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(UCCJEA) AFFIDAVIT – Grandfather

UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) AFFIDAVIT – Grandfather

IN THE CIRCUIT COURT OF THE 17TH JUDICIAL CIRCUIT IN AND FOR BROWARD COUNTY, FLORIDA

 

In Re: The Matter of  XXXX (a minor)                                                         Case Number:

JIMMY DOE

Petitioner/Paternal Grandfather,

and

 

JANE DOE,

Mother,

 

JOHN  DOE,

Father.

 _______________________________________/

UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) AFFIDAVIT

I, JIMMY DOE being sworn, certify that the following statements are true:

  1. The number of minor children subject to this proceeding is two. The name, place of birth, birth date and sex of each child; the present address, periods of residence and places where each child has lived within the past five (5) years; and the name, present address, and relationship to the child of each person with whom the child has lived during that time are:

THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD#   1   :

Child’s Full Legal Name: XXXXX

Place of Birth: XXXX, XXXX Date of Birth: XXXX Sex: XXXXX

THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD#   2   :

Child’s Full Legal Name: XXXXX

Place of Birth: XXXXXX Date of Birth:XXXXX Sex: XXXXX

Children’s Residence for the past 5 years:

 

Dates – (From/To)

  

Address (including city and state) where child lived

  

Name and present address of person child lived with

  

Relationship to child
 

 

 

  

 

 

  

 

  

 

 

 

 

 

 

 

  1. Participation in custody proceeding(s):

[one only]

   X                 I HAVE NOT participated as a party, witness, or in any capacity in any other litigation or custody proceeding in this or any other state, concerning custody of a child subject to this proceeding.

  1. Information about custody proceeding(s):

[one only]

   X                 I HAVE NO INFORMATION of any custody proceeding pending in a court of this or any other state concerning a child subject to this proceeding.

  1. Persons not a party to this proceeding:

[one only]

    X                I DO NOT KNOW THAT THE FOLLOWING NAME PERSON not a party to this proceeding has physical custody or claim(s) to have custody or visitation rights with respect to any child subject to this proceeding:

  1. Knowledge of prior child support proceedings:

[one only]

    X     The children described in this affidavit are NOT subject to existing child support order(s) in this state or territory.

  1. I acknowledge that I have a continuing duty to advise this Court of any custody, visitation, child support, or guardianship proceeding (including dissolution of marriage, separate maintenance, child neglect, or dependency) concerning the child(ren) in this state or any other state about which information is obtained during this proceeding.

______________________________
Jimmy Doe

 

STATE OF FLORIDA         )

COUNTY OF BROWARD  )

BEFORE ME, the undersigned authority, personally appeared, JIMMY DOE known to me or who produced _______________as identification, under penalties of perjury and having been sworn under oath, verifies that the above contents and information is true and correct to the best of his/her personal knowledge and that he/she executed this document this ____day of XXXX 20__.

WITNESS my hand and seal in the State and County aforesaid this ____ day of XXXX, 20__,

___________________________
NOTARY PUBLIC

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing was provided to JANE DOE, Mother and JOHN  DOE, Father, by hand delivery.

SCHOTT & TOLCHINSKY, P.A.

Attorney for Petitioner

By:______________________________
LARRY D. SCHOTT

 

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This document is a sample pleading related to a specific set of facts and circumstances and should not be used or relied upon for any family law matter. This document is being provided for illustrative purposes only. We recommend and urge you to consult with an experienced divorce lawyer for professional advice as each case is unique.