Petition for Emergency Special Relief

NOTICE YOU HAVE AN INTEREST IN COURT. If you wish to contest the claims set forth in the following pages you must appear at the scheduled hearing and should obtain legal advice. If you fail to appear at the hearing, Court action may pay proceed without you. IF YOU WISH TO HAVE A LAWYER AND DO NOT HAVE ONE OR CANNOT AFFORD ONE, YOU CAN GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. NORTH PENN LEGAL SERVICES, INC. 33 North Main Street Pittston, PA 18640 570-299-4100
Date
Plaintiff's Name First Last
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone
Defendant's Name First Last
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone
Petitioner First Last
Initials and ages of minor child(ren):
Petitioner’s relationship to the minor child(ren)
Petitioner’s relationship to the minor child(ren)
Petitioner’s relationship to the minor child(ren)
Petitioner’s relationship to the minor child(ren)
Petitioner’s relationship to the minor child(ren)

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