Form 16.1 - Affidavit - Lorain County Probate