Name 

 
Address 

 
Phone 

 
Email 

 
City, State, Zip 

 

This motion will be decided by the court 
commissioner at an upcoming hearing. If 
you do not appear at the hearing, the 
Court might make a decision against you 
without your input. In addition, you may 
file a written response at least 14 days 
before the hearing. 

 
 
 
 
 
 
 
Check your email. You will receive information and 
documents at this email address.  
 

I am   [  ]  Petitioner 

[  ]  Petitioner’s Attorney 
[  ]  Petitioner’s Licensed Paralegal Practitioner 
[  ]  Respondent’s Licensed Paralegal Practitioner   (Utah Bar #:__________) 

[  ]  Respondent 
[  ]  Respondent’s Attorney                     (Utah Bar #:__________) 

In the District Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

In the Matter of (select one) 
 

[  ]  the Marriage of (for a divorce with or without 
children, annulment, separate maintenance, or 
temporary separation case) 

[  ]  the Children of (to establish custody, parent-

time or child support) 

[  ]  the Parentage of the Children of (for a 

paternity case) 

____________________________________ 
(name of Petitioner) 

and  

 

____________________________________ 
(name of Respondent) 
____________________________________________ 
Other parties (if any) 

Motion for Temporary Order – With 
Children - Commissioner 

[  ]  Hearing Requested 

_______________________________ 
Case Number 

_______________________________ 
Judge 

_______________________________ 
Commissioner 

I ask the court to enter temporary orders in the paragraphs I have marked below.  

1. 

[  ]  Children (including only unborn, minor and adult incapacitated children) 

1102FAJ-C Approved December 18, 
2017 / Revised September 15, 2022 
 

Motion for Temporary Order – With Children - 
Commissioner 

Page 1 of 18 

 

 

 

 

 

 

 

 

 

 

 

 

 

The petitioner and the respondent are the parents of the following children: (Add 
additional pages if needed.) 

Child’s name 
(first, middle and last) 

Example:  
Jennie Eliza Jones 

Month and 
year of birth 

January 2017 

Type of child 

[  ]  Unborn 
[x]  Minor 
[  ]  Adult incapacitated 
[  ]  Unborn 
[  ]  Minor 
[  ]  Adult incapacitated 
[  ]  Unborn 
[  ]  Minor 
[  ] Adult incapacitated 
[  ]  Unborn 
[  ]  Minor 
[  ] Adult incapacitated 
[  ]  Unborn 
[  ]  Minor 
[  ] Adult incapacitated 
[  ]  Unborn 
[  ]  Minor 
[  ] Adult incapacitated 

 

 

 

 

 

 

 

 

 

 

The children have lived at the addresses listed below and with the persons listed 
below for the past five years:  (Add additional pages if needed.) 

Child’s name 

Address (street, 
city, state, ZIP) 

Example: 
Jennie Jones 

123 Maple St 
Mayberry, UT 84444 

Dates child 
lived at this 
address 

Name(s) of 
person(s) who 
lived with child at 
this address 

5/15/15 to present 

Jane Doe, John Jones 

Relationship(s) 
to child 

Mother, maternal 
grandfather 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.  

[  ]  Child custody 

All orders involving children will include two types of custody: physical custody and legal 
custody. 

Physical custody deals with where the children live and how many overnights the children 

1102FAJ-C Approved December 18, 
2017 / Revised September 15, 2022 
 

Motion for Temporary Order – With Children - 
Commissioner 

Page 2 of 18 

spend with each parent.   

Sole physical custody means that the children live primarily with one parent  and have 
parent time (visitation) with the other parent (see parent-time options in Section 3).   
Joint physical custody means that the children typically spend at least 30% of overnights 
with both parents each year and that both parents contribute to the expenses of the child in 
addition to paying child support.   
Split physical custody means that where there is more than one child, each parent is 
awarded sole physical custody of at least one of the children. 

Legal custody deals with access to information and decision making.   

Sole legal custody means that one parent has the right to make important decisions about 
the child.   
Joint legal custody means that both parents: (1) have the right to information about the child 
(events, appointments, access to school and medical records, etc.); and (2) that both parents 
discuss and make major decisions together – (education, religion, medical, extra-curricular 
activities, etc.) but designate a parent to make the final decision if they cannot agree. 

