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Ccdr004 (Maryland Courts)

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Defendant 2
Street Address
Street Address
City, State, Zip
Telephone
City, State, Zip
Telephone
COMPLAINT FOR CUSTODY
(Md. Code, Family Law Art., § 5-203)
MDEC counties only: If this submission contains Restricted Information (confidential by statute, rule
or court order) you must file a Notice Regarding Restricted Information Pursuant to Rule 20-201.1
(form MDJ-008) with this submission, and check the Restricted Information box on this form.
NOTE: Use this form if there is no court order for child custody to which you are a party. Attach a
completed Civil Domestic Case Information Report (CC-DCM-001). You must “serve” the other
party(ies) with a copy of this paperwork. See General Instructions (CC-DRIN) for information on
service of process, filing fees, and other topics. Also see Maryland Parenting Plan Instructions (CC-DRIN-
109) and Maryland Parenting Plan Tool (CC-DR-109).
I/We state that:
1. I am/We are the
☐ mother ☐ father ☐
of
the following minor child(ren):
Name(s)
Date(s) of birth
2. is the ☐ mother ☐ father
☐ of the minor child(ren).
is the
☐ mother ☐ father
☐ of the minor child(ren).
3. Th
e child(ren) live(s) at
with .
CC-DR
-004 (Rev. 01/2021) Page 1 of 4
Relationship (for example, aunt, grandfather, guardian)
Name of defendant 1
Relationship (for example, aunt, grandfather, guardian)
Name of person(s) and relationship to child(ren)
CIRCUIT COURT FOR
City/County
Located at
Case No.
, MARYLAND
Court Address
vs.
Defendant 1
Plaintiff 1
Street Address
Street Address
City, State, Zip
Telephone
City, State, Zip
Telephone
Your name(s)
Relationship (for example, aunt, grandfather, guardian)
Name of defendant 2
Plaintiff 2
☐ Mark this box if this form contains Restricted Information.
COMCU
4. The minor child(ren) has/have lived in Maryland for at least six (6) months ☐ yes ☐ no. In the
past five (5) years the minor child(ren) has/have lived in the following places with the followin
g
persons:
Time Period
City and State
Name(s) and Current Address(es) of Person(s)
with whom Child(ren) Lived
5. I/We know of the following cases, or I/we have been involved (as a party, witness, etc.) in the
f
ollowing cases about me/us, the other party(ies), or the child(ren). Include cases such as custody
,
c
hild support, guardianship, domestic violence/protective order, paternity, divorce, visitation (chil
d
ac
cess), CINA, delinquency, termination of parental rights, adoption or other cases.
Court
Case No.
Kind of Case
Year Filed
Result or Status
(if you know)
Attach the most recent court order for these cases.
6. I
/We know of the following people, who are not parties to this case, who have physical custody of
,
or
claim rights of legal custody (decision-making authority), physical custody (parenting time), or
visitation (child access) with the minor child(ren):
Name
Current Address
CC
-DR-004 (Rev. 01/2021) Page 2 of 4
Case No.
COMCU
7. It is in the best interest of the minor child(ren) that I/we have (check one selection from each line):
☐ joint ☐ primary physical custody (parenting time) of
b
ecause:
☐ joint ☐ sole legal custody (decision-making authority) of
b
ecause:
I
/We and the other party(ies) (select one):
☐ have agreed on a parenting plan(s) that we believe is/are in the best interest of the minor
child(ren)
.
A
ttach your signed parenting plan agreement.
☐ have not agreed on a parenting plan(s).
See: Maryland Parenting Plan Instructions (CC-DRIN-109) and Maryland Parentin
g
Pl
an Tool (CC-DR-109).
F
OR THESE REASONS, I request the court (check all that apply):
☐ Grant me/us ☐ joint ☐ primary (check one) physical custody (parenting time) of the child(ren).
☐ Grant me/us ☐ joint ☐ sole (check one) legal custody of the child(ren).
☐ Allow to visit with the child(ren).
☐ Allow to visit with the child(ren) on the following
terms (for example, how often, on what holidays, or location of visits):
C
C-DR-004 (Rev. 01/2021) Page 3 of 4
Name(s)
Name(s) of child(ren)
Name(s) of child(ren)
Name(s)
Case No.
COMCU
☐ Allow no visitation because:
☐
Order to pay health insurance for child(ren).
☐ Order
to pay child support.
If parents’ combined gross monthly income (not take home pay) is $15,000 or less, attach
Financial Statement (Child Support Guidelines) (CC-DR-030); if combined gross monthly
income is more than $15,000, attach
Financial Statement (General) (CC-DR-031).
☐ (State other requests relating to the child(ren)):
☒ Order any other appropriate relief.
I/We solemnly affirm under the penalties of perjury that the contents of this document are true to the best of
my/our knowledge, information, and belief.
CC-DR-004 (Rev. 01/2021) Page 4 of 4
Name(s)
Name(s)
Signature 1
Printed Name
Telephone Number
City, State, Zip
Date
Address
E-mail
Fax
Signature 2
Printed Name
Telephone Number
City, State, Zip
Date
Address
E-mail
Fax
Case No.
COM
CU
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Ccdr004 (Maryland Courts)

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Completed 21 April 2022

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