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Petition To Establish Custody And Visitation 3609 - Nevada
| Petition To Establish Custody And Visitation Form. This is a Nevada form and can be used in Family District Court Washoe County . |
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1 2 3 4 5 6 Code: $3609 Name:______________________________ Address:____________________________ ___________________________________ Telephone:__________________________ Acting In Proper Person IN THE FAMILY DIVISION 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF WASHOE ________________________________, Petitioner vs __________________________________, Respondent. ____________________________________/ Case No. _____________________ Dept. No._________________ PETITION TO ESTABLISH CUSTODY AND VISITATION Petitioner, ______________________________, acting in proper person, petitions this (Your name) Court for an Order judicially establishing custody and visitation for the following minor children Child's Name _________________________________ Child's Birthdate ___________________ ___________________ ___________________ ___________________ ___________________ 22 23 24 25 26 27 28 _________________________________ _________________________________ _________________________________ _________________________________ Petitioner, _______________________________states as follows: REVISED 12/3/2010 AA 1 D8 PETITION CUSTODY/VISITATION American LegalNet, Inc. www.FormsWorkFlow.com 1 2 3 I. My present address is: ______________________________________ 4 5 6 7 8 9 ______________________________________ I have lived at that address for:__________________(circle one) days, months, years. Prior to living at my present address, I lived at: ______________________________________ ______________________________________ 10 11 12 13 14 I lived at that address for ______________(circle one) days, months, years. II. The child(ren) presently live at: ______________________________________ 15 16 17 18 19 20 21 22 23 ______________________________________ The child(ren) have lived at that address for _______________ (circle one) days, months, years. The child(ren) are presently living with __________________________________________. (State with whom the children are presently living) Prior to the present address the child(ren) lived at: _______________________________________ _______________________________________ And the child(ren) lived at that address for ___________ (circle one) days, months, years. 24 25 26 The child(ren) lived at the prior address with ________________________________________. (State with whom the children lived at that address) III. 27 28 The other parent of the child(ren) is:____________________________________________ (Name of the other parent) REVISED 12/3/2010 AA 2 D8 PETITION CUSTODY/VISITATION American LegalNet, Inc. www.FormsWorkFlow.com 1 2 3 That parent resides at: ___________________________________ ___________________________________ 4 5 6 7 8 9 The other parent has lives at that address for ___________(circle one) days, months, years. Prior to living at that present address, the other parent lived at: ___________________________________ ____________________________________ The other parent lived at that address for _____________(circle one) days, months, years. 10 11 12 13 14 15 16 IV. Print "YES" on the line in front of the statement that fits your circumstances. Print "NO" on those lines that are not applicable to your set of circumstances. The paternity of the child(ren) has been established by: __________ A voluntary acknowledgment of paternity was signed by both parents at the time of the child's birth and Father's name is on the birth certificate. 17 18 19 20 21 22 23 24 25 26 27 28 __________ Paternity was established through a court proceeding in: Name of court:________________________________________ Address of court:_______________________________________ Date proceeding was held:________________________________ Case Number of court proceeding:__________________________ __________ __________ Through genetic testing, a copy of which is attached to this pleading. The child(ren) have the Father's last name. V. Child Support Print "YES" on each line in front of all of the statements that fit your circumstances and fill in the blanks regarding each of the "yes" answers. Print "N/A" (not applicable) on each line in front of all of the statements that do not fit your circumstances. REVISED 12/3/2010 AA 3 D8 PETITION CUSTODY/VISITATION American LegalNet, Inc. www.FormsWorkFlow.com 1 2 3 __________ I am paying child support directly to the other parent in the amount of $____________ per (circle one) week, month. I am paying child support through the District Attorney's Office in the amount of $_______________ per (circle one) week, month. I am not paying child support. I am receiving child support directly from the other parent in the amount of $______________ per (circle one) week, month. I am receiving child support through the District Attorney's Office in the amount of $_______________ per (circle one) week, month. I am not receiving any child support. I am receiving welfare benefits for the child(ren). The child(ren) is /are on Medicaid. __________ 4 5 6 __________ __________ 7 8 9 10 11 12 13 14 15 16 17 18 19 20 __________ __________ __________ __________ __________ The child(ren) is / are currently covered by health insurance provided by __________________ and the premiums are $__________per ______________. (Mother or Father) (week or month) I wish this Court to enter an Order for child support as follows: ___________________ shall pay child support to ______________________ in the amount of (Father or Mother) (Father or Mother) $_________________ per month, per child, for a total of $_________________ per month, the payment to be due on or before the __________day of the month. 21 22 23 24 25 26 27 28 Print "YES" on every line in front of the statement that fits your circumstances. Print "no" on those lines that are not applicable to your set of circumstances. This request is made based upon the following information: __________ The parent paying child support is unemployed and therefore the child support should be set at the minimum statutory requirement. The parent paying child support is employed and earns $_______________ per (circle one) hour, day, week, month. __________ REVISED 12/3/2010 AA 4 D8 PETITION CUSTODY/VISITATION American LegalNet, Inc. www.FormsWorkFlow.com 1 2 3 4 5 6 7 8 9 10 11 12 13 14 __________ The parent paying child support is capable of earning $________________ per (circle one) hour, day, week, month but is currently unemployed and the child support
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