Declaration Under Uniform Child Custody Jurisdiction And Enforcement Act (Uccjea) Form - The Court Of Common Pleas - Ohio

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IN THE COURT OF COMMON PLEAS
COLUMBIANA COUNTY, OHIO
DECLARATION UNDER UNIFORM CHILD CUSTODY
Case No. _____________________
JURISDICTION AND ENFORCEMENT ACT (UCCJEA)
I, (full legal name)________________________________________, being sworn according to law, certify that
these proceedings involve the custody of a child, or children and the following statements are true:
1. [ ] I am requesting the court to not disclose my address or that of the child(ren). My address is confidential
pursuant to ORC 3127.23(0) and should be placed under seal in that the health, safety, or liberty of myself and/or the
child(ren) would be jeopardized by the disclosure of the identifying information.
2. (Number): ___________ Minor Child(ren) are subject to this proceeding as follows:
(Insert the information requested below. The residence information must be given for the last FIVE years.)
a. Child's name
Place of birth
I Date of birth
Sex
M
Period of residence
Person child lived with (name & address)
Relationship
Address
To Present
Confidential
to
to
to
to
a. Child's name
Place of birth
Date of birth
Sex
F
Period of residence
Person child lived with (name & address)
Relationship
Address
to Present
Confidential
-
to
to
to
to

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