I ask the court to order temporary custody below (Choose one. If you ask for any joint 
legal custody or joint physical custody arrangement, you must file or attach a Parenting Plan 
based on Utah Code 30-3-10.7 to 30-3-10.10.): 

[  ]  Custody arrangement:  (Add additional pages if needed.) 

Child’s name 

Example: 
Jennie Jones 

Month and 
year of birth 

Order physical 
custody to 

Order legal 
custody to 

[  ] Petitioner    

[  ] Petitioner    

January  2013 

[x] Respondent 

[x] Respondent 

 

 

 

 

 

[  ] Joint physical 

[  ] Joint legal 

[  ] Petitioner    
[  ] Respondent 
[  ] Joint physical 

[  ] Petitioner    
[  ] Respondent 
[  ] Joint legal 

[  ] Petitioner    
[  ] Respondent 
[  ] Joint physical 

[  ] Petitioner    
[  ] Respondent 
[  ] Joint legal 

[  ] Petitioner    
[  ] Respondent 
[  ] Joint physical 

[  ] Petitioner    
[  ] Respondent 
[  ] Joint legal 

[  ] Petitioner    
[  ] Respondent 
[  ] Joint physical 

[  ] Petitioner    
[  ] Respondent 
[  ] Joint legal 

[  ] Petitioner    
[  ] Respondent 
[  ] Joint physical 

[  ] Petitioner    
[  ] Respondent 
[  ] Joint legal 

 

 

 

 

 

 

 

[  ]  Other custody arrangement (Describe in detail.): 

1102FAJ-C Approved December 18, 
2017 / Revised September 15, 2022 
 

Motion for Temporary Order – With Children - 
Commissioner 

Page 3 of 18 

I ask the court to order the custody arrangement I have marked above because: 

[  ]  Parent-time 

3. 

 

I ask the court to order temporary parent-time below (Choose one.): 

[  ]  Statutory parent-time schedule: (Choose all that apply. You can find the Utah Code 
at le.utah.gov/xcode/code.html. Print and attach a copy of the statute(s) for the option(s) 
you choose.) 

     [  ] Children under 5 (Utah Code 30-3-35.5) 

     [  ] Children 5-18 (Utah Code 30-3-35) 

     [  ] Children 5-18 (expanded schedule) (Utah Code 30-3-35.1) 

     [  ] Children 5-18 (equal parent-time) (Utah Code 30-3-35.2) 

[  ]  Parent-time described in the filed or attached Parenting Plan. 

[  ]  Other parent-time schedule: (Describe in detail.) 

I ask the court to order the parent-time schedule I chose above because: 

1102FAJ-C Approved December 18, 
2017 / Revised September 15, 2022 
 

Motion for Temporary Order – With Children - 
Commissioner 

Page 4 of 18 

     

 

       

 

       

 

 

 

 

[  ]  Parent-time transfers  

4. 

 

I ask the court to order transfer (pick-up and drop-off) of the children for parent-
time described below (Choose one.): 

[  ]  Order transfer of the children for parent-time described in the filed or 

attached Parenting Plan.  

[  ]  Order transfer at beginning of parent-time with  

[  ] petitioner    

[  ] respondent  

[  ] other adult (Name) _______________________________________  

transferring the children at this address: 
_________________________________________________________  

and transfer at end of parent-time with  

[  ] petitioner    

[  ] respondent  

[  ] other adult (Name) _______________________________________  

transferring the children at this address: 
_________________________________________________________  

 [  ]  Order curbside transfers (The parent/person picking up or dropping off the 

children does not leave the vehicle and the other parent/person does not leave the 
residence). 

[  ]  Other transfer arrangements (Describe in detail.): 

I ask the court to order the transfer arrangement I chose above because: 

1102FAJ-C Approved December 18, 
2017 / Revised September 15, 2022 
 

Motion for Temporary Order – With Children - 
Commissioner 

Page 5 of 18 

       

 

 

 

     

[  ]  Communication between parties 

5. 

 

I ask the court to order communication between the parties as described below 
(Choose as many options as you want.): 

[  ]  In person 

[  ]   Phone 

[  ]   Text 

[  ]   Email 

Petitioner’s # ________________  Respondent’s #________________ 

Petitioner’s # ________________  Respondent’s #________________ 

Petitioner’s email address ____________________________________ 

Respondent’s email address __________________________________ 

[  ]   Through a third party 

Name ____________________________ Phone # ________________ 

[  ]   Other method of communication: (Describe in detail.) 

