841 In the matter of the adoption and amendment of local rules of civil procedure for actions involving the custody of minor children; misc. doc. no. 1910 of 2011?

FRANKLIN AND FULTON COUNTIES

In the Matter of the Adoption and Amendment of Local Rules of Civil Procedure for Actions Involving the Custody of Minor Children; Misc. Doc. No. 1910 of 2011

[41 Pa.B. 2532]
[Saturday, May 21, 2011]

Order Pursuant to Pa.R.C.P. 239

 And Now, this 3rd day of May, 2011, in light of the enactment of new statutory provisions governing actions in custody,

 It Is Hereby Ordered That the following Rules of the Court of Common Pleas of the 39th Judicial District of Pennsylvania, Franklin and Fulton County Branches, Civil Division, are amended, rescinded or adopted as indicated this date, to be effective thirty (30) days following the date of their publication in the Pennsylvania Bulletin:

 Local Rule of Civil Procedure 39-1915.3 shall be amended as provided in the following.

 Local Rule of Civil Procedure 39-1915.7 shall be adopted in the following form.

 It Is Further Ordered That the District Court Administrator shall:

 1. Cause seven (7) certified copies of the Local Rules to be filed with the Administrative Office of Pennsylvania Courts.

 2. Distribute two (2) certified copies of the Local Rules and a computer diskette containing the text of the Local Rules to the Legislative Reference Bureau for publication in the Pennsylvania Bulletin. The computer diskette shall be formatted and labeled as provided under the Note to Pa.R.C.P. 239(c)(3).

 3. Cause one (1) certified copy of the Local Rules to be filed with the Domestic Relations Procedural Rules Committee.

 4. Ensure a copy of the amended Local Rules, as well as all Local Civil Rules, shall be continuously available for public inspection and copying in the office of the Prothonotary of Franklin County and the Office of the Prothonotary of Fulton County. Upon request and payment of reasonable costs of reproduction and mailing, the Prothonotary shall furnish to any person a copy of any Local Rule.

 5. Provide one (1) certified copy of the Local Rules to the Franklin County Law Library, and one (1) certified copy of the Local Rules to the Fulton County Law Library.

 6. Arrange for the publication of the Local Rules on the Franklin County Bar Association Website at www.franklin bar.org.

By the Court

DOUGLAS W. HERMAN, 
President Judge

Rule 39-1915.3. Commencement of Action. Complaint. Order.

 (a) Commencement of Action

 (1) Filing and Service Generally. All Complaints and/or Petitions to Modify relating to custody of minor children shall be presented to the Court Administrator for assignment, after filing, in accordance with these rules. Filing shall be accompanied by the payment of the designated filing and administrative fees. After the signing of the temporary order, the Order shall be filed with the Office of the Prothonotary and the Complaint and Order served in accordance with the Pennsylvania Rules of Civil Procedure governing the service of Custody Complaints.

 (2) Contents of Complaint. The Complaint shall specifically designate the relief sought by the party who filed the pleading and include specific terms of legal custody (sole or shared) or physical custody [partial custody or visitation] (sole, primary, partial, shared, or supervised) sought by the Moving Party as well as the factual basis therefore. In addition to those averments required by the Pennsylvania Rules of Civil Procedure governing actions relating to Custody, the Complaint shall also contain:

 (i) an averment as to whether or not the Moving Party or a member of the Moving Party's household has been convicted of or has pleaded guilty or no contest to any of the enumerated offenses found at 23 Pa.C.S.A. Section 5329(a) or of an offense in another jurisdiction substantially equivalent to the enumerated offenses and the date of the conviction or plea;

 (ii) an averment as to the Moving Party's knowledge of the Non-Moving Party's representation or non-representa- tion by counsel, and if represented, an averment as to the Non-Moving Party's counsel's name;

 (iii) an averment as to the form and time and manner of furnishing a copy of the Complaint to the Non-Moving Party or to legal counsel; and

 (iv) if a Temporary Order is requested, the Proposed Temporary Order shall be stated as a paragraph of the Complaint.

