Form Jdf 1413 - Petition For Allocation Of Parental Responsibilities Page 3
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410. The following people are not parties in this matter but have physical custody of the child(ren) or claim rights of
parental responsibilities with the child(ren). Identify name and address of those persons.
Name of Person
Address (City/State & Zip Code)
11. The best interests of the child(ren) would be served by allocating parental responsibilities to the Petitioner(s)
as follows and for the following reasons:
12. Required Notice of Human Services Involvement.
The parents or dependent child(ren) listed on this Petition has/have received within the last five years, or
is/are currently receiving benefits or public assistance from the state Department of Human Services or the
.
County Department of Social Services
No
Yes If your answer was Yes, complete the following:
Name of Person Receiving Benefit
Name of County and State
Case Number
Month/Year
13. Required Notice of Prior Protection/Restraining Orders.
Have any Temporary or Permanent Protection/Restraining Orders to prevent domestic abuse or any Criminal
Mandatory Protection/Restraining (MRO) Orders or Emergency Protection Orders been issued against either
party by any Court within two years prior to the filing of this Petition?
No
Yes
If your answer was Yes, complete the following:
The
Protection/Restraining
Order
was
Temporary
Permanent
MRO
and
issued
against
_________________________________ in a
Municipal Court
County Court
District Court in the
County of ____________________, State of _______________, in case number ________________ on
________________________ (date).
What was the subject matter of the Protection/Restraining Order or Emergency Protection Order?
JDF 1413
R11/10 PETITION FOR ALLOCATION OF PARENTAL RESPONSIBILITIES
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