Free PDF - Kansas


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State: Kansas
Category: Court Forms - State
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http://www.kansasjudicialcouncil.org/Documents/Protection%20From%20Abuse/PDF/PFA_UCCJEA.pdf

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IN THE DISTRICT COURT OF ______________ COUNTY, KANSAS

____________________, Plaintiff vs. ____________________, Defendant Case No. _______________

UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) AFFIDAVIT (Pursuant to K.S.A. 60-3101, et seq.) I, (full legal name) that the following statements are true: , of lawful age, being first duly sworn, certify

. Each child's name, 1. The number of minor children subject to this proceeding is birth date, present address, the places where the child has lived during the last five years, and the names and present addresses of the persons with whom the child has lived during that period are:

THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD #
Child's Full Legal Name: Date of Birth Child's Residence for the past 5 years:
Dates (From/To) /present* / / / / / Address (including city and state) where child lived

1

.

Sex:

Name and present address of person child lived with

Relationship to child

*If you are the petitioner and have requested that the court keep your address confidential pursuant to K.S.A. 603104(e), you should write "confidential" in any space that would require you to enter the address where you are currently living.

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(Make as many copies of this page as necessary.)

THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD #
Child's Full Legal Name: Date of Birth Child's Residence for the past 5 years:
Dates (From/To) /present* / / / / / Address (including city and state) where child lived Name and present address of person child lived with

.

Sex:

Relationship to child

THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD #
Child's Full Legal Name: Date of Birth Child's Residence for the past 5 years:
Dates (From/To) /present* / / / / / Address (including city and state) where child lived Name and present address of person child lived with

.

Sex:

Relationship to child

*If you are the petitioner and have requested that the court keep your address confidential pursuant to K.S.A. 603104(e), you should write "confidential" in any space that would require you to enter the address where you are currently living.

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2.

Participation in custody proceeding(s): (Select one) I HAVE (Please explain below) I HAVE NOT (Go to # 3) participated as a party, witness, or in any capacity in any other proceeding concerning the custody of or visitation with a child subject to this proceeding. Explain: a. Name of each child: b. Type of proceeding and case number: c. Court and state: d. Date of child-custody determination (if any):

3.

Information about other proceeding(s): I HAVE INFORMATION (Please explain below) I DO NOT HAVE ANY INFORMATION (Go to #4) concerning ANY proceeding that could affect the current proceeding, including but not limited to, proceedings for enforcement and proceedings relating to domestic violence, protective orders, termination of parental rights and adoption. Explain: a. Name of each child: b. Type of proceeding and case number: c. Court and state: d. Date of court order or judgment (if any): (Select one)

4.

Persons not a party to this proceeding: (Select one) 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. (Go to #5). I KNOW THAT THE FOLLOWING NAMED PERSON(S) not a party to this proceeding has (have) physical custody or claim(s) to have custody or visitation rights with respect to any child subject to this proceeding: a. Name and address of person:
has physical custody Name of each child: claims custody rights claims visitation rights.

b. Name and address of person:
has physical custody Name of each child: claims custody rights claims visitation rights.

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c. Name and address of person:
has physical custody Name of each child: claims custody rights claims visitation rights.

5.

I acknowledge that I have a continuing duty to inform the court of proceeding in this or any other state that could affect the current proceeding.

STATE OF KANSAS ) COUNTY OF __________ ) ) ss:

_____________________________, of lawful age, being first duly sworn states that (she)(he) has read the foregoing Affidavit and knows the contents of it and that the declarations in it are true and correct to the best of (her)(his) knowledge and belief. __________________________________________ Party's signature

SIGNED AND SWORN to before me on this _____ day of _______________, ______.

__________________________________________ Clerk of the District Court/Notary Public My Appointment Expires: ___________________

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