Commonwealth of Massachusetts
The Trial Court Probate and Family Court Department
COMPLAINT FOR SUPPORT-CUSTODY-VISITATION PURSUANT TO G.L. c. 209 C
, Plaintiff 1. Plaintiff, who resides at
, is father
the the the the
mother guardian parent
of a child born out of wedlock.
a child born out of wedlock. custodian of a child born out of wedlock. personal representative of the mother father of a child born out of wedlock. agency licensed under G.L. c. 28A
Department of Social Services
the Department of Revenue 2. The child who is the subject of this complaint is: Name who resides at 3. Defendant, who resides at
( State) ( Zip) (Street address) (City/Town)
Date of Birth
(County) ( State) ( Zip)
of the above-named child who was born out of wedlock.
4. The plaintiff and defendant are not married. 5. The mother of the child was not married at the time of the child's birth and was not married within three hundred days before the birth of the child. 6. The on plaintiff
signed a voluntary acknowledgement of paternity , a copy of which is attached to this complaint.
was adjudicated the father
7. Wherefore, plaintiff requests that the Court: order a suitable amount of support for the child. order the grant the grant the plaintiff plaintiff plaintiff defendant to maintain provide health insurance for the benefit of the child. plaintiff and/or the child. prohibit the defendant from imposing any restraint on the personal liberty of the defendant custody of the child. defendant visitation rights with the child.
(Signature of attorney or plaintiff, if pro se) (Print name)
CJ-D 109 (10/07)