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SUPERIOR COURT OF THE DISTRICT OF COLUMBIA FAMILY (LawHelp.org)

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SUPERIOR COURT OF THE DISTRICT OF COLUMBIA
FAMILY COURT
Domestic Relations Branch
ANS
WER CONSENTING TO THIRD PARTY CUSTODY ORDER -
REVOCABLE AT WILL
I, _________________________________, am the Defendant in this case.
PRINT YOUR NAME
1. I agree with ALL of the statements regarding custody, numbered 1 - 13 in Plaintiff’s
Complaint for Custody and/or Access to Children.
2. (If applicable) I agree with the statements regarding child support, numbered 14 in Plaintiff’s
Complaint for Custody and/or Access to Children.
3. I understand the custody and visitation arrangement that Plaintiff is requesting and I consent
to it.
_________ DRB ______________
Related Cases:
____________________________
____________________________
________________________________________
P
RINT OTHER PARTY’S NAME
__________
______________________________
S
TREET ADDRESS
__________
______________________________
C
ITY, STATE AND ZIP CODE
PLAINTIFF,
v.
________________________________________
P
RINT YOUR NAME
__________
______________________________
S
TREET ADDRESS
__________
______________________________
C
ITY, STATE AND ZIP CODE
SUBSTITUTE ADDRESS: CHECK BOX IF YOU
HAVE WRITTEN SOMEONE ELSE’S ADDRESS BECAUSE
YOU FEAR HARASSMENT OR HARM.
DEFENDANT,
________________________________________
PRINT OTHER PARTY’S NAME
__________
______________________________
S
TREET ADDRESS
__________
______________________________
C
ITY, STATE AND ZIP CODE
OTHER DEFENDANT.
DC Bar Pro Bono Center (revised 12/2018)
Answer Consenting to Third Party Custody Order (Revocable) - Page 1 of 9
4. I reserve the right to revoke my consent at any time.
• If I decide that I want custody of the child[ren] in this case, I can file a revocation of
consent with the Court and serve it on the other parties;
• I understand that Plaintiff has the same right to revoke her/his consent;
• If I or Plaintiff file a revocation of consent, the award of custody to Plaintiff will be
immediately vacated and of no further effect; AND
• I understand that if I revoke my consent, Plaintiff could ask the Court to issue a new
custody order for the child[ren] at that time.
5. I agree to this custody arrangement voluntarily.
6. I also state that THERE ARE NO CONTESTED ISSUES for this Court to decide.
Request for Relief
I RESPECTFULLY REQUEST that the Court grant ALL the relief requested in Plaintiff’s
Complaint for Custody and/or Access to Children.
I ALSO REQUEST that the Court award any other relief it considers fair and proper.
[CHECK ONE]
I do not know of any proceedings in the District of Columbia or in any state or territory
involving the same claim or subject matter as this case.
I do know of proceedings in the District of Columbia or in any state or territory involving
the same claim or subject matter as this case, as listed on the first page of this Answer (“Related
Cases”).
DC Bar Pro Bono Center (revised 12/2018)
Answer Consenting to Third Party Custody Order (Revocable) - Page 2 of 9
Respectfully Submitted,
SIGN YOUR NAME
DATE (mm/dd/yyyy)
STREET ADDRESS
CITY, STATE AND ZIP CODE
TELEPHONE NUMBER
_____________________________________________
EMAIL ADDRESS
SUBSTITUTE ADDRESS: CHECK BOX IF YOU HAVE
WRITTEN SOMEONE ELSE’S ADDRESS BECAUSE YOU FEAR
HARASSMENT OR HARM.
DC Bar Pro Bono Center (revised 12/2018)
Answer Consenting to Third Party Custody Order (Revocable) - Page 3 of 9
I declare under penalty of perjury that the foregoing is true and correct.
If this document is to be signed outside the geographic boundaries of the United States, Puerto Rico,
the United States Virgin Islands, and any territory or insular possession subject to the jurisdiction of
the United States, additional requirements must be met prior to signing. See SCR-Dom. Rel. 2(c)(1)(B).
RULE 5
PROOF OF SERVICE
IF YOU HAVE ALREADY SERVED THE OTHER PARTY, YOU CAN FILL OUT AND FILE THIS CERTIFICATE
OF
SERVICE ON THE SAME DAY YOU FILE YOUR PAPERS.
IF YOU HAVE NOT ALREADY SERVED THE OTHER PARTY, YOU MUST FILL OUT AND FILE THIS
CERTIFICATE OF SERVICE AFTER YOU SERVE THE OTHER PARTY.
I
F THE OTHER PARTY HAS A LAWYER IN THIS CASE, YOU MUST SERVE THE PAPERS TO THE
LAWYER
. IF THE OTHER PARTY DOES NOT HAVE A LAWYER, THE PAPERS SHOULD BE SERVED
DIRECTLY TO THE OTHER PARTY
.
I certify that on _________________ I served a copy of ___________________________ to:
DATE OF SERVICE TITLE OF PLEADING
the other party, or
the other party’s attorney.