_________________________________________________________ 

[  ]   Communications between the parties must be civil and respectful and 

limited to parent-time issues only. 

[  ]   The parties must not make negative or harmful remarks about each other in 
the presence of the children, must not allow other people to do so and must 
remove the children if anyone makes negative remarks about the other 
party.  

[  ]   The parties must not discuss this case in the presence of the minor children, 

must not allow other people to do so and must remove the children if 
anyone discusses the case in the presence of the minor children. 

1102FAJ-C Approved December 18, 
2017 / Revised September 15, 2022 
 

Motion for Temporary Order – With Children - 
Commissioner 

Page 6 of 18 

 

       

 

 

 

 

 

[  ]   The parties must not harm or threaten to harm the other parent or the 

children and must not allow other people to do so and must remove the 
children if anyone harms or threatens harm to the other parent or children. 

6. 

[  ]  Child support 

I ask the court to order child support based on the parties’ incomes or estimate of 
income based on ability or work history.   

a.  Petitioner’s total countable gross monthly income for child support 

purposes is $______________ (Utah Code 78B-12-203).  

 

This income is from these sources: 
___________________________________________________________ 

__________________________________________________________. 

[  ]  The court should consider petitioner's income to be $______________ 

based on (Choose one.): 

[  ] minimum wage. 

[  ] historical earnings. 

 

 

 

 

 

[  ]  Petitioner does receive or has received public assistance. 

b.  Respondent’s total countable gross monthly income for child support 

purposes is $________________ (Utah Code 78B-12-203).  

This income is from these sources: 
___________________________________________________________ 

__________________________________________________________. 

[  ]  The court should consider respondent's income to be  

$______________ based on (Choose one.): 

[  ] minimum wage. 

[  ] historical earnings. 

 

[  ]  Respondent does receive or has received public assistance. 

c.  Order  [  ] petitioner   [  ] respondent to pay $________________ per 

month for child support. The following child support worksheet is filed or 
attached (Choose one.):  

[  ]  sole physical custody worksheet 

 

 

1102FAJ-C Approved December 18, 
2017 / Revised September 15, 2022 
 

Motion for Temporary Order – With Children - 
Commissioner 

Page 7 of 18 

[  ]  joint physical custody worksheet 

[  ]  split custody worksheet 

(Choose one.) 

[  ]  This amount is based on the Uniform Child Support Guidelines (Utah 

Code 78B-12-201 et seq.). 

[  ]  This amount is not based on the Uniform Child Support Guidelines 
and I am asking for a different amount because (Choose one.):  

[  ] the guidelines are unjust.  

[  ] the guidelines are inappropriate. 

(Utah Code 78B-12-202 and 210.) 

Explain your choice: 

[  ]  the guidelines amount is not in the best interest of the children.  

_______________________________________________________ 

______________________________________________________. 

d.  Effective date (Choose one.): 

[  ]  The child support is effective upon entry of this order.  

[  ]  The child support is effective as of this date: ____________________. 

e.  Child support will be paid as follows (Choose one.): 

[  ]  Mandatory income withholding by the Office of Recovery Services.  

Unless the Office of Recovery Services gives notice that payments will 
be sent elsewhere, all child support payments must be made to:  Office 
of Recovery Services, PO Box 45011, Salt Lake City, UT 84145  

OR 

OR 

[  ]  Direct payments to the parent receiving child support by: 

[  ]  Check 

[  ] Deposit in bank account 

[  ] Cashier’s check or money order 

[  ] Other: ________________________________________________ 

I ask for direct payment because (Utah Code 62A-11-404): 

________________________________________________________ 

1102FAJ-C Approved December 18, 
2017 / Revised September 15, 2022 
 

Motion for Temporary Order – With Children - 
Commissioner 

Page 8 of 18 

________________________________________________________ 

f. 

I ask that child support payments be made (Choose one.): 

[  ]  One-half on or before the 5th day of each month, and one-half on or 

before the 20th day of each month. 

OR 

[  ]  Other payment arrangement: 

________________________________________________________ 

g.  Child support not paid on or before the due date is delinquent on the day 

after the due date.  

h.  Child support arrearages will be determined by further judicial or 

administrative process. Any federal or state tax refund or rebate due to the 
non-custodial parent will be intercepted by the state of Utah and applied to 
child support arrearages. 

 7. 

[  ]  Child care expenses 

I ask the court to order that both parties share equally the reasonable child care 
expenses related to the custodial parent’s work or occupational training. 

