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UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) AFFIDAVIT

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 Former Marriage of                                          Case Number:

 

JAMIE CROWN,

 

Petitioner/Former Wife,

and

 

JACK KING,

 

Respondent/Former Husband.

_____________________________________/

UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) AFFIDAVIT

 

I, JAMIE CROWN, being sworn, certify that the following statements are true:

 

  1. The number of minor children subject to this proceeding three (3). 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: XXXXXXXXXX

Place of Birth: Florida Date of Birth: XXXXXXX Sex: XXXXX

 

THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD#   2   :

 

Child’s Full Legal Name: XXXXXX

Place of Birth: Florida  Date of Birth: XXXXXXX Sex: XXXXX

 

THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD#   3   :

 

Child’s Full Legal Name: XXXXX

Place of Birth: Florida  Date of Birth: XXXXXX Sex: XXXXXX

 

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

  

Relationshipto child
 

02/18/2016

To

Present

 

 

December 2015

To

02/18/2016

 

 

October 2015

To

December

2015

 

November

2013

To

October 2015

 

 

  

 

  

 

 

 

 

 

 

 

 

 

  

Mother

 

 

 

 

 

 

Mother

 

 

 

 

 

Mother

 

 

 

 

 

 

Mother

and

Father

 

 

* If you are the petitioner in an injunction for protection against domestic violence case and you have filed.

 

 

 

  1. Participation in custody proceeding(s):

[one only]

 

   X                              I HAVE 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 children subject to this proceeding.

 

                       

  1. 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.

 

 

  1. Knowledge of prior child support proceedings:

[one only]

   X                              The child described in this affidavit are 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.

 

______________________________

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 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:    Jack King, Former Husband, by personal service.

 

LARRY D. SCHOTT

Attorney for Former Wife

 

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.

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