 (3) Time for Furnishing a Copy of the Complaint and Proposed Order to the Non-Moving Party; Record Proof. When a Non-Moving Party is represented, a true, attested copy of the Complaint and Proposed Order shall be furnished to the Non-Moving Party's counsel of record, and to the non-moving party, not less than forty-eight (48) hours prior to its anticipated presentation to the Court. In the case of an unrepresented Non-Moving Party, a true, attested copy of the Complaint and Proposed Order shall be furnished directly to the Non-Moving Party not later than forty-eight (48) hours prior to its anticipated presentation to the Court; or it shall be furnished to the Non-Moving Party by regular First Class U.S. mail not later than the end of business five (5) actual days preceding the date of its anticipated presentation. The Moving Party shall allege in his/her Complaint the form and manner of [providing service] furnishing notice to the Non-Moving Party and whether said [service] notice was [made] given directly to the named Non-Moving Party or to named legal counsel.

 (4) Scheduling Presentations; Pleadings Delivered to Court Administrator. To facilitate the proper giving of notice of the presentation of Custody Complaints, the Court Administrator shall establish a regular time each week for the presentation of Custody Complaints and the entry of Orders of Court establishing temporary custody arrangements pending a full hearing. Counsel may obtain the specific time for presentation of Complaints from the Court Administrator's Office and shall deliver a copy of the filed Complaint to the Court Administrator a minimum of five (5) days in advance of the scheduled time of any planned presentations of Custody Complaints and Proposed Orders of Court.

 (5) Formal Presentation to the Court Not Necessary. Certain Complaints and Petitions may be presented in the same manner and at the same times as all other petitions and need not be presented in open Court at the time assigned for presentation of Custody Complaints and Petitions in these cases:

 (i) When the Proposed Temporary Order and Directive for Conciliation makes no provision at all for an interim custody of the child or children.

 (ii) When the Proposed Temporary Order and Directive for Conciliation simply maintains the status quo as evidenced by a prior Court Order, a copy of which must be attached to the Complaint or Petition.

 (iii) When all parties have stipulated to the entry of a Temporary Order and Directive for Conciliation, without respect to whether any party is represented by counsel. However, if counsel represents any party, they shall be so identified by name, and counsel's signature shall be required on the Stipulation.

Explanatory Comment—2011

 To satisfy the requirement under (a)(2)(i) of this Subsection, parties to a custody action or their attorney may obtain information about Pennsylvania criminal convictions only for parties in a custody proceeding at www.jendaveprogram.us, or by calling 1-866-536-3286.

 (b) Reference to Conciliator and Assignment to Judge

 (1) Assignment to Conciliator. The Court Administrator shall assign all custody actions to a Conciliator designated by the Court, who shall conduct a Conciliation Conference with both legal counsel and the parties. Further, the Court Administrator shall assign the Conciliator, date, time and place for the Conciliation Conference after the Order has been signed by the Court. The Order of Court and Directive for Conciliation shall be in a form similar to Sample Form ''A.'' (See Sample Form ''A'').

 (2) Assignment to Judge. The Court Administrator shall assign all custody actions to a Judge after the Order has been signed by the Court and at the same time that the Court Administrator assigns the Conciliator, date, time and place for the Conciliation Conference.

 (3) Conciliator. The Conciliator shall be a member of the Bar of this Court who, along with any other members of his/her professional practice, shall not be engaged in the practice of law in the field of Domestic Relations. The Conciliator shall not be subject to the subpoena power of this Court to force testimony regarding information revealed during the Conciliation Conference.

 (4) Service. [Counsel for the] The Moving Party shall serve a copy of the [Complaint and] Order for Conciliation and accompanying Pleading upon the Non-Moving Party in accordance with the Pennsylvania Rules of Civil Procedure. The Moving party shall also serve a copy of the Order for Conciliation and accompanying Pleading upon the assigned Conciliator within ten (10) days of the date of the Order. Failure of the Moving party to comply with the service requirements upon the Conciliator may result in the cancellation of the Conciliation Conference unless actual notice has been provided by the Non-Moving Party. The Moving Party [shall serve a copy of the Complaint and Order for Conciliation upon the assigned Conciliator and] shall certify service by filing a Certificate of Service with the Office of the Prothonotary. Additionally, the Court Administrator shall notify the Conciliator of the list of cases scheduled for Conciliation one (1) week in advance.

 (5) Administrative Fee. The Moving Party shall deposit a nonrefundable administrative fee of [$200.00] $250.00 with the Office of the Prothonotary upon the filing of the Complaint. The Conciliator shall be compensated at the rate of [$200.00] $250.00 for each Custody Conciliation scheduled. Each conference is expected to last one (1) hour. In the event the Conciliation lasts more than one hour, the Conciliator may petition the Court for additional compensation at the rate of [$100.00] $150.00 per hour. This additional fee shall be added to the cost of the action and shall be collected by the Prothonotary as directed by the Court. The fee may be changed from time to time upon direction from the Court without the necessity for amending these Rules. The Prothonotary shall post the administrative fee for such filings in its office. The fee shall be paid to the Conciliator by the Prothonotary [upon receipt of the conciliator's billing statement].

