Nevada > County > Washoe > District Court > Family
Personal Case Information (UCCJA) 3385 - Nevada
| Personal Case Information (UCCJA) Form. This is a Nevada form and can be used in Family District Court Washoe County . |
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Code: 3385 Name:________________________ Address:______________________ _____________________________ Telephone:____________________ IN THE FAMILY DIVISION OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF WASHOE ____________________________________ Plaintiff/Petitioner vs ____________________________________ Defendant/Respondent Case No.________________ Dept No. _______________ PERSONAL CASE INFORMATION as required under the Uniform Child Custody Jurisdiction Act This document is submitted by:_______________________________________ (Your name) Wife/Mother Information Name:__________________________________ Address:_________________________________ ________________________________________ Place of Employment:_______________________ Address of Employer:_______________________ _________________________________________ Age:_______ Husband/Father Information Name:____________________________________ Address:__________________________________ _________________________________________ Place of Employment:________________________ Address of Employer:_________________________ __________________________________________ Age:_______ Education:__________________________________ Education:__________________________________ Date of Marriage (if applicable)____________________________ Date of Separation (if applicable)___________________________ 9/2010 AA 1 American LegalNet, Inc. www.FormsWorkFlow.com CHILDREN BORN TO THIS MARRIAGE OR RELATIONSHIP Name __________________________ __________________________ __________________________ __________________________ __________________________ Date of Birth/Age ___________________ ___________________ ___________________ ___________________ ___________________ With Whom Child Resides/ How Long There __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ OTHER DEPENDANTS FOR WHOM YOU ARE RESPONSIBLE (Including other children who are not of this marriage or relationship) Name _________________________ _________________________ _________________________ Date of Birth/Age With Whom That Person Resides/How Long ____________________ __________________________________________ ____________________ __________________________________________ ____________________ __________________________________________ ===================================================================================== Only for each child directly involved in these proceedings, the residence of the child, and with whom the child has lived, must be traced for the past five (5) years. Start with the current address of the child and with whom the child is presently living and continue tracing where the child has lived, and with whom the child has lived prior to the present, for the past five (5) years. If more space is needed, please attach additional sheets or request additional sheets from the Facilitator's Office. CHILD NUMBER 1 Child's Full Name:______________________________________________________________________________ Present Address:________________________________________________________________________________ Date child moved to the present address:____________________________________________________________ Child currently lives with: (check one) ______Mother _______Father _______Both parents _______Adults other than parents If the child is presently residing with adults other than parents, please state who the adults are and their relationship to the child. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _______________________________________________________________________________________________ 9/2010 AA 2 American LegalNet, Inc. www.FormsWorkFlow.com Child's address prior to the present address: _____________________________________________________________ How long did the child live at that address:__________________________________ With whom did the child live at that address? ______Mother _______Father _______Both parents _______Adults other than parents If the child lived with someone other than the parents, please state with whom the child resided and their relationship to the child. _____________________________________________________________________________________________ _____________________________________________________________________________________________ ===================================================================================== Child's address prior to the address listed above:_________________________________________________________ How long did the child live at that address:__________________________________ With whom did the child live at that address? ______Mother _______Father _______Both parents _______Adults other than parents If the child lived with someone other than the parents, please state with whom the child resided and their relationship to the child. _____________________________________________________________________________________________ _____________________________________________________________________________________________ ===================================================================================== CHILD NUMBER 2 Child's Full Name:______________________________________________________________________________ Present Address:________________________________________________________________________________ Date child moved to the present address:____________________________________________________________ Child currently lives with: (check one) ______Mother _______Father _______Both parents _______Adults other than parents If the child is presently residing with adults other than parents, please state who the adults are and their relationship to the child. _____________________________________________________________________________________________ _____________________________________________________________________________________________ ====================================================================================== 9/2010 AA 3 American LegalNet, Inc. www.FormsWorkFlow.com Child's address prior to the present address: _____________________________________________________________ How long did the child live at that address:__________________________________ With whom did
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