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In Re the Marriage of: , Name of Petitioner and . Name of Respondent

Affidavit in Support of Motion to Change Custody

STATE OF MINNESOTA COUNTY OF

) ) SS )

Instructions: If you are only asking the Court to change legal custody, answer questions 1 through 11, 36 and 37. If you are asking the Court to change physical custody or both physical and legal custody, answer all questions. My name is 1. I am the (check one): Petitioner/Plaintiff and I state under oath that: Respondent/Defendant other in this case, and I

make this Affidavit in support of my Motion to Change Custody. My relationship to the child(ren) is . 2. A juvenile court proceeding or child protection case involving any or all of the children in this case is open: YES NO. If YES, this case is in , and the file number is worker's name is 3. . County in the State of The child protection

. A copy of the Order is attached.

An Order for Protection involving me and the other party and/or the child(ren) exists: YES NO. If YES, it is in and the file number is attached. County in the State of A copy of the Order for Protection is

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4.

The child(ren) currently live with: child(ren)'s: child(ren) is , State of Mother

Petitioner/Plaintiff Father

Respondent/Defendant

who is the

Other relation to the children.

The address of the in the City of

, zip code

.

5. 6.

The current custody order which I am requesting be modified is dated ________________________. The current order grants legal custody of the child(ren) as follows: Sole legal custody to: custody to: both parties Petitioner/Plaintiff other Respondent/Defendant Other Joint legal .

7.

Legal custody identifies which parent(s) have the right to make decisions regarding the upbringing of the child including education, health care and religious training. I do not want to change legal custody. I want to change legal custody to: Sole legal custody in favor of Joint legal custody to both parents , or

8.

The current order grants physical custody of the child(ren) as follows: Sole physical custody to: Petitioner/Plaintiff Respondent/Defendant Other

Joint physical custody to both parties.

9.

Physical custody identifies the person(s) with whom the child(ren) will live. I do not want to change physical custody. I want to change physical custody to: Sole physical custody in favor of Joint physical custody to both parents , or

10.

I want to change physical and/or legal custody, or modify a parenting plan provision specifying the child's primary residence, because: (check all that apply): a. A change of custody is in the best interests of the child(ren) and the parties previously agreed, in a writing approved by a court, to apply the best interests standard from Minnesota

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Statutes section 518.17 or 257.025 (Attach a copy of the court Order approving the agreement) and either: (check one) i. Each party was represented by an attorney when the agreement was approved by the court OR ii. The court made a finding in the Order approving the agreement that the parties were fully informed, the agreement was voluntary, and the parties were aware of its implications.

The change of primary residence is in the best interests of the child(ren) because: (Explain in detail)

.

b. Both parties have agreed that it is in the best interests of the minor child(ren) to change custody. Attached is our signed and notarized agreement. (Note: The Agreement MUST do more than just state that a change of custody is in the best interests of the minor child(ren). It MUST explain in detail HOW and WHY the change will be in the child(ren)'s best interests.) c. The child(ren) has/have been living with me since the date:
·

.

The child(ren) came to live with me because (describe the reason(s) the child(ren) came to live with you):

·

The child(ren) has/have become integrated into my home in the following way: (give specific examples):

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·

The child is living with me with the consent of the other parent.

YES

NO.

If YES, the other parent has said or done the following to make me believe he or she agrees that the child should live permanently with me

d. My child is in danger if s/he lives with the other parent.* The other parent is putting the child in danger by doing the following: (Give very specific facts and details):

* If an extreme emergency exists, request an expedited hearing.

e. The other parent has denied or interfered with my court-ordered parenting time. The following is a list of each date, in the past 6 months, that I was denied

parenting time, and an explanation of exactly what the other parent did on each date to stop my parenting time:

11.

I understand that the court cannot change custody unless there is a change in the circumstances of the child or parents since the last custody order. The following is a description of the changes that are a basis for modifying the most recent custody order or parenting plan:

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12.

I understand that moving a child to a different family and home can be stressful for the child. I believe that living with the other parent is more harmful to my child(ren) than the stress of moving to a new home and family because:

13.