 (i) In the event the Moving Party is unable to pay the administrative fee, such party may apply for an Order to Proceed In Forma Pauperis. If the Court authorizes In Forma Pauperis status, the administrative fee shall be paid by the County of Franklin.

 (ii) In the event a party files a request for an additional Conciliation, the party shall pay an additional administrative fee for such Conciliation Conference which must be paid prior to the scheduling of an additional Conciliation Conference.

 (iii) In the event a party requests a general continuance of a scheduled Conciliation Conference, if the rescheduled Conciliation Conference is scheduled more than six (6) months after the continued Conciliation Conference, the party shall pay an additional administrative fee of [$200.00] $250.00 for such Conciliation Conference which must be paid prior to the scheduling of an additional Conciliation Conference.

 (6) Authority of Conciliator. The Conciliator shall have the following authority and responsibility:

 (i) To conciliate custody cases, which specifically includes meeting with the parties and children, if appropriate. If a party desires the children to be present at the Conciliation Conference, he/she shall make said request of the Conciliator no later than seven (7) days prior to the scheduled conference. The Conciliator shall determine the appropriateness of the request on a case-by-case factual basis after consultation with counsel for both parties or with a pro se party;

 (ii) To address the need for home studies, as appropriate;

 (iii) To address the issue of utilization of expert witnesses, as appropriate;

 (iv) To recommend to the Court, where appropriate, the need for evaluation of either party or members of their household pursuant to 23 Pa.C.S.A. § 5329; and

 (v) To recommend a resolution of the custody conflict which recommendation shall be included in the Summary Report and submitted to the Court for further action.

 If the parties are not able to agree upon the need for home studies and/or the need for any other expert witnesses, either party may petition the Court pursuant to Pa.R.C.P. 1915.8 for the appointment of an expert and the payment of his or her fees.

 (7) Memorandum by Parties. At least three (3) days prior to the scheduled Conciliation Conference, each party shall furnish to the Conciliator and counsel for the opposing party, or the pro se party individually, [shall receive] a Memorandum addressing the following:

 (i) Factual background, including a brief history of the case;

 (ii) Disclosure of any criminal convictions of the offenses enumerated in 23 Pa.C.S.A. Section 5329 for the party or any member of that party's household, stating for each offense:

 a. The date of the conviction;

 b. The nature of the offense;

 c. Any evaluation, counseling or other treatment undergone as a result; and

 d. Safety concerns for the subject child related to the offense, if any.

 (iii) Names and ages of the children;

 (iv) A proposed order for resolution of matters;

 (v) Issues, both factual and legal, for resolution;

 (vi) Whether a home study is requested; and

 (vii) Whether the parties will agree to a particular psychologist/psychiatrist for evaluation or request psychological evaluations.

 The parties are directed to supplement the Memorandum from time to time if new information becomes available prior to conciliation.

 (8) Summary by Conciliator. Following the conclusion of each conference and within seven (7) business days thereof, the Conciliator shall file with the Prothonotary a Summary Report and Proposed Order of Court, if applicable, in the original plus two (2) copies. The Conciliation Memorandums of the parties shall be attached to the original Summary Report for filing.

 (i) In the event the parties reach a comprehensive agreement at the Conciliation Conference, the Summary Report shall so state and the Proposed Order of Court shall reflect the terms of the agreement and shall be titled a Final Order of Court.

 (ii) In the event the parties reach a partial agreement, or fail to reach any agreement to modify the existing order, said Summary Report shall include the following:

 a. Custody status at the time of conciliation;

 b. Summary of the parties' positions;

 c. Identification of legal and factual issues before the Court; and

 d. The Conciliator's recommendation and rationale therefore.

 (iii) The Proposed Order of Court shall reflect the terms of any partial agreement reached and the need for home studies, psychological evaluations, or [both] need for evaluation of either party or members of their household pursuant to 23 Pa.C.S.A. § 5329. If the proposed order of court amends the temporary order entered at the custody presentation, the order shall also include a provision stating that the order will become a final appealable order of court one hundred eighty-one (181) days after the date of filing of the complaint/petition and shall include the exact date that the order will become final.