The parent who pays child care expenses must immediately provide to the other 
parent written verification of the cost of the child care expenses and the identity 
of the child care provider when hired, within 30 calendar days after a change in 
the provider or the expense, and anytime upon the request of the other parent. 

If the parent who pays child care expenses fails to provide written verification of 
child care above, that parent may be denied the right to recover or receive credit 
for the other parent’s one-half share of the child care expense.   

The other parent must begin paying one-half the child care amount on a monthly 
basis immediately after receiving proof from the parent that pays the child care 
expense. 

[  ]  Other request for child care payment:  

   

 

8. 

[  ]  Health insurance, medical and dental expenses 

1102FAJ-C Approved December 18, 
2017 / Revised September 15, 2022 
 

Motion for Temporary Order – With Children - 
Commissioner 

Page 9 of 18 

 

Our minor children currently have health insurance coverage through: 

[  ]  Petitioner’s insurance 

[  ]  Respondent’s insurance 

[  ]  Medicaid 

[  ]  CHIP 

[  ]  Not covered by insurance 

[  ]  Other: _______________________________________________ 

Both parties must provide health care coverage for the medical expenses of 
the dependent children. Heath care coverage means coverage under which 
medical services are provided to a dependent child through: fee for service, 
a health maintenance organization, a preferred provider organization, any 
other type of private health insurance, or public health care coverage. Utah 
Code 78B-12-102(13). 

[  ] 

I ask the court to order that  [  ] petitioner   [  ] respondent maintain health 
insurance for our minor children. Both parties must share equally: 

a.  the cost of the premium paid by a parent for the children's portion of the 
insurance. The children's portion of the premium will be calculated by 
dividing the premium amount by the number of people covered by the 
policy and multiplying the result by the number of minor children of the 
parties; and 

b.  all reasonable and necessary uninsured medical and dental expenses 

incurred for the children and paid by a parent, including deductibles and 
co-payments. 

If medical insurance is not available at reasonable cost then both parents 
must ensure the children have health care coverage. This may require 
applying for public health care coverage, such as CHIP or Medicaid. 

The parent ordered to maintain insurance must provide written verification of 
coverage to the other parent or the Office of Recovery Services when the 
children are first enrolled, on or before January 2nd of each calendar year 
and upon any change of insurance carrier, premium, or benefits within 30 
calendar days after the date that parent knew or should have known of the 
change. 

If the parent ordered to maintain insurance fails to provide written 
verification of coverage to the other parent or to the Office of Recovery 
Services, or if the parent incurring medical expenses fails to provide written 
verification of the cost and payment of the expenses to the other parent 

1102FAJ-C Approved December 18, 
2017 / Revised September 15, 2022 
 

Motion for Temporary Order – With Children - 
Commissioner 

Page 10 of 18 

within 30 days of payment, that parent may be denied the right to receive 
credit for the expenses or to recover the other parent's share of the 
expenses.  

The parent receiving written verification will reimburse the parent who 
incurred the medical or dental expenses one-half of the amount within 30 
days after receiving the written verification. 

I ask for this order because (Choose all that apply.): 

[  ]  the insurance is available to  [  ] petitioner   [  ] respondent; 

[  ]  the cost of the insurance is reasonable 

[  ]  the custodial parent prefers this arrangement. 

[  ]  Other reasons:  

[  ] 

I ask for these additional orders regarding health insurance and medical and 
dental expenses:  

9. 

[  ] Pregnancy expenses 

I ask the court to order that  [  ] petitioner   [  ] respondent pay 50% of the 
pregnancy expenses. These expenses were billed for services the mother 
received after becoming pregnant and before the pregnancy ended. (You must 
attach all documents supporting the amounts you are requesting.) 

[  ] One-half of health insurance premiums not paid 

$ _______________ 

by an employer or government program   

from _________ to ________ (dates) 

[  ] One-half of medical costs related to the 
pregnancy not covered by insurance or 
government program  

$ _______________ 

1102FAJ-C Approved December 18, 
2017 / Revised September 15, 2022 
 

Motion for Temporary Order – With Children - 
Commissioner 

Page 11 of 18 

   

 

   

 

10. 

