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 Marriage of Case Number:
JAMIE CROWN,
Petitioner/Wife,
and
JACK KING,
Respondent/Husband.
__________________________/
UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) AFFIDAVIT
I, JAMIE CROWN, being sworn, certify that the following statements are true:
- The number of minor child subject to this proceeding is one (1). 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: XXXXXXX
Place of Birth: XXXX Date of Birth: XX/XX/20__ Sex: XXXX
Child’s Residence for the past 5 years:
01/14 Father and Mother
to
Present
Birth Father and Mother
To
01/14
- 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 INFORMATION of any custody proceeding pending in a court of this or any other state concerning a child subject to this proceeding.
Domestic Violence – Case Number: XXXXXX
Order of Dismissal – XXXXXX XX, 20__
- 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 children described in this affidavit are 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.
______________________________
JAMIE CROWN
STATE OF FLORIDA )
)§:
COUNTY OF BROWARD )
BEFORE ME, the undersigned authority, personally appeared, JAMIE CROWN, 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 her personal knowledge and that she executed this document this ____day of XXXXXX 20__.
WITNESS my hand and seal in the State and County aforesaid this _____day of XXXXXXX 20__.
___________________________
NOTARY PUBLIC
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing was provided to Jack King, by personal service.
LAW OFFICES OF LARRY D. SCHOTT
Attorney for Wife
By:_____________________________
LARRY D. SCHOTT
Do You Have a Question?
If you have a question about a family law case, please feel free to call us at 954-880-1302. We promise to get back to you promptly.
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.
To Learn About Larry Schott’s Qualifications as a Divorce Lawyer and Family Law Advocate, See His About Me Page.