State Of Maine
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| District Court |
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| Location: Cumberland |
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| Docket Number ______________________ |
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| P_______ and D ________ also agree to communicate in
advance all major decisions concerning the welfare of C
________. Each also agrees not to argue with each other in
front of C _________ and they shall not discuss the other
parent in disparaging terms to C _________. |
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| PRIMARY RESIDENCE - Both P _______ and D
_______ agree at this time that it is in the best interest
of C _________ not to interrupt the current living
arrangement and C _______ shall live primarily with
___________ |
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| NOTICE OF RELOCATION - (Parent's Name
with physical custody ) agrees to give ( Other
Parent ) at least 30 days notice before the intended
relocation of C _________ due to leaving or moving from
the residence. If the relocation must occur in less than
30 days, ( Parent's Name With Physical Custody)
agrees to provide notice as soon as possible to ( Other
Parent ) |
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| ACCESS TO CHILDREN’S RECORDS - Both P
_________ and D ________ agree that each shall have equal
and unrestricted access to C __________ records,
including, but not limited to, medical, dental and school
records, whether or not the child(ren) resides with the
parent seeking such records and information. |
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CHILD SUPPORT - The issue of child
support: ( has been or is being,) established by the
Department of Human Services. A copy of the
"Certificate in Lieu of Case Management Conference" and
this agreement will be sent to the Department of Human
Services, Child Support Services.
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"If this is agreement is
contested, or the issue of Child Support has NOT been
established, you cannot use the "Certificate in Lieu"
form. Delete what I have underlined if necessary." |
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PARENT - CHILD CONTACT - ( Parent With
Physical Custody ) and ( Other Parent ) agree that ( Other
Parent ) shall have the following parent - child contact
with the C _________
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| (A) - Weekend Visits - Every other
weekend, from Friday after school to Sunday at 6 P.M.;
provided, however, in the event that C ____________ does
not have school on the Monday following a visitation
weekend, then such visitation weekend shall be extended to
said following Monday at 6 P.M. |
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| (B) - Summer Visits - Fours weeks during
the summer to include two weeks at the beginning and two
weeks later in the summer vacation, unless both P
____________ and D _________________ mutually agree
otherwise. |
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| (C) - Christmas - In all even numbered
years from Christmas Eve at 12:00 P.M. to Christmas Day at
12:00 P.M. In all odd numbered years, from Christmas Day
at 12:00 P.M. to December 26th at 7:00 P.M. |
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| (D) - Other Holidays - In all even
numbered years from 9:00 A.M. to 7:00 P.M. on the day of
the following holidays: Easter; Memorial Day; Labor Day;
and Veterans Day. In all odd numbered years from 9:00 A.M.
to 7:00 P.M. on the following holidays: Independence Day;
Columbus Day; and Thanksgiving. |
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| (E) - School Vacations - ( Parent
Without Physical Custody ) shall have additional
rights to visit with and be visited with C ___________ as
follows: |
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| (1.) In all even numbered years: The
February School Vacation period from after
school on the first day to 7:00 P.M. of the last day of
the vacation period. |
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| (2.) In all odd numbered years: The
April School Vacation period from after school
of the first day to 7:00 P.M. of the last day of the
vacation period. |
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| (F) - Birthdays - ( Other
Parent ) shall have the right to visit with C
______ from 3:00 P.M. to 8:00 P.M. on their birthday in
all odd numbered years. |
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| (G) - Father’s Day - C _______ shall be
with ____________ on Father’s Day from 9:00 A.M. to 7:00
P.M. in any year in which Father’s Day falls on ( Other
Parent's) contact time or as mutually agreed upon by
both P ______and D ________ |
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"This can be
changed to "Mother's Day" if the Father has physical
custody." |
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| (I) - Other Contact - Such other and
further reasonable contact as both parents may mutually
agree. P ________ and D ________ each agree that each
parent shall have reasonable telephone contact with C
__________ while they are in the other parent’s home. |
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| (J) - Interference With Contact - Neither
parent shall interfere with the other parent’s contact
rights established in this agreement. |
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| This agreement is being filed with the court and is in
effect on the date noted below. Both parties are aware
that at anytime, each has a right to file a "Motion to
Modify." and ask the court to change some, or all of this
agreement. |
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"This sentence is included if
this agreement is NOT being contested." (delete
sentence below) |
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| This agreement is being filed with the court and the
Plaintiff respectfully prays that the court approves and
orders the above Parental Rights Agreement. The Plaintiff
is aware that at anytime, each parent has a right to file
a "Motion to Modify" and ask the court to change some or
all of this agreement. |
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"This sentence is included if
this agreement IS being contested." (delete
sentence above) |
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| _________________________________ |
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| _______Plaintiff's Name |
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| ________________________________ |
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| ____________Date |
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| ________________________________ |
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| ________Defendant's Name |
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"If Contested, Delete
Defendant's Name" |
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| ________________________________ |
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| ______________Date |
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| Personally appeared the above named Plaintiff ( and
Defendant ) If NOT contested and
signed and made oath to the truth of the statements in the
above agreement, before me. |
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| _______________________________ |
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| _______Notary Public |
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| ______________________________ |
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| ________ Date |
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