"IN THE __________________ COURT OF __________________ COUNTY STATE OF GEORGIA | |||
A.B., | |||
__________________ | ) | ||
Plaintiff | ) | ||
) | |||
) | Civil Action | ||
) | File no. __________________ | ||
C.D., | |||
__________________ | ) | ||
Defendant | ) |
COMPLAINT
The defendant C.D., herein named, is a resident of __________________(street), __________________, (city) __________________ County, Georgia, and is subject to the jurisdiction of this court.
As of __________________ (date), Plaintiff can fully demonstrate to the court that he or she:
cal, committed, and responsible parental role in the child's life;
child, which relationship was fostered or supported by a parent of
the child, and Plaintiff and the parent have understood, ac-
knowledged, or accepted that or behaved as though Plaintiff
is a parent of the child; and
The facts of the case are:
____________________________________Dated Pro Se Applicant
__________________
Address
__________________
Address
(CERTIFICATE OF SERVICE)""AFFIDAVIT OF PETITIONER
STATE OF GEORGIACOUNTY OF __________________
Personally appeared before me, the undersigned officer duly authorized to administer oaths, __________________, who, after having been sworn, deposes, and says as follows:
That my name is: __________________
That my address is: __________________
These are the facts to support the existence of an equitable caregiver relationship with a child as set forth in subsection (c) of O.C.G.A. 19-7-3.1:
____________________________________Dated Pro Se Applicant
__________________
Address
__________________
Address
Sworn to and subscribed
before me this __________________
day of __________________, __________________.
__________________
Notary public (SEAL)
My commission expires: __________________
OCGA § 19-7-3.1