Custody-Visitation Statement {2F-P-338}

CUSTODY/VISITATION STATEMENT (To Be Attached to Pre/Post Decree) 1. The parties are the parents of: Child222s Initials: Year of Birth: Child222s Initials: Year of Birth: Child222s Initials: Year of Birth: (if additional children, attach separate sheet) 2. The child(ren)222s initials whose custody/visitation is at issue (223the subject child/ren224) is/are: 3. The current address(es) of the subject child(ren) is/are: 4. The address(es) where the subject child(ren) has/have lived in the past five (5) years are: 5. The name(s) and current address(es) of the person(s) with whom the subject child(ren) has/have lived within the last five (5) years is/are: 6. [ ] I have not participated in the past as a party, witness or in any other capacity in any litigation in Hawaii or elsewhere involving the subject child(ren). [ ] Other litigation involving the subject child(ren) (including both those in which I have participated as a party, witness, or in any other capacity, as well as those in which I have not participated) has/have been as follows: Case Name: Case Number: Location of Court: Date filed: Date concluded: Type of Case: American LegalNet, Inc. www.FormsWorkFlow.com CUSTODY/VISITATION STATEMENT Page 2 7. [ ] I do not know of any custody proceeding currently pending in Hawai222i/elsewhere involving the subject child(ren). [ ] The following proceedings involving the subject child(ren) are currently pending in Hawai222i/elsewhere: Case Name: Case Number: Location of Court: Date filed: Date concluded: Type of Case: 8. [ ] I do not know of any person not a party to this case who is not identified in paragraph 5 above and who (a) has had the physical custody of the subject child(ren) in the past and/or (b)claims to have custody/visitation rights with respect to the subject child(ren). [ ] The following other person(s) has/have had the physical custody of the subject child(ren) and/or is/are claiming custody/visitation rights: Movant222s signature Date American LegalNet, Inc. www.FormsWorkFlow.com