The papers were delivered by: [CHECK ONE]
handing it to them
first class mail to their last known address;
________________
________________________________________________________
S
TREET ADDRESS CITY, STATE AND ZIP CODE
Case No. _______________
______
SUPERIOR COURT OF THE DISTRICT OF COLUMBIA
FAMILY COURT
DC Bar Pro Bono Center (revised 12/2018)
Answer Consenting to Third Party Custody Order (Revocable) - Page 4 of 9
leaving a copy at the other party’s home with a person of suitable age and discretion
who lives there:
________________________________________________________________________
P
RINT NAME OF PERSON SERVED WITH PAPERS
_____________
___________________________________________________________
S
TREET ADDRESS CITY, STATE AND ZIP CODE
leaving a copy at the attorney’s office with a clerk or other person in charge:
________________________________________________________________________
P
RINT NAME OF PERSON SERVED WITH PAPERS
_____________
___________________________________________________________
S
TREET ADDRESS CITY, STATE AND ZIP CODE
sending it electronically through CaseFileExpress or some other electronic means
agreed to by the other party in writing:
_____________
___________________________________________________________
S
PECIFY
some other means agreed to by the other party in writing:
________________________________________________________________________
S
PECIFY
DC Bar Pro Bono Center (revised 12/2018)
Answer Consenting to Third Party Custody Order (Revocable) - Page 5 of 9
I declare under penalty of perjury that the foregoing is true and correct.
If this document is to be signed outside the geographic boundaries of the United States, Puerto
Rico, the United States Virgin Islands, and any territory or insular possession subject to the
jurisdiction of the United States, additional requirements must be met prior to signing. See SCR-
Dom. Rel. 2(c)(1)(B).
Respectfully Submitted,
SIGN YOUR NAME
DATE (mm/dd/yyyy)
STREET ADDRESS
CITY, STATE AND ZIP CODE
TELEPHONE NUMBER
EMAIL ADDRESS
SUBSTITUTE ADDRESS: CHECK BOX IF YOU HAVE
WRITTEN SOMEONE ELSE’S ADDRESS BECAUSE YOU FEAR
HARASSMENT OR HARM.
DC Bar Pro Bono Center (revised 12/2018)
Answer Consenting to Third Party Custody Order (Revocable) - Page 6 of 9
click to sign
signature
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RULE 5
PROOF OF SERVICE
IF YOU HAVE ALREADY SERVED THE OTHER PARTY, YOU CAN FILL OUT AND FILE THIS CERTIFICATE
OF
SERVICE ON THE SAME DAY YOU FILE YOUR PAPERS.
IF YOU HAVE NOT ALREADY SERVED THE OTHER PARTY, YOU MUST FILL OUT AND FILE THIS
CERTIFICATE OF SERVICE AFTER YOU SERVE THE OTHER PARTY.
I
F THE OTHER PARTY HAS A LAWYER IN THIS CASE, YOU MUST SERVE THE PAPERS TO THE
LAWYER
. IF THE OTHER PARTY DOES NOT HAVE A LAWYER, THE PAPERS SHOULD BE SERVED
DIRECTLY TO THE OTHER PARTY
.
I certify that on _________________ I served a copy of ___________________________ to:
DATE OF SERVICE TITLE OF PLEADING
the other party, or
the other party’s attorney.
The papers were delivered by: [CHECK ONE]
handing it to them
first class mail to their last known address;
________________
________________________________________________________
S
TREET ADDRESS CITY, STATE AND ZIP CODE
Case No. _______________
______
SUPERIOR COURT OF THE DISTRICT OF COLUMBIA
FAMILY COURT
DC Bar Pro Bono Center (revised 12/2018)
Answer Consenting to Third Party Custody Order (Revocable) - Page 7 of 9
leaving a copy at the other party’s home with a person of suitable age and discretion
who lives there:
________________________________________________________________________
P
RINT NAME OF PERSON SERVED WITH PAPERS
_____________
___________________________________________________________
S
TREET ADDRESS CITY, STATE AND ZIP CODE
leaving a copy at the attorney’s office with a clerk or other person in charge:
________________________________________________________________________
P
RINT NAME OF PERSON SERVED WITH PAPERS
_____________
___________________________________________________________
S
TREET ADDRESS CITY, STATE AND ZIP CODE
sending it electronically through CaseFileExpress or some other electronic means
agreed to by the other party in writing:
_____________
___________________________________________________________
S
PECIFY
some other means agreed to by the other party in writing:
________________________________________________________________________
S
PECIFY
DC Bar Pro Bono Center (revised 12/2018)
Answer Consenting to Third Party Custody Order (Revocable) - Page 8 of 9
I declare under penalty of perjury that the foregoing is true and correct.
If this document is to be signed outside the geographic boundaries of the United States, Puerto
Rico, the United States Virgin Islands, and any territory or insular possession subject to the
jurisdiction of the United States, additional requirements must be met prior to signing. See SCR-
Dom. Rel. 2(c)(1)(B).
Respectfully Submitted,
SIGN YOUR NAME
DATE (mm/dd/yyyy)
STREET ADDRESS
CITY, STATE AND ZIP CODE
TELEPHONE NUMBER
EMAIL ADDRESS
SUBSTITUTE ADDRESS: CHECK BOX IF YOU HAVE
WRITTEN SOMEONE ELSE’S ADDRESS BECAUSE YOU FEAR
HARASSMENT OR HARM.
DC Bar Pro Bono Center (revised 12/2018)
Answer Consenting to Third Party Custody Order (Revocable) - Page 9 of 9
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Completed 13 June 2021

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