Custody Intake Form - Lehigh County
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1
2LEHIGH COUNTY FAMILY COURT
rd
ROOM 325, 3
FLOOR
CUSTODY INTAKE FORM
Print Clearly
Today’s Date: __________________
Docket Number: _______ - FC -_______
Plaintiff
Name: _____________________
_____
______________________________
(first)
(m)
(last)
Address: __________________________________________
Apt: ____________
City: ______________________________ State: ____________ Zip: ____________
Home Phone: ________________ Cell: _______________ Work: ______________
Plaintiff’s Date of Birth: _______________________
Plaintiff’s Attorney: ________________ Attorney Phone: ______________________
Defendant
Name: _______________________
_____
__________________________
(first)
(m)
(last)
Address: __________________________________________
Apt/: ___________
City: ______________________________ State: ____________ Zip: ___________
Home Phone: _______________ Cell: ________________ Work: ____________
Defendant’s Date of Birth: ________________________
Defendant’s Attorney: ________________ Attorney Phone: ___________________
Children
Name: ________________________________ Date of Birth: ________________
Name: ________________________________ Date of Birth: ________________
Name: ________________________________ Date of Birth: ________________
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J: Forms:Intake Form
October 2014
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Parent category: Legal