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Child Custody Affidavit - Ohio
| Child Custody Affidavit Form. This is a Ohio form and can be used in Legal Division Greene County (Court Of Common Pleas) . |
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IN THE COMMON PLEAS COURT OF GREENE COUNTY, OHIO DOMESTIC RELATIONS DIVISION ___________________________________ Plaintiff/Petitioner -vs- Case No._____________ Judge Steven L. Hurley CHILD CUSTODY AFFIDAVIT __________________________________ Defendant/Petitioner _____________________________________________________________________________ I, (full legal name)__________________________________, being sworn according to law, certify that these proceedings involve the custody of a child, or children and the following statements are true: 1. [ ] I am requesting the court to not disclose my address or that of the child(ren). My address is confidential pursuant to ORC 3127.23(0) and should be placed under seal in that the health, safety, or liberty of myself and/or the child(ren) would be jeopardized by the disclosure of the identifying information. 2. (Number): ___________ Minor Child(ren) are subject to this proceeding as follows: (Insert the information requested below. The residence information must be given for the last FIVE years.) a. Child's name Period of residence To Present From To From To From To From To Address Confidential Place of birth I Date of birth Sex Relationship Person child lived with (name & address) American LegalNet, Inc. www.FormsWorkFlow.com a. Child's name Period of residence to Present From To From To From To a. Child's name Period of residence to Present From To From To From To From To Address Confidential Place of birth Date of birth Sex Relationship Person child lived with (name & address) Place of birth Address Confidential Date of birth Sex Person child lived with (name & address) Relationship b. Additional children are listed on an attached addendum. (Provide all information for additional children on an attachment.) 3. Participation in custody proceeding(s): (Check only one) _____ I HAVE NOT participated as a party, witness, or in any capacity in any other litigation, in this or any other state, concerning the custody of or visitation (parenting time) with any child subject to this proceeding. _____ I HAVE participated as a party, witness, or in any capacity in any other litigation, in this or any other state, concerning the custody of or visitation (parenting time) with any child subject to this proceeding. Explain: a. Name of each child__________________________________________________________________ b. Type of proceeding__________________________________________________________________ c. Court and state_____________________________________________________________________ d. Date of court order or judgment (if any):_________________________________________________ 4. Information about custody proceeding(s): (Check only one) _____ I HAVE NO INFORMATION of any proceedings that could affect the current proceeding, including any proceedings relating to custody, domestic violence or protection orders, dependency, neglect or abuse allegations, or that a parent or any member of their household has been convicted of a sexually oriented offense or adoptions concerning any child subject to this proceeding. American LegalNet, Inc. www.FormsWorkFlow.com ______ I HAVE THE FOLLOWING INFORMATION concerning proceedings that could affect the current proceeding, including any proceedings relating to custody, domestic violence or protection orders, dependency, neglect or abuse allegations, convictions of a sexually oriented offense or adoptions concerning any child subject to this proceeding, other than set out in item 3. Explain: a. Name of each child__________________________________________________________________ b. Name of parent or member of household_________________________________________________ c. Type of proceeding__________________________________________________________________ d. Court and state______________________________________________________________________ e. Date of court order or judgment (if any):__________________________________________________ 5. Persons not a party to this proceeding: (Check only one) _____ I DO NOT KNOW OF ANY PERSON not a party to this proceeding whom has physical custody or claims to have custody or visitation rights with respect to any child subject to this proceeding. _____ 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: (See next page) a. Name and address of person _____________________________________________________________ ( ) has physical custody ( ) claims custody rights ( ) claims visitation rights Name of each child _______________________________________________________________________ b. Name and address of person _____________________________________________________________ ( ) has physical custody ( ) claims custody rights ( ) claims visitation rights Name of each child _______________________________________________________________________ c. Name and address of person _____________________________________________________________ ( ) has physical custody ( ) claims custody rights ( ) claims visitation rights Name of each child _______________________________________________________________________ 6. Knowledge of prior child support proceedings: (Check only one) ______ The child(ren) described in this affidavit are NOT subject to existing child support order(s) in this or any state or territory ______ The child(ren) described in this affidavit ARE subject to the following existing child support order(s): a. Name of each child __________________________________________________________________________ b. Type of proceeding ___________________________________________________________________________ c. Court and address ___________________________________________________________________________ d. Date of court order or judgment (if any): ___________________________________________________________________________ e. Amount of child support paid and by whom: ___________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 4 7. I acknowledge that I have a continuing duty to advise this Court of any custody, visitation, child support, or guardianship proceeding (including dissolution of marriage, child neglect, or dependency) concerning the child(ren) in this state or any other state about which information is obtained during this proceeding. I certify that a copy of this document was
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