Affidavit Regarding Parenting Form - The Court Of Common Pleas - Geauga County - Ohio Page 2
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1
2Living with ________________________
Other_______________________________
At: _______________________________
____________________________________
_______________________________
____________________________________
From _____________ To _____________
3. Have you participated as a party, as a witness, or in any other capacity, in any other
proceeding concerning the allocation, between the parents of the same child, of parental rights and
responsibilities for the care of the child, including any designation of parenting time rights and the
designation of the residential parent and legal custodian of the child, or that otherwise concerned the
custody of or visitation with the same child? Yes _____ / No ______.
If your answer is “YES” state, for each proceeding, the court in which that proceeding was or is
pending, the case number, and the date of the child custody determination, if any:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
4.
Do you know of any proceedings that could affect the current proceeding, including
proceedings for enforcement of child custody determinations, proceedings relating to domestic violence
or protection orders, proceedings to adjudicate the child as an abused, neglected, or dependent child,
proceedings seeking termination of parental rights, and adoptions? Yes ____ / No _____.
If your answer is “YES” state, for each proceeding, the court in which that proceeding is pending,
the case number, and the nature of the proceeding:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
5. Do you know of any person who is not a party to this case (including grandparents, if
relevant) who has physical custody of the child or children, or who claims to have custody, parenting
time, or visitation rights with the child or children? Yes _____ / No _____.
If your answer is “YES” state the name and address of each of those persons:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
________________________________________
AFFIANT
Sworn to and subscribed before me, the undersigned Notary Public, this
_________________ day of _______________________________, _____________
_______________________________________
Notary Public
11/08
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