Form CJ-D 109 at a glance
What it is: Form CJ-D 109 is the Commonwealth of Massachusetts Trial Court, Probate and Family Court complaint for custody-support-parenting time pursuant to G. L. c. 209C.
Who signs: Sign the Signature of Attorney or Plaintiff, if pro se.
The plaintiff and defendant are not married. 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.
A filled-in Form CJ-D 109 example: a mother files for support, health insurance and custody
How to fill out Form CJ-D 109, box by box
Docket No., Division, Plaintiff and Defendant
Enter the Docket No. and the Division. For the Plaintiff and the Defendant, enter the First Name, M.I and Last Name.
Plaintiff, who resides at
Under 1, enter where the plaintiff resides: the Address, Apt, Unit, No. etc., City/Town, State and Zip.
Plaintiff is
Plaintiff is the father or mother of a child born out of wedlock, a child born out of wedlock, the custodian or guardian of a child born out of wedlock, or the parent or personal representative of the father or mother of a child born out of wedlock.
Plaintiff is also: Department of Children and Families, an agency licensed under G. L. c. 28A, or Department of Revenue.
The child who is the subject of this complaint
Under 2, enter the First Name, M.I., Last Name, Current age and Date of Birth of the child who is the subject of this complaint, and the Address, Apt, Unit, No. etc., City/Town, State and Zip.
Defendant, who resides at
Under 3, enter where the defendant resides: the Address, Apt, Unit, No. etc., City/Town, State and Zip.
Defendant is the father or mother of the child in 2 who was born out of wedlock.
Voluntary acknowledgement of paternity
The plaintiff or defendant signed a voluntary acknowledgement of paternity or was adjudicated the father on the date you enter, a copy of which is attached to this complaint.
Wherefore, plaintiff requests that the Court
Order a suitable amount of support for the child.
Order the defendant or plaintiff to provide or maintain health insurance for the benefit of the child.
Prohibit the defendant from imposing any restraint on the personal liberty of the plaintiff and/or the child.
Grant the plaintiff or defendant custody of the child.
Grant the plaintiff or defendant parenting time with the child.
Date, Print name, Address and Primary Phone
Enter the Date, then the (Print name), (Address), (Apt, Unit, No. etc.), (City/Town), (State), (Zip) and Primary Phone #.
Common questions about Form CJ-D 109
Who signs it?
Sign the Signature of Attorney or Plaintiff, if pro se.
Sources
[1] Form CJ-D 109 (7/15/15), Complaint for Custody-Support-Parenting Time Pursuant to G. L. c. 209C, The Trial Court, Probate and Family Court, Commonwealth of Massachusetts (the Official source link on this page).