Emergency Custody Order Affidavit {DNA-2.1} | Pdf Fpdf Doc Docx | Kentucky

Emergency Custody Order Affidavit {DNA-2.1}

Emergency Custody Order Affidavit {DNA-2.1} | Pdf Fpdf Doc Docx | Kentucky

Emergency Custody Order Affidavit Form

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This is a Kentucky form that can be used for Dependency Neglect And Abuse within Statewide.

Last updated: 11/30/2016
AOC-DNA-2.1 Rev. 1-15 Page 1 of 3 Doc. Code: AECO COM M O NW E A LT H O F K E lex et justitia Case No._____________________ U C KY NT Court [] District [ ] Family CO Commonwealth of Kentucky Court of Justice www.courts.ky.gov KRS 620.060; FCRPP 19 U RT OF JUS TI C E County_______________________ Division ______________________ EMERGENCY CUSTODY ORDER AFFIDAVIT IN THE INTEREST OF: ____________________________________________________________________, A CHILD DOB Sex Race SSN I, __________________________________________________, swear or affirm under oath the following statements are true to the best of my knowledge (if more space is needed, attach second page): _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ ______________________________________________________________________________________________. As required by KRS 620.030(1) I have made a report regarding these facts to the following entity: [ ] Local law enforcement [ ] Kentucky State Police [ ] County Attorney [ ] Cabinet for Health & Family Services [ ] Commonwealth Attorney [ ] Did not report If you did not report, please explain why: _____________________________________________________________ Juvenile's Address: _______________________________________________________________________________________ ______________________________________________________________________________________ () __________________________________________ Phone No. _______________________________ Juvenile currently resides with [ ] Mother [ ] Father [ ] Other ____________________________________ Juvenile attends school at ___________________________________________________________________ If removal from the custodial parent(s) is requested has the non-custodial parent been contacted for placement of the child? [ ] Yes [ ] No. If No, is there any existing Order which restricts placement with the non-custodial parent? [ ] Yes [ ] No [ ] Unknown. If yes, list state, county, case number and date of order if known (or attach copy if available): _________________________________________________________________________ _______________________________________________________________________________________________ Are there other proceedings pending in this or any other jurisdiction? [ ] Yes [ ] No If yes, please explain: _____________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com AOC-DNA-2.1 Rev. 1-15 Page 2 of 3 Case No. ___________________________ Juvenile's Legal Mother: _______________________________________________________________ Address: _____________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ () Phone No.: _______________ SSN: _______________ DOB: ___________ Legal Custodian? [ ] Yes [ ] No Name of Other(s) Living in Mother's Home and relationship to Child: [ ] Stepparent _______________________________________________________________________ [ ] Sibling(s) ________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ [ ] Other ___________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Juvenile's Legal Father: _______________________________________________________________ Address: _____________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ) Phone No.: (_______________ SSN: _______________ DOB: ___________ Legal Custodian? [ ] Yes [ ] No Name of Other(s) Living in Father's Home and relationship to Child: [ ] Stepparent ______________________________________________________________________ [ ] Sibling(s) ________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ [ ] Other ___________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ [ ] Name, address and relation of other person exercising custodial control or supervision of the child (PECCS) _____________________________________________________________________________________________ _____________________________________________________________________________________________ ) Phone No.: (_______________ SSN: _______________ DOB: ___________ Legal Custodian? [ ] Yes [ ] No Name of Other(s) Living in the PECCS's Home and relationship to the Child: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ American LegalNet, Inc. ww