[  ] Tax exemptions for dependent children   

I ask the court to order tax exemptions for the dependent children for tax year  

_____________, as follows: 

Child’s name 

Month and 
year of birth 

Parent who may 
claim exemption 

 

 

 

 

 

 

 

 

 

 

[  ] Petitioner      
[  ] Respondent 

[  ] Petitioner      
[  ] Respondent 

[  ] Petitioner      
[  ] Respondent 

[  ] Petitioner      
[  ] Respondent 

[  ] Petitioner      
[  ] Respondent 

[  ]  Other: ________________________________________________________ 

_____________________________________________________________ 

11. 

[  ]  Payment of bills and debts 

I ask the court to order payment of bills and debts (such as mortgage, rent, credit 
card, utilities, medical expenses, car payments, insurance, etc.) as follows (File or 
attach Financial Declaration. Add additional pages if needed.): 

[  ]  Petitioner to pay:  

Type of debt 

Name of creditor 

 

 

 

 

 

 

[  ]  Respondent to pay:  

Last 4 
digits of 
account 
no. 

Total 
amount 
owed 

Monthly 
amount 
owed 

 

 

 

$ 

$ 

$ 

$ 

$ 

$ 

1102FAJ-C Approved December 18, 
2017 / Revised September 15, 2022 
 

Motion for Temporary Order – With Children - 
Commissioner 

Page 12 of 18 

Last 4 
digits of 
account 
no. 

Total 
amount 
owed 

Monthly 
amount 
owed 

 

 

 

$ 

$ 

$ 

$ 

$ 

$ 

The bills and debts should be paid as requested because: 

Type of debt 

Name of creditor 

 

 

 

 

 

 

   

12. 

[  ]  Property 

[  ]  To petitioner 

I ask the court to order the temporary use and possession of the following 
property (File or attach Financial Declaration. File or attach additional pages if needed.):  

[  ] Residence (Address): ________________________________________ 

[  ] Vehicle(s) (Make/model/year): __________________________________ 

[  ] Personal property items: 

________________________________________________________ 

________________________________________________________ 

[  ] Other: ___________________________________________________ 

[  ]  To respondent 

[  ] Residence (Address): ________________________________________ 

[  ] Vehicle(s) (Make/model/year): __________________________________ 

[  ] Personal property items: 

________________________________________________________ 

________________________________________________________ 

[  ] Other: ___________________________________________________ 

[  ]  I ask the court to order that neither party sell, transfer or dispose of any 

property without a court order or written agreement signed by both parties. 

 

1102FAJ-C Approved December 18, 
2017 / Revised September 15, 2022 
 

Motion for Temporary Order – With Children - 
Commissioner 

Page 13 of 18 

13. 

[  ]  Temporary alimony (Divorce cases only. (Utah Code 30-3-5(8)).)   

I am unable to meet my own financial needs, and I ask the court to order 
temporary alimony as follows (File or attach Financial Declaration.): 

 

[  ] petitioner   [  ] respondent shall pay to    [  ] petitioner    [  ] respondent 
temporary alimony in the amount of $ _______________ per month by: 
(Choose one.): 

[  ] Check   

[  ]  Deposit in bank account 

[  ]  Cashier’s check or money order 

[  ] Other: ________________________________________________ 

[  ]  Petitioner   [  ] Respondent needs temporary alimony because : 

[  ]  Petitioner   [  ] Respondent has the financial ability to pay temporary alimony 

because: 

14. 

[  ] Attorney fees 

I ask the court to order the other party to pay $___________ to my attorney. (You 
can only ask for this if you are paying an attorney to represent you in this case. You must file or 
attach a Financial Declaration.) 

I ask for attorney fees because: 

1102FAJ-C Approved December 18, 
2017 / Revised September 15, 2022 
 

Motion for Temporary Order – With Children - 
Commissioner 

Page 14 of 18 

     

 

 

 

 

   

I ask for this property order because: 

16.  Documents 

I have filed or attached the following documents in support of this Motion for 
Temporary Order (Check all that apply. Forms can be found at www.utcourts.gov.):  

[  ]  Parenting Plan (Utah Code 30-3-10.7 to 30-3-10.10) 

[  ]  Parent time Schedule (Utah Code 30-3-35; 30-3-35.5; 30-3-35.1; 30-3-35.2) 

[  ]  Child Support Obligation Worksheet (Utah Code 78B-12) 

[  ]  Financial Declaration (Utah Rule of Civil Procedure 26.1) 

[  ]  Income verification (Most recent tax return and pay stub) 

[  ]  Other supporting documents:_____________________________________ 

etitioner or Respondent  

I declare under criminal penalty under the law of Utah that everything stated in this document is true. 