I understand that the Judge must decide custody based on what is best for my child(ren), and that by filling in (a) through (o) of this paragraph 13, that I am giving the Judge information needed to make that decision. a. Describe the custody arrangement you want:

Describe the custody arrangement the other parent wants:

b. Describe the custody arrangement the child wants: (if the child is old enough to decide)

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Describe what you do each and every day to take care of your child(ren): (be very detailed)

c. In contrast, the other parent does the following each day to take care of the child:

d. Describe the closeness of the relationship of each parent and child:

e. Describe the interaction of the child(ren) with each parent, brother, sister, and anyone else who is important to the child(ren) and how that will change with a change in custody:

f. Describe the child(ren)'s adjustment to home, school and community:

g. Describe the length of time the child(ren) has/have lived in a stable satisfactory place and the need to stay in that place:

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h. Describe the permanence, as a family unit, of the existing or proposed custodial home:

i. Describe the mental and physical health of all individuals involved:

. j. Describe the ability of each parent to give the child(ren) love, affection and guidance and continue educating and to raise the child(ren) in the child(ren)'s culture, religion or creed, if any:

k. Describe the child(ren)'s unique cultural needs and what role you play in meeting the cultural needs; then describe the role the other parent plays:

l. There:

is

is not domestic abuse in my household. The following people are involved

in the domestic abuse: (tell how the people are related to the child(ren) and/or to you):

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The domestic abuse in my household affects the child(ren) in the following way:

m. There

is

is not domestic abuse in the other parent's household. The following people

are involved in the domestic abuse: (tell how the people are related to the child(ren) and/or to the other parent):

The domestic abuse in the other parent's household affects the child(ren) in the following way:

n. Describe what you will do to encourage and permit frequent and continuing contact by the other parent with the child(ren); (except when there is domestic abuse):

o. Describe what the other parent does to encourage or discourage your contact with the child:

14.

If the court changes physical custody, the parenting time schedule should be changed. (Check all that apply. Be as complete as possible.)

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a. Changing the existing parenting time schedule to the following schedule: Weekends:

Week nights or after school:

Holidays:

Summer:

School Holidays:

Telephone contact:

Other:

b. Requiring supervised parenting time because:

Parenting time should be supervised by: NOTE: You and the other party may have to pay a fee for each supervised visit. Who should pay the fee? c. Requiring that the child(ren) be transferred at a parenting time exchange center if one is located in the area and for both parties to follow all rules of the parenting time exchange

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center. NOTE: The parenting time exchange center may require the parties to pay a fee for such an exchange. Who should pay the fee? d. Requiring that the child(ren) be transferred at:

Current Information About Me 15. I am currently (check all that apply): Married Separated Divorced

Living with a companion

Single

16. I am currently (check one) employed unemployed (if employed, answer the following): a. Employer: b. Address: c. Work telephone number: d. Occupation /Type of work: e. Length of employment: f. Supervisor: g. Gross Pay: $_________________ This does does not include overtime pay. h. Paid: Weekly Every other week Twice a month Monthly i. Previously employed by for ___________ years prior to the above employment. 17. I have the following additional sources of income: Commissions $ Annuity Payments $ Military / Naval Retirement $ Spousal Maintenance Received $ Self-Employment $ Pension Payments $ Unemployment Benefits $ Workers' Compensation $ Disability Payments $ Other $ MinnesotaCare

18. I receive (check only if it applies) MFIP Medical Assistance General Assistance SSI Child Care Assistance

19. The joint child(ren) currently receives monthly social security or veteran's benefits in the amount based on my disability the other parent's disability and is paid to of $ me other parent. 20. I am court ordered to pay monthly spousal maintenance. (check one) YES NO If yes, how much? 21. I support the following nonjoint child(ren): Child's Name Date of Birth

Child support Living in monthly amount my home $ Yes / No $ Yes / No $ Yes / No $ Yes / No $ Yes / No (If ordered to pay child support for any child listed above, provide copies of court orders)

Relationship

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22. My monthly expenses at the present time are as follows (if remarried, include total of household expenses): Monthly Payment at Present Time a. b. c. d. House payment or Rent Real Estate Taxes, if not included in (a) Association Dues or Lot Rent (for property) Insurance: Homeowners, if not included in (a) Car Life Utilities: (Average Monthly Amount) Gas Electricity Telephone Water and garbage Cable TV Food Clothing Laundry/dry cleaning Personal allowances and incidentals Magazine and newspapers Uninsured / unreimbursed medical expenses Uninsured / unreimbursed dental expenses Child care expenses Transportation expenses: Car payment License Gasoline Repairs Recreation/Entertainment Child(ren)'s needs (sports/school/hobbies) Allowances Other (list) Charge accounts and loans (list): Name of Account 1. 2. 3. 4. 5. TOTAL MONTHLY EXPENSES: $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Balance Owed $ ____________________ $ ____________________ $ ____________________ $ ____________________ $ ____________________ $ 0.00

e.

f. g. h. i. j. k. l. m. n.

o. p. q. r. s.