 (iv) The Prothonotary shall serve copies of the Summary Report and any Order entered upon the parties, or their legal counsel if represented, in accordance with Pa.R.C.P. 236.

 (c) Entry of Court Order. Upon review of the Conciliator's Summary, the Court may issue an Order addressing the appropriate issues. A copy of said Order of Court shall be furnished to legal counsel for the parties or in the event a party is unrepresented, to the party directly, according to the procedures outlined in local rule 39-1915.3(b)(8).

 (d) Scheduling of Pre-Trial Conferences and Hearings. Upon the completion of home studies and psychological evaluations (if applicable), and at any time after the entry of the Order of Court approving the Conciliator's Summary, either party may present a Motion and Proposed Order for scheduling a Pre-Trial Conference with the Court. (See Sample Form ''B'').

 (1) Education Program for Divorcing Parents. The Order of Court for Pre-Trial Conference shall contain language requiring the parties to the proceedings to attend and successfully complete the Education Program for Divorcing Parents.

 (i) The party filing the Motion for Pre-Trial Conference shall provide the Prothonotary with a pre-addressed, envelope for each party to the custody action.

 (ii) The Court Administrator's office shall send to each party the pamphlet regarding the Education Program for Divorcing Parents.

 (2) Scheduling. [Every effort shall be made by the Court Administrator's office to] The assigned Judge shall schedule a Pre-Trial Conference within [thirty (30)] sixty (60) days of the submission of a Motion by either party requesting said conference [taking into consideration the availability of the Court]. Each party's presentation at the Pre-trial Conference shall not exceed a time limit of fifteen (15) minutes.

 (3) Pre-Trial Conference Memorandum. At least three (3) days prior to the scheduled Pre-Trial Conference, a Pre-Trial [memorandum] Conference Memorandum containing the following matters shall be filed of record, and a copy provided to the assigned Judge:

 (i) Statement of the case;

 (ii) Issues to be resolved;

 (iii) Disclosure of criminal convictions and related information required by 39-1915.3(b)(7)(ii) if not previously disclosed in a Conciliation Memorandum;

 (iv) Names and addresses of all factual witnesses, and a brief summary concerning the anticipated testimony of each listed witness and a certification by counsel that all witnesses listed have been directly contacted by counsel or by pro se party to confirm the substance of the testimony proffered;

 (v) Names and addresses of all expert witnesses;

 (vi) Identification of exhibits for trial; and

 (vii) Expected length of trial.

 Failure to produce the information set forth in this Rule may be grounds for imposition of sanctions upon legal counsel or the party directly if appearing pro se.

 (4) Appearance by the Parties. At the scheduled Pre-Trial Conference, both counsel shall be present and the parties shall be personally present.

 (i) In the event that neither legal counsel nor a party appears, the Pre-Trial Conference shall be held in that party's absence upon proof of service of the Order of Court for Pre-Trial Conference in accordance with the Pennsylvania Rules of Civil Procedure.

 (ii) Although the Court may not discuss the case with represented parties, they are directed to be present in the event issues arise where the parties' input may be beneficial.

 (5) Hearing Date. In the event that an agreement is not reached at the Pre-Trial Conference, a hearing date shall be established by the Court [Administrator] at the conclusion of said conference.

SAMPLE FORM ''A''

IN THE COURT OF COMMON PLEAS OF THE 39TH JUDICIAL DISTRICT PENNSYLVANIA— FRANKLIN/FULTON COUNTY BRANCH

,
Plaintiff	:	Civil Action—Law
	:
	:	No. F.R.
vs.	:
,	:
Defendant	:	In Custody
	:	Judge:

ORDER OF COURT AND DIRECTIVE FOR CONCILIATION

 NOW, this ____ day of ______ , 20 ______ , this Order will notify ______ , Defendant, that you have been sued in Court to obtain custody of the child(ren): ______ , date of birth ____.

 It is ordered and directed that ______ , Esquire, the Court's Child Custody Conciliation Officer, is hereby directed to conduct a Conciliation Conference on ______ , 20 ______ at ____ o'clock __ .M at the Assigned Room, Third Floor, Franklin County Courthouse, Chambersburg, Pennsylvania. The anticipated length of the Conciliation Conference is one (1) hour. The parties along with their legal counsel shall appear in person at the designated time for the Conciliation Conference. A memorandum shall be furnished to the Conciliator at least three (3) days prior to the scheduled Conciliation Conference pursuant to 39th Judicial District Civil Rule No. 1915.3(b)(7).

