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:
UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT
I, JAMIE CROWN, being sworn, certify that the following statements are true:
- The number of minor child subject to this proceeding 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: XXXXXX Date of Birth: XXXXX XX, 20__ Sex: Female
Children’s Residence for the past 5 years:
Address (including city and state) where child lived
Name and present address of person child lived with
* If you are the petitioner in an injunction for protection against domestic violence case and you have filed.
- Participation in custody proceeding(s):
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):
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.
- Persons not a party to this proceeding:
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:
X The child 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.
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__.
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing was provided to: XXXXXXX, Esquire, Attorney for Husband, XXXXXXXXXX on this _______day of XXXXXXX 20__.
LAW OFFICES OF LARRY D. SCHOTT
Attorney for Wife
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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