23. The following people help me pay my current monthly expenses listed in question 15: Spouse Companion Roommate(s) Relatives No One

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24. The value of the property I currently own by myself or with someone else is: Home $____________________ Household goods $____________________ Purchase price of my home $_________________ Balanced owed on my home $____________________ Other real estate $____________________ Checking/savings $____________________ Automobiles $____________________ (year and make) Recreational vehicles $____________________ (year and make) Personal property $____________________ Stocks/bonds/etc. $____________________ Current Information About Other Parent 25. To the best of my knowledge, the other parent is currently: (check one) employed unemployed (if employed, answer the following): a. Employer: b. Address: c. Work telephone number: d. Occupation / Type of work: e. Length of employment: f. Supervisor: g. Gross Pay: $_________________ This does does not include overtime pay. h. Paid: Weekly Every other week Twice a month Monthly Unknown i. Previously employed by for ___________ years prior to the above employment. 26. To the best of my knowledge, the other parent has the following additional sources of income: Commissions $ Pension Payments $ Annuity Payments $ Unemployment Benefits $ Workers' Compensation $ Military / Naval Retirement $ Spousal Maintenance Received $ Disability Payments $ Other $ Self-Employment $ 27. To the best of my knowledge, the other parent receives (check only if it applies) Medical Assistance MinnesotaCare General Assistance SSI Child Care Assistance MFIP

28. To the best of my knowledge, the other parent is ordered to pay spousal maintenance. (check one) YES NO If yes, how much? 29. To the best of my knowledge, the other parent supports the following nonjoint child(ren): Child's Name Date of Birth Relationship Child support Living in monthly amount the home $ Yes / No $ Yes / No $ Yes / No $ Yes / No $ Yes / No

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Parents Health Care Coverage Information 30. About me: (check all that apply) I am court ordered to carry health care coverage for the joint child(ren) I now have private health care coverage available for the joint child(ren) I do not have or no longer have private health care coverage available for the joint child(ren) I cannot afford to pay my proportionate share of health care coverage for the joint child(ren) My proportionate share of health care coverage for the joint child(ren) should be changed I am court ordered to maintain health care coverage for other nonjoint children and coverage is in place for other nonjoint children. I have private health care coverage and/or dental insurance coverage in place for the following people: Cost of monthly health care coverage for self: $ Cost of monthly health care coverage for dependents: $ Cost of monthly dental insurance for self (if separate coverage from health care coverage): $ Cost of monthly dental insurance for dependents (if separate coverage from health care coverage): $ 31. Currently, there is: no court order that directs either parent to carry private health care coverage for the joint child(ren). a court order that directs me the other parent to carry private health care coverage for the joint child(ren). Medical Assistance MinnesotaCare currently in place for the joint child(ren). 32. About the other parent: (check all that apply) The other parent is court ordered to carry health care coverage for the joint child(ren) The other parent has private health care coverage available for the joint child(ren) The other parent does not have or no longer has private health care coverage available for the joint child(ren) The other parent is court ordered to maintain health care coverage for other nonjoint children and coverage is in place for other nonjoint children. The other parent has private health care coverage and/or dental insurance coverage in place for the following people: Cost of monthly health care coverage for self: $ Cost of monthly health care coverage for dependents: $ Cost of monthly dental insurance for self (if separate coverage from health care coverage): $ Cost of monthly dental insurance for dependents (if separate coverage from health care coverage): $ Child Care Obligation 33. I am court ordered to pay a proportionate share of child care support and the amount of child care support has changed. There is no court ordered child care obligation and I have child care expenses. 34. If there is an existing court order for monthly child care expenses, list the court ordered amount: $

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35. The current total monthly costs of child care are $ 36. At paragraph/question 7 or 9 of this Affidavit, I asked the Court for joint custody: YES NO. (If NO, go to question 37. If YES, fill in the rest of question 36).

I provide the following information to help the judge decide if joint custody is appropriate: a. Describe the ability of the parents to cooperate in rearing their child(ren):

b. Describe the methods parents have for working through disagreements regarding major decisions about the child(ren)'s life and their ability to use these methods:

c. Describe whether it would be harmful to the child(ren) if one parent had total authority over the child's upbringing:

d. Describe whether domestic abuse as defined in Minn. Stat. § 518B.01 has occurred between the parents:

37.

The following is additional information regarding the reasons I am requesting a change of custody:

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Dated:
Signature (Sign only in front of notary public or court administrator.)

Name: Subscribed and sworn to before me this day of , . Address: City/State/Zip: Telephone:
Notary Public \ Deputy Court Administrator

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