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In Re the Marriage of: ,

Name of Petitioner/Plaintiff

v. .
Name of Respondent/Defendant

Affidavit in Support of Motion for Parenting Time Assistance

STATE OF MINNESOTA

) ) S.S. COUNTY OF _____________________________ ) My true and correct name is In answering the following questions I understand that I am under oath and I must tell the truth. 1. a. This Notice of Motion is NOT a request to establish parenting time rights because an Order establishing parenting time rights for (check one): parenting time problem. b. An Order exists reserving parenting time rights. This Notice of Motion requests an Order granting me parenting time rights. 2. An Order for Protection involving me and the other party and/or the child(ren) (check one): a. IS NOT currently in effect in any state. b. IS in effect from and its court file number is 3. County in the State of . me the other party has already been issued in this case. Instead, my Notice of Motion and Motion is a request to resolve a .

A juvenile court (child protection, delinquency, or foster care) proceeding involving one or more of the children in this case (check one) a. IS NOT now taking place in any state.

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b. IS now taking place in and its court file number is 4.

County in the State of .

The following child(ren) are involved in this case (attach another sheet of paper if necessary): Name of Child Birth Date My Relationship to Child

5.

The child(ren) live in the State of (month) who is related to them as is: Street Address: City/State/Zip: , . The child(ren) live with

and have lived there since . The address of the child(ren)

6.

I have a parenting time problem. It is:

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For questions 7-18, check off only those that apply ­ the same as on your Notice of Motion and Motion form. 7. I was scheduled to have parenting time on the following date(s): ____________________ at the following times but the other party wrongfully denied my scheduled parenting time by doing the following:

I ask the Court to give me makeup (compensatory) parenting time because of the parenting time that was denied to me. The makeup parenting time should take place on the following date(s): at the following time(s) which is within one year of the date my scheduled parenting time was wrongfully denied.

8.

I ask the Court to appoint a Parenting Time Expeditor to help me and the other party resolve this parenting time problem and/or any future parenting time problems that may happen. I understand that the other party and I may be required by the Court to pay for the fees and costs of the Parenting Time Expeditor.

9.

I ask the Court to change the parenting time to supervised parenting time. I believe that it is in the best interests of the child(ren) that the existing Parenting Time Order be changed to require supervised parenting time because:

10.

I ask the Court to change the parenting time to unsupervised parenting time. I believe it is in the best interests of the child(ren) that the existing Parenting time Order be changed to allow unsupervised parenting time because:

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11.

I ask that the existing Parenting Time Order be changed to provide for drop-offs and pick-ups of the child(ren) to occur at a parenting time exchange center, and for both parties to be ordered to follow all rules of the parenting time exchange center because:

12.

I ask that the existing Parenting Time Order be changed to provide for the transportation of of the child(ren) for parenting time as follows: because:

13.

I ask that the parenting time be changed to a specific schedule. I believe that it is in the best interests of the child(ren) that the existing Order be changed from "reasonable parenting time/visitation" the specific parenting time schedule stated in my motion because:

14.

I ask that the Court change the existing schedule to a new schedule as in my Notice of Motion and Motion. I believe that it is in the best interest of the child(ren) that the existing Parenting Time schedule should be changed because:

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15.

I ask that the Court change the existing Order "reserving parenting time/visitation" to give me specific scheduled parenting time as requested in my Notice of Motion and Motion. (Answer all of a-f) a. I believe it is in the best interests of the child(ren) that I have parenting time with the child(ren) because:

b. I last saw the child(ren) on the following date: The circumstances were:

c. My last overnight visit with the child(ren) was on the following date: The circumstances were:

d. My work schedule is: (list hours and days of the week that you work) e. My net monthly income is: $ insurance.) f. If I am awarded parenting time, I or from visits. 16. I ask that the other party be ordered to pay me for my court fees and costs which total $ for each) and consist of: (list each fee/cost, and the separate amount will will not be able to transport the child(ren) to . (Net income is gross income

minus deductions for taxes, social security, child support payments, pension, and health

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I am asking the Court to order the other party to pay me for my court fees and costs because:

17.

Because the other party wrongfully disobeyed the Parenting Time Order or an agreement made with or a decision made by a Parenting Time Expeditor, I incurred expenses I would not have otherwise had. I ask the Court to order the other party to pay me for my other expenses which total $ and consist of (list each expense separately, the reason for each expense and the amount of each expense):

18.

Because the other party wrongfully disobeyed the existing Parenting Time Order, or wrongfully failed to follow our agreement made with a Parenting Time Expeditor or failed to follow the decision of a Parenting Time Expeditor, I ask that the other party be ordered to pay to the Court a civil penalty of up to $500.

19.

I have already paid a total of $ state the amount of each expense):

for (list each expense separately, and

in connection with an upcoming scheduled parenting time. As allowed under Minnesota Statutes section 518.175, subdivision 6(d), I ask the Court to direct the other party to pay to the Court to be held in escrow account an amount of money equal to my prepaid expenses for the upcoming parenting time to help guarantee that the other party obeys the Parenting Time Order. I also ask that if the other party denies my upcoming parenting time that the money be paid to me.

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20.

I believe the following additional information would be helpful to the Court in understanding this parenting time problem:

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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