 Failure to provide said memorandum may result in the imposition of sanctions. At the Conciliation Conference, an effort will be made to see if the issues can be resolved by an agreement between the parties. If an agreement cannot be reached, the Conciliator will assist in defining and narrowing the issues to reduce the time required for hearing by the Court. At the conclusion of the conference, the Conciliator will prepare a Conference Summary Report for further action by the Court.

 You have the right to be represented by an attorney who may attend the Conciliation Conference with you. If you have not secured an attorney by the date of the scheduled Conciliation Conference, you shall nonetheless personally appear at the time scheduled for the Conciliation Conference without an attorney.

 The Plaintiff has deposited a sum of [$200.00] $250.00 with the Prothonotary for the cost of the Conciliation Conference and the Court reserves the right to further assign or divide these costs.

 ______ , Defendant, is notified that if you fail to appear as provided by this Order, an Order of Court for Custody, partial custody or visitation may be entered against you or the court may issue a warrant for your arrest.

 Pending the hearing, with emphasis placed on the arrangements for the six (6) months preceding the filing of this Complaint and with particular attention paid to the role of primary caretaker, the Court hereby establishes the following temporary Order for custody pending a hearing:

 [The appropriate language should be inserted at this point detailing the custody arrangements sought by the Plaintiff keeping in mind the emphasis to be placed upon the prior six (6) months and the role of primary caretaker. It is suggested one (1) inch of blank space be left for judge's comments or changes to the proposed Order.]

 No party shall be permitted to relocate the residence of the child/ren to significantly impair the ability of another person to exercise custody UNLESS every individual who has custody rights to the child/ren consents to the proposed relocation OR the Court approves the proposed relocation. A person proposing to relocate MUST comply with the notice requirements pursuant to 23 Pa.C.S.A. Section 5337(c).

 Defendant is hereby notified that if (s)he disputes the Plaintiff's averments regarding the current status of the custody arrangements and this Order is entered on the basis of those averments, (s)he has the right to request a prompt conference with the Court. If the matter of the temporary custody arrangements is not resolved at the Conference, the Court may in atypical factual situations and at its sole discretion schedule a brief hearing limited to the issues of determining temporary custody arrangements pending the scheduled Conciliation Conference.

 The parties and their legal counsel, if applicable, are hereby directed to engage in meaningful negotiations to resolve this matter before the Conciliation Conference.

 This Order shall become a final appealable order 181 days after the date of filing of the attached Complaint/Petition, that is, on ____ [fill in date 181 days after the date of filing of the complaint/petition] ______ , unless prior to that date (1) a party files a praecipe, motion or request for a trial, or (2) there is filed a final intervening order

 YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE.

Pennsylvania Bar Association
Lawyer Referral Service
1-800-692-7375 (PA ONLY) or 1-717-238-6715

AMERICANS WITH DISABILITIES ACT OF 1990

 The Court of Common Pleas of Franklin County is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the court, please contact our office. All arrangements must be made at least 72 hours prior to any hearing or business before the court.

 By the Court,
_________________
J.

SAMPLE FORM ''B''
IN THE COURT OF COMMON PLEAS
OF THE 39TH JUDICIAL DISTRICT
PENNSYLVANIA—FRANKLIN/
FULTON COUNTY BRANCH

,
Plaintiff	:	Civil Action—Law
	:
	:	No. F.R.
vs.	:
,	:
Defendant	:	In Custody
	:	Judge:

ORDER OF COURT

 AND NOW, this ______ day of ______ , 20 ______ , upon consideration of the within Motion,

 IT IS HEREBY ORDERED, that a Pre-Trial Conference in the above-captioned custody matter is scheduled for ______ , 20 ______ , at ______ o'clock __ .m. in the Chambers of the Honorable ______ , Franklin County Courthouse, Chambersburg, Pennsylvania.

 A Pre-Trial Memorandum shall be filed of record and a copy furnished to the Court at least three (3) days prior to the scheduled Pre-Trial Conference pursuant to 39th Judicial District Civil Rule No. 1915.3(d). Failure to provide said Pre-Trial Memorandum may be grounds for imposition of sanctions.

 Failure of a party or legal counsel to appear upon proper notice shall result in the holding of the conference in absentia and the entry of an Order of Court that may be to the detriment of the absent party.

