UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) AFFIDAVIT
IN THE CIRCUIT COURT OF THE 17TH JUDICIAL CIRCUIT IN AND FOR BROWARD COUNTY, FLORIDA
In Re: The Matter of Case Number:
JACK KING,
Petitioner/Father,
and
JAMIE CROWN,
Respondent/Mother.
________________________/
UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) AFFIDAVIT
I, JACK KING, being sworn, certify that the following statements are true:
- The number of minor child subject to this proceeding is one. 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: Prince King
Place of Birth: Florida Date of Birth: XX/XX/20__ Sex: XXX
Child’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 |
Relationshipto child |
|
2011 to Present
2010 To 2011
|
|
Father
Mother And Maternal Grandmother
|
* If you are the petitioner in an injunction for protection against domestic violence case and you have filed.
- 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.
- 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.
- Persons not a party to this proceeding:
[one only]
X I DO NOT KNOW OF ANY PERSON not a party to this proceeding who has physical custody or claims to have custody or visitation rights with respect to any child subject to this proceeding.
- Knowledge of prior child support proceedings:
[one only]
X The child described in this affidavit is not subject to existing child support order(s) in this state or territory
- 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.
______________________________
JACK KING
STATE OF FLORIDA )
)§:
COUNTY OF BROWARD )
BEFORE ME, the undersigned authority, personally appeared, JACK KING, 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 ____________ 20__.
WITNESS my hand and seal in the State and County aforesaid this _______day of ___________, 20__.
___________________________
NOTARY PUBLIC
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing was provided to: Jamie Crown, by personal service.
LAW OFFICES OF LARRY D. SCHOTT
Attorney for Father
By:____________________________
LARRY D. SCHOTT
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