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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 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:

 

  1. The number of minor children 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: Jack King, Jr.                                                            

Date of Birth: XXXXXXX 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

 

8/2013

 

To

 

Present

 

1/2011

 

To

 

7/2013

 

 

 

 

 

 Mother

 

 

 

 

Father

 

 

 

 

  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.

 

Jamie Crown v. Jack King

                        Broward Case Number:

                        Agreed Recommended Order of the Hearing Officer on Support and

                        Order of Court Upon Report of Hearing Officer

 

  1. Information about custody proceeding(s):

[one only]

   X                  I HAVE NO KNOWLEDGE 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 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.

 

______________________________

JACK KING 

 

STATE OF HAWAII            )

)§:

COUNTY OF __________ )

 

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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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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