Jurisdictional Affidavit - State Of Maine (Page 2 of 2) in pdf

10. I, ______________, state under oath, that I know of no guardianship, adoption, or name

change case concerning the child(ren) that was transferred from any Probate Court to the District

Court.

In order to determine whether there are any such pending or transferred cases, I have (check all

that apply):

Asked the the child(ren)’s first legal parent, who told me there is no case pending, and

no case ever transferred.

Asked the the child(ren)’s second legal parent, who told me there is no case pending,

and no case ever transferred.

Asked the the child(ren)’s guardian, who told me there is no case pending, and no case

ever transferred.

Checked with the clerk of the _______________ Probate Court, who told me there is no

case concerning the child(ren) pending in that court, and no case ever transferred.

Checked with the clerk of the ________________ District Court, who told me there is

no case concerning the child(ren) pending in that court, and no case ever transferred.

(Other) ______________________________________________________________

________________________________________________________________________

10. I, ______________, state under oath, that there is a judgment or order issued by the

____________________________ Court that currently affects the care and custody of the

child(ren), but there is no open or pending case concerning the child(ren) in that court. A copy

of that order is attached.

I understand that, if I give false information on this form, I may be subject to a

determination that I am in contempt of court, and I may be sanctioned for that contempt.

I understand that, if the Probate Court learns, at any time, that there is a case concerning

the child(ren) pending in one of the Maine District Courts, the case initiated by this

petition may be immediately transferred to that court.

_____________________________________ ________________________________

Petitioner Signature

Date

STATE OF MAINE

COUNTY OF _____________

____________________________ personally appeared and made oath that the foregoing is true

to the best of his/her knowledge, information and belief and, to the extent it is based upon his/her

information and belief, that s/he believes the same to be true.

Dated: _______________________________ Notary Public: _________________________

Jurisdictional Affidavit - State Of Maine Page 2