Petition For Dissolution Of Marriage Page 8
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15Child’s Name
Place of Birth
Birthdate
Sex
Marital Status
School Grade
Present Address (since
/
/
)
Who Has Custody Relationship
Prior Residences for
City & State
Person child lived with
Relationship
past 5 years (dates)
(Name & Current Address)
to
to
to
B. Has either the husband or the wife participated as a party, a witness or in another capacity in
another proceeding concerning the custody of any of the above children or visitation with
them?
Yes
No
If yes, describe the previous child custody determination:
Name of Court
Case Number
Date
Court’s Decision
C. Does either the husband or the wife know of a proceeding that could affect the current
proceeding (including a proceeding relating to domestic violence, protective orders,
termination of parental rights, adoption or enforcement of a court order)?
Yes
No
If so, describe: Name of Court
Case Number
Nature of Proceeding
D. Does either the husband or the wife know of any person not a party to this proceeding who has
physical custody of any of the above children or claims to have the right to physical custody,
legal custody, or visitation?
Yes
No
If so, list each person’s name and address and what the person claims:
E. Is the wife pregnant?
Yes
No
If yes, include arrangements for this child in the
following sections.
NOTE: You both have a continuing duty to inform the court of any other court proceeding in
this state or any other state concerning any of the children listed above.
IV. CHILD CUSTODY AGREEMENT
Name of Child
Physical Custody
Legal Custody
Awarded To
Awarded To
Husband’s Signature
Wife’s Signature
Page 8 of 15
AS 25.30.380
DR-105 (4/09)(cs)
AS 25.24.200-.260
PETITION FOR DISSOLUTION OF MARRIAGE (WITH CHILDREN)
Civil Rule 90.1(a), f(2)(A)(B), (i)(1)
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