Parenting Time Complaint Form
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1GENESEE COUNTY FRIEND OF THE COURT CUSTODY OR
PARENTING TIME COMPLAINT FORM
FRIEND OF THE COURT CAN ONLY TAKE ENFORCEMENT ACTION IF THERE IS
A COURT ORDER FOR PARENTING TIME AND THERE HAS BEEN A VIOLATION
OF THE ORDER. IF NO VIOLATION OF A COURT ORDER EXISTS FRIEND OF THE
COURT CAN NOT TAKE ANY ENFORCEMENT ACTION.
CASE NUMBER:_____________________
CASEWORKER:____________________
YOUR NAME:
________________________________
TELEPHONE: _________________________
ADDRESS:
________________________________
WORK: __________________________
________________________________
CELL: __________________________
SOCIAL SECURITY NUMBER: ______________________
COMPLAINT AGAINST:________________________________ Alias:_________________________________
Address:
______________________________________
City/State/Zip_____________________________
Physical attributes:
Height_______
Weight________
Race__________ Hair __________
Eye Color_____________
Tattoos/Distinguishing Marks___________________________________ Gender M/F
Telephone:
Daytime___________________ Work_____________________ Cell__________________
PLEASE GIVE THE SPECIFIC COMPLAINT REGARDING THE DENIAL OF YOUR COURT ORDERED
PARENTING TIME:
Denied Holiday?
YES
NO
Dates: _________________________
Denied summer parenting time?
YES
NO
Dates: _________________________
Denied weekend parenting time?
YES
NO
Dates: _________________________
Child picked up/returned late?
YES
NO
Dates: _________________________
OTHER: Give a brief explanation of the alleged violations of the court order for custody or parenting time,
and the custody or parenting time the order allows:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
COMPLAINANT’S SIGNATURE: ________________________________
DATE: ____________________
COMPLAINTS WILL RECEIVE A WRITTEN RESPONSE ONLY WHEN THE COURT
ORDER FOR PARENTING TIME AND/OR CUSTODY HAS ALLEDGLY BEEN VIOLATED.
DO NOT WRITE BELOW THIS LINE – FOR OFFICE USE ONLY
Complaint taken by__________
*COPT*
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