Rule 1915.15. Form of Complaint. Caption. Order. Petition to Modify a Custody
Order.
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        (b)   A petition to modify a custody order shall be in substantially the following
form:

                                         (Caption)

              PETITION FOR MODIFICATION OF A CUSTODY ORDER

     1.    Petitioner is _____________________ and resides at
____________________________.

     2.    Respondent is ___________________ and resides at
____________________________.

       [1.    The petition of __________________]3.             Petitioner respectfully
represents that on ____________, 20__ an Order of Court was entered for (shared
legal custody) (sole legal custody) (partial physical custody) (primary physical custody)
(shared physical custody) (sole physical custody) (supervised physical custody)[, a]. A
true and correct copy of [which]the Order is attached.

     [2]4. This Order should be modified because:
_____________________________________________________________________
_____________________________________________________________________

       [3]5. Petitioner has attached the Criminal Record/Abuse History Verification
form required pursuant to Pa.R.C.P. No. 1915.3-2.

      WHEREFORE, Petitioner requests that the Court modify the existing Order
because it will be in the best interest of the child(ren).

                                          ______________________________
                                          (Attorney for Petitioner) (Petitioner)

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

_________________________________ _________________________________
     Date                                        Petitioner
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