Uccjea Form 1 - Request For Child Custody Determination
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1STATE OF MICHIGAN
REQUEST FOR CHILD CUSTODY
Case No.
COUNTY OF OAKLAND
DETERMINATION/REGISTRATION
____________________
SIXTH JUDICIAL CIRCUIT
UNDER THE UNIFORM CHILD
FAMILY DIVISION
CUSTODY JURISDICTION AND
ENFORCEMENT ACT
1200 N. Telegraph, Pontiac, MI
PETITIONER name, address, and telephone no.
RESPONDENT name, address, and telephone no.
PETITIONER attorney name, bar no., address, and telephone no.
RESPONDENT attorney name, address, and telephone no.
PETITIONER states as follows in support of the Request to Register Child Custody Determination:
1. That there is a child custody determination as to the following minor child(ren):
Child’s full name________________________________Age_________DOB___________
Child’s full name________________________________Age_________DOB___________
Child’s full name________________________________Age_________DOB___________
(Attach a separate sheet if necessary)
2. That petitioner requests that this court register the attached child custody determination under the
Uniform Child Custody Jurisdiction and Enforcement Act, MCL 722.1101 et seq.
3. That the petitioner has attached two copies one of which is a certified copy of the child custody
determination, which consists of all judgments; decrees; and temporary, initial, and modification orders
issued to date.
4. That the petitioner has attached a statement under the penalty of perjury affirming to the best of his/her
knowledge and belief that the child custody determination are attached has not been modified other
than shown in the attached documents.
5. That the respondent is a parent or a person acting as a parent who has been awarded custody or
parenting time in a child custody determination. The respondent’s full name and address are set
forth above.
6. That the full names and addresses of persons other than the petitioner and respondent who are either
parents or persons acting as a parent who has been awarded custody or parenting time in a child
custody determination are: (Attach a separate sheet if necessary.)
7.
That the petitioner does not request that his/her address remain confidential
OR
That the petitioner requests his/her address remain confidential. The alternate address to be used for
services is _______________________________________________________________________.
I have attached a separate sheet for the Court’s records with my residential information.
The petitioner requests that this court register the attached child custody determination.
Under the penalty of perjury, I declare that the statements made are true to the best of my belief and knowledge and that
the child custody determination has not been modified.
DATE: __________________________________
_______________________________________
Petitioner
DATE: __________________________________
________________________________________
Attorney for Petitioner
UCCJEA FORM 1 6/8/2009
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