Plaintiff Defendant No. 1
Name
Street Address Apt. #
City State Zip Code Area Telephone
Code
Defendant No. 2
COMPLAINT FOR CUSTODY
(DOM REL 4)
I, , representing myself, state that:
Your name
1. I am the mother father or
Relationship (for example, aunt, grandfather, guardian, etc.)
of the following minor child(ren):
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
Defendant (check one) Relationship
of the child(ren). Defendant No. 2 is the mother father of the child(ren).
(check one)
3. The child(ren) live(s) at
Address
with .
Name of person
4. The child(ren) have lived in the following places, with the persons indicated during the last
five years:
Time Period Place Name(s)/Current Address of Person(s) with whom Child Lived
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DR 4 (Rev. 9/2005)
———————– Page 2———————–
5. I know of the following cases concerning the child(ren) (such as domestic violence
(protective order), paternity, divorce of the child(ren)’s parents, custody, visitation,
termination of parental rights, adoption or other cases):
Court Case No. Kind of Case Year Filed Results or Status (if you know)
Attach the most recent court order for the above-referenced court cases.
6. I have been a party, witness, or otherwise involved in the following cases about custody or
visitation of the child(ren):
State Court Case No. Date of Child Custody Determination
Attach the most recent court order for the above-referenced court cases.
7. I know of the following people, not parties to this case, who have physical custody of, or
claim rights of legal custody or physical custody of, or visitation with the child(ren):
Name Current Address
Name Current Address
Name Current Address
8. It is in the best interests of the child(ren) to be in my custody because:
FOR THESE REASONS, I request the court (check all that apply):
Grant me sole joint physical custody of the child(ren).
(check one)
Grant me sole joint legal custody of the child(ren).
(check one)
Allow to visit with the child(ren).
Name(s)
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DR 4 (Rev. 9/2005)
———————– Page 3———————–
Allow to visit with the child(ren) on
Name(s)
the following terms:
Allow no visitation because
Order to pay health insurance for child(ren).
Name(s)
Order to pay child support (attach Financial
Name(s)
Statement. Use Form Dom. Rel. 30 or Dom. Rel. 31).
(State other requests relating to the children.)
Order any other appropriate relief.
I, solemnly affirm under the penalties of
Your Name
perjury, that the contents of this document are true to the best of my knowledge,
information and belief.
Date Signature
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DR 4 (Rev. 9/2005)