 IT IS FURTHER HEREBY ORDERED that all parties to this custody proceeding shall enroll in, attend and successfully complete the Education Program for Divorcing Parents, a four-hour educational seminar which has been established by the Court to provide guidance to the parties in helping children to adjust to custody changes. Failure of any party to comply with this provision of this Order may result in a finding of contempt with the imposition of sanctions including fine or imprisonment or both.

 BY THE COURT,
_________________
J.

IN THE COURT OF COMMON PLEAS
OF THE 39TH JUDICIAL DISTRICT
PENNSYLVANIA—FRANKLIN/
FULTON COUNTY BRANCH

,
Plaintiff	:	Civil Action—Law
	:
	:	No. F.R.
vs.	:
,	:
Defendant	:	In Custody
	:	Judge:

MOTION FOR SCHEDULING OF
A PRE-TRIAL CONFERENCE

 AND NOW comes ______ , Esquire, legal counsel for the above-captioned Plaintiff and moves the Court as follows:

 1. A Conciliation Conference in the above-captioned matter was held on ______ .

 2. A Summary Report and proposed Order of Court was prepared by the Conciliator and filed of record on ______ .

 3. An Order of Court was signed on ______ containing further directives in this matter.

 4. The undersigned legal counsel hereby certifies that all Court-ordered directives have been complied with and the matter is now ready for a hearing.

 5. Notification of this Motion has been given to ______ , Esquire, attorney for (Plaintiff/Defendant) who concurs with/opposes the request.

 6. WHEREFORE, it is respectfully requested that an Order be entered by the Court establishing a date and a time for a Pre-Trial Conference.

Date: ______
By: ______
(Signature), Esquire
Counsel for (Plaintiff/Defendant)

 I verify that the statements made in this Motion are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities.

Date: ______
______

 (Editors Note: The following text is new and printed in regular type to enhance readability.)

Rule 39-1915.7. Consent Order.

 (e) Required Submissions to the Court

 (1) Form. Any agreement between the parties for legal or physical custody of a minor child shall be submitted the Court in the form of a motion entitled ''Stipulation and Agreement,'' bearing the signature of each parent, and their counsel of record, if any, and requesting the entry of the agreed upon terms as an Order of Court. The motion shall be accompanied by a Proposed Order for entry by the Court.

 (2) Contents of Stipulation and Agreement Where No Complaint has been Filed. If no Complaint for Custody or Petition for Modification has been filed, the motion requesting entry of the Proposed Order of Court shall contain:

 (i) Averments required under 23 Pa.C.S.A. Section 5429(a), to enable the Court to determine whether jurisdictional requirements have been met, including:

 a. The child's present address or whereabouts;

 b. The child's residence address(es) for the five (5) years preceding the filing of the Stipulation and Agreement, and the names of the persons with whom the child resided during such period;

 c. An averment whether any party has participated as a party or witness or in any other capacity in any other proceeding concerning the legal or physical custody of the child, and, if any such actions exist, stating the presiding court, case number, and nature of such proceeding; and

 d. An averment whether any party knows the names and addresses of any person not a party to the proceeding who has any form of physical custody of the child, or claims rights of legal or physical custody to the child, stating for any such person(s) their name(s) and address(es).

 (ii) An averment whether or not either party or a member of their household has been convicted, pled guilty, or entered a plea of no contest, to any of the offenses enumerated at 23 Pa.C.S.A. Section 5329(a), or of an offense in another jurisdiction substantially equivalent to the enumerated offenses; and

 (iii) An averment whether or not either party or a member of their household has engaged in past violent or abusive conduct, as described at 23 Pa.C.S.A. Section 5303(a)(3), and, if so, whether the parties believe there is any risk of harm to the child or abused party.

 (3) Contents of Proposed Order. The agreed upon Proposed Order for custody shall contain:

 (i) The terms of the agreement, as to both legal and physical custody of the subject child;

 (ii) An averment pursuant to 23 Pa.C.S.A. Section 5323(c), giving notice of the parties' obligations under Section 5337, related to relocation, substantially equivalent to that set forth in Sample Form A to Rule 39-1915.3;

 (iii) If either party has engaged in past violent or abusive conduct, and, if a risk of harm exists to the child or the abused party, conditions for protection of the child or abused party as required pursuant to 23 Pa.C.S.A. Section 5323(e).

[Pa.B. Doc. No. 11-841. Filed for public inspection May 20, 2011, 9:00 a.m.]