Petition For Custody Form
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1NO. _________________________
IN THE DISTRICT COURT
PETITIONER
JUDICIAL DISTRICT
RESPONDENT
{COUNTY, STATE}
PETITION FOR CUSTODY
Legal Guardian 1:
¨ Petitioner ¨ Respondent
Address:
City:
State:
Zip:
Legal Guardian 2:
¨ Petitioner ¨ Respondent
Address:
City:
State:
Zip:
Child Name
DOB
1.
2.
3.
4.
5.
The Petitioner hereby requests that the Court grant him/her full legal and physical custody of the
child(ren) named above. The Respondent’s role would be limited to the following arrangements:
Medical Insurance
Visitation
¨ Days and Times:
¨ Weekends:
¨ Holidays:
Custody Payments
Inheritance
Petitioner Signature
Date
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