Signed at ______________________________________________________ (city, and state or country). 

  P

 
Date 

Signature ► 

Printed Name 

 

 

1102FAJ-C Approved December 18, 
2017 / Revised September 15, 2022 
 

Motion for Temporary Order – With Children - 
Commissioner 

Page 15 of 18 

 15. 

[  ]  Other 

 

I ask the court for these additional orders: 

I ask for these additional orders because: 

 

     

     

Aviso para la parte que responde 
Su tiempo para responder a esta moción es 
limitado. En la mayoría de casos deberá 
presentar una respuesta escrita con el tribunal 
y darle una copia de la misma a la otra parte: 
• dentro de 14 días del día que se presenta 
la moción, si la misma será resuelta por un 
juez, o 

• por lo menos 14 días antes de la 

audiencia, si la misma será resuelta por un 
comisionado.  

n algunos casos debido a un estatuto o a una 

orden de un juez la fecha límite podrá ser 
distinta.  
  
Si usted no responde a esta moción ni se 
presenta a la audiencia, la persona que 
presentó la moción podría recibir lo que pidió.  
  
Vea la página del tribunal sobre Mociones para 
encontrar más 
información sobre el 
proceso de las mociones, 
las fechas límites y los 
formularios:  
utcourts.gov/motions-span 

Para accesar esta página 
escanee el código QR 

  E

Cómo encontrar ayuda 
legal 
La página de la internet 
del tribunal Cómo 
encontrar ayuda legal 

Scan QR code  
to visit page 

Para accesar esta página 
escanee el código QR 

Motion for Temporary Order – With Children - 
Commissioner 

Page 16 of 18 

otice to responding party 

You have a limited amount of time to 
respond to this motion. In most cases, 
you must file a written response with 
the court and provide a copy to the 
other party: 

• within 14 days of this motion being 
filed, if the motion will be decided 
by a judge, or 

• at least 14 days before the 

hearing, if the motion will be 
decided by a commissioner. 

n some situations a statute or court 
order may specify a different deadline.  

f you do not respond to this motion or 
attend the hearing, the person who 
filed the motion may get what they 
requested.  

Scan QR code  
to visit page 

ee the court’s 

Motions page for more 
information about the 
motions process, 
deadlines and forms: 
utcourts.gov/motions 

Finding help 
The court’s Finding 
Legal Help web page 
(utcourts.gov/help) 
provides information 

1102FAJ-C Approved December 18, 
2017 / Revised September 15, 2022 
 

    A

    N

  I

  I

  S

ttorney or Licensed Paralegal Practitioner of record (if applicable) 

 
Date 

Signature ► 

Printed Name 

 

 

about the ways you can get legal help, 
including the Self-Help Center, 
reduced-fee attorneys, limited legal 
help and free legal clinics.  

(utcourts.gov/help-span)  
tiene información sobre algunas maneras de 
encontrar ayuda legal, incluyendo el Centro de 
Ayuda de los Tribunales de Utah, abogados 
que ofrecen descuentos u ofrecen ayuda legal 
limitada, y talleres legales gratuitos. 

1102FAJ-C Approved December 18, 
2017 / Revised September 15, 2022 
 

Motion for Temporary Order – With Children - 
Commissioner 

Page 17 of 18 

I certify that I filed with the court and am serving a copy of this Motion for Temporary Order – With 
Children on the following people. 

Certificate of Service 

Person’s Name 

Service Method 

Service Address 

Service 
Date 

 

 

 

[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
[  ]  Email 
[  ]  Left at business (With person in charge 

or in receptacle for deliveries.) 

[  ]  Left at home (With person of suitable 

age and discretion residing there.) 

[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
[  ]  Email 
[  ]  Left at business (With person in charge 

or in receptacle for deliveries.) 

[  ]  Left at home (With person of suitable 

age and discretion residing there.) 

[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
[  ]  Email  
[  ]  Left at business (With person in charge 

or in receptacle for deliveries.) 

[  ]  Left at home (With person of suitable 

age and discretion residing there.) 

 

 

 

Signature ► 

Printed Name 

 

 

 

 

 

 

 
Date 

 

1102FAJ-C Approved December 18, 
2017 / Revised September 15, 2022 
 

Motion for Temporary Order – With Children - 
Commissioner 

Page 18 of 18