Caretaker Authorization Affidavit Form - Hamilton County Juvenile Court (Page 2 of 4) in pdf

Caretaker Authorization Affidavit Form - Hamilton County Juvenile Court Page 2

I declare that the foregoing is true and correct:

Signed:

Date:

Grandparent

Signed:

Date:

Grandparent

State of Ohio

)

) ss:

County of

)

Subscribed, sworn to, and acknowledged before me this

day of

, Notary Public

Notices:

1. The grandparent's signature must be notarized by an Ohio notary public.

2. The grandparent who executed this affidavit must file it with the juvenile court of the county in which the

grandparent resides or any other court that has jurisdiction over the child under a previously filed motion or

proceeding not later than five days after the date it is executed.

3. A grandparent who executes a second or subsequent caretaker authorization affidavit regarding a child who is

the subject of a prior caretaker authorization affidavit must file the affidavit with the juvenile court of the

county in which the grandparent resides or any other court that has jurisdiction over the child under a previously

filed motion or proceeding. On filing, the court will schedule a hearing to determine whether the caretaker

authorization affidavit is in the child's best interest.

4. This affidavit does not affect the rights of the child's parents, guardian, or custodian regarding the care,

physical custody, and control of the child, and does not give the grandparent legal custody of the child.

5. A person or entity that relies on this affidavit, in good faith, has no obligation to make any further inquiry or

investigation.

6. This affidavit terminates on the occurrence of whichever of the following occurs first: (1) the child ceases to

live with the grandparent who signs this form; (2) the parent, guardian, or custodian of the child acts to negate,

reverse, or otherwise disapprove an action or decision of the grandparent who signed this affidavit; or (3) the

affidavit is terminated by court order; (4) the death of the child who is the subject of the affidavit; or (5) the

death of the grandparent who executed the affidavit.

A parent, guardian, or custodian may negate, reverse, or disapprove a grandparent's action or decision only by

delivering written notice of negation, reversal, or disapproval to the grandparent and the person acting on the

grandparent's action or decision in reliance on this affidavit.

Page 2 of 4

Form 1345

Caretaker Authorization Affidavit Form - Hamilton County Juvenile Court Page 2