Warren-Forest Court of Common Pleas Thirty Seventh Judicial District
of the Commonwealth of Pennsylvania

In cases in which the parties waive the right to proceed before the Court with a custody matter and in which a hearing is held before the Court Hearing Officer, the Court Hearing Officer shall file a report in the same manner as provided by Pa. R.C.P. 1915.4-2 for cases of partial custody and visitation. The recommended order submitted by the Court Hearing Officer shall become a final order of Court within ten days from the date of entry unless a party files a written demand for a de novo hearing with the Court. A written demand for a de novo hearing in substantially the form hereinafter set forth shall be filed with the Prothonotary, who shall time stamp the demand and forward it to the Court Administrator for a hearing date. A demand for a de novo hearing shall not stay the recommended order entered by the Court unless the Court so directs. The Court Hearing Officer's Report shall be filed within thirty days of the hearing.

                    IN THE COURT OF COMMON PLEAS
               OF THE 37TH JUDICIAL DISTRICT OF PENNSYLVANIA
                         FOREST/WARREN COUNTY

	_______________________________
	Plaintiff 
	       vs.			No.
	_______________________________
	Defendant

                        REQUEST FOR A HEARING

	AND NOW, this ________day of _____________, _____, the
Plaintiff/Defendant,________________________________, by 
his/her Attorney________________________, respectfully requests the Court
Administrator to list the above case for hearing de novo before the Court
for the following reasons:_____________________
	The hearing is de novo and therefore is not limited in scope to the
reasons set forth herein.
					________________________________
		Plaintiff/Defendant

Attorney for Plaintiff: ________________________________
Attorney for Defendant: ______________________________
Name of Conference Officer: __________________________
Date of Recommendations: ____________________________
Judge (if any) who has heard previous custody matter(s)______
Estimated Court time required:__________________________

	I certify under penalty of 18 Pa. C.S.A. Section 4904, relating to
unsworn falsification to authorities, that this Request was mailed on the
______ day of_______________, _____ by first class mail, postage prepaid.

				By:  ________________

                   IN THE COURT OF COMMON PLEAS
          OF THE 37TH JUDICIAL DISTRICT OF PENNSYLVANIA
                      WARREN COUNTY BRANCH
                             CIVIL

	______________________________
	Plaintiff
					In Custody
	   vs.										
	______________________________	
	Defendant
                             WAIVER	

	I, the undersigned, having been informed of the right to have this matter
heard by a Judge or the Court of Common Pleas, hereby agree:
	1.  This matter may be heard by the Court Hearing Officer duly appointed
by the Court.
	2.  Stenographic recording is waived.
	3.  The Court Hearing Officer may make Findings of Fact, Conclusions of
Law and a Recommended Order after having heard the testimony of witnesses.
	4.  The Findings of Fact, Conclusions of Law and Recommended Order shall
be binding upon all parties in the event that there are no exceptions
filed.
	5.  If exceptions are filed in this matter within ten (10) days from the
Recommended Order, the Court shall schedule a hearing de novo in this
matter.
		DATE:______________________________

		____________________________
		Signature

                      Exhibit L1915.4