Affidavit Regarding Parenting Form - The Court Of Common Pleas - Geauga County - Ohio
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IN THE COURT OF COMMON PLEAS
GEAUGA COUNTY, OHIO
_____________________________________
: CASE NO. _________________________
Plaintiff / Petitioner
: JUDGE _________________________________
-vs-
: MAGISTRATE __________________________
_____________________________________
: AFFIDAVIT REGARDING PARENTING
Defendant / Respondent / Petitioner
PROCEEDING (R.C. §3127.23)
:
Instructions: If you need more space to answer any questions, please attach a separate sheet of
paper to the back of this form. If the answers to the following questions are not the same for all the
children, you must file a separate affidavit for each child. You must answer all questions.
I, ______________________________________ , the undersigned, being first duly sworn,
acknowledge and understand that I have a continuing duty to inform the Court of any child custody
proceeding concerning the child or children in this or any other state that could affect this proceeding.
My answers to the questions in this Affidavit are true.
1. What are the name(s) and date(s) of birth of the child or children to whom this affidavit
applies?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
2. Where and with whom did the child or children this affidavit applies to live within the last
five years, and what are the names and present addresses of the persons the child or children lived with
during that period? Begin your answer with the child or children’s present address:
Part A: Places and Dates where child(ren)
Part B: Present residence address for each
have lived in last five years:
person listed in Part A
Living with ________________________
Mother’s address ______________________
At: _______________________________
____________________________________
_______________________________
____________________________________
From _____________ To _____________
Living with ________________________
Father’s address ______________________
At: _______________________________
____________________________________
_______________________________
____________________________________
From _____________ To _____________
Living with ________________________
Other_______________________________
At: _______________________________
____________________________________
_______________________________
____________________________________
From _____________ To _____________
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