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Affidavit Of Visitation Supervisor - Illinois
| Affidavit Of Visitation Supervisor Form. This is a Illinois form and can be used in Order Of Protection Lake Local County . |
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IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT, LAKE COUNTY, ILLINOIS ) ) ) _____________________________________ ) Petitioner ) General No. ____________________ vs. ) ) _____________________________________ ) Respondent AFFIDAVIT OF VISITATION SUPERVISOR I, __________________________________________, state as follows: (Print Nam e) 1. I reside at: (Street Address, City, State, Zip) 2. My telephone number is: 3. My relationship to the parties is: 4. I accept the responsibility to supervise the visitation of ________________________ pursuant to the order of this court dated ____________________. 5. My signature on this affidavit certifies that I will require that the visiting parent follow these rules of conduct: a. No discussion with the child(ren) about the divo rce and/or any petition fo r order of protection. b. No discussion with the children about the custodial parents activities. c. No use of alcohol or drugs. d. No abusive language. e. No hitting or striking. f. No physical discipline. g. No threatening behavior. 6. I will cancel the visitation se ssion if the visiting parent arrive s for visitation under the influence of alcohol or drugs. 7. I will terminate a visitation session if, at any time, it is necessary to protect the child(ren)s best interests. 8. I acknowledge my responsibility to account to the court for complianc e with the Order for supervised visitation. * Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, theundersigned certifies that the statements set fo rth in this instrument are true and correct. _________________________________ Dated this ____ day of __________________,20____ Signature _________________________________ Printed Name *Any person who makes a false statement, material to the issue or point in question, which he does not believe to be true, in any document certified by such person in ac cordance with 735 ILCS 5/1-109 shall be guilty of a Class 3 felony punishable by two (2) to five (5) years imprisonment and/or a $10,000.00 fine. American LegalNet, Inc. www.USCourtForms.com
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