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Response to Alleged Parenting Time Denial Form

2. 

4. Notice
   Do not include any sensitive information on this form or (if applicable) files uploaded to this form. Sensitive information includes, but is not limited to, social security numbers, driver’s license numbers, bank account information, routing numbers, medical information, passport numbers, or passwords.

   Do not include any sensitive information on this form or (if applicable) files uploaded to this form. Sensitive information includes, but is not limited to, social security numbers, driver’s license numbers, bank account information, routing numbers, medical information, passport numbers, or passwords.

6. To disagree with the alleged denial you must respond in writing to the Friend of the Court. Supporting information may be attached at the end of this form.

   To disagree with the alleged denial you must respond in writing to the Friend of the Court. Supporting information may be attached at the end of this form.

8. Docket Number*

12. Plaintiff*

14. Address

16. City

17. State

18. Zip Code

22. Defendant*

24. Address

26. Address

27. State

28. Zip Code

32. 

34. Name of person submitting response:*

36. Dates of Alleged Denials:
    Dates of Alleged Denials: Start Date

    Dates of Alleged Denials: Start Time

    —

    Dates of Alleged Denials: End Date

    Dates of Alleged Denials: End Time

38. Location of attempted exchange:

40. Street Name

42. City

43. State

44. Zip Code

48. The plaintiff arrived at:
    The plaintiff arrived at:

    The plaintiff arrived at:

49. The plaintiff departed at:
    The plaintiff departed at:

    The plaintiff departed at:

51. The defendant arrived at:
    The defendant arrived at:

    The defendant arrived at:

52. The defendant departed at:
    The defendant departed at:

    The defendant departed at:

54. If there is more than one date of alleged denied parenting time, please list them below:

58. Do you agree or not agree that parenting time was denied, or did not occur?

    1. I agree
    2. I do not agree

60. 

62. This form must be completed in full and signed by the complaining party

64. Parenting time was denied, or did not occur, because,

66. Parenting time was not denied because:

68. Additional Documents

    You may upload additional documents or pages here. Please reference the notice at the top of the form and be sure that none of your documents include any sensitive information.

70. Select your Judge:*

    1. Judge Mabel Johnson Mayfield
    2. Judge Brian Berger
    3. Judge Jennifer L. Smith

72. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
74. Electronic Signature*

Leave This Blank:


80. 1. Receive an email copy of this form.
81. Email address

    This field is not part of the form submission.

82. Submit

* indicates a required field