Free CCDR 0502 12-21-04 - Illinois

Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA)

(Rev. 12/21/04) CCDR 0502 A

IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, DOMESTIC RELATIONS DIVISION IN RE THE MARRIAGE OF:

____________________________________________________
PETITIONER

____________________________________________________
RESPONDENT

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GEN. NO. ____________________________

DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA)
1. 2. Party's Name:__________________________________ Attorney's Name:

______________________________

Number of minor children subject to this proceeding: _______________ Additional list attached. (Provide requested information for additional children on an attachment)
Insert the information requested below. The residence information must be given for the last five years.

____________________________________________________________________________________________________________________________
Child's Name and Sex _______________________________________________________________________________________________________________________ Date of Birth _______________________________________________________________________________________________________________________

Child One

Child Two

Child Three

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Child's Current Address and Length of Residence

Place of Birth

_______________________________________________________________________________________________________________________
Name, Present Address and Relationship to Child of person that lived at current address

_______________________________________________________________________________________________________________________
Child's Previous Address and Dates of Residence

_______________________________________________________________________________________________________________________
Name, Present Address and Relationship to Child of person that lived at 1st previous address

_______________________________________________________________________________________________________________________
Child's Previous Address and Dates of Residence

_______________________________________________________________________________________________________________________
Name, Present Address and Relationship to Child of person that lived at 2nd previous address

DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS

(Rev. 12/21/04) CCDR 00502 B

3. Have you participated as a party, witness, or in some other capacity in another litigation or custody proceeding, either in Illinois or elsewhere, concerning custody of a child subject to the proceeding? Yes No 4. Do you have information about a custody proceeding pending in an Illinois court or any other court concerning a child subject to this proceedings, other than that stated in item 3? Yes No 5. Do you know of any person who is not a party to this proceeding who has physical custody, or claims to have custody of, or visitation rights with, any child subject to this proceeding? Yes No

If the declaration as to any of the above items is in the affirmative the declarant shall give additional information under oath as required by the Court. Each party has a continuing duty to inform the Court of any custody proceeding concerning the child in this or any other state of which s/he obtained information during this proceeding.

I declare under penalty of perjury under the laws of the State of Illinois that the foregoing is true and correct.

____________________________________________
(Type or print name)

____________________________________________
(Signature of Declarant)

Date:______________________________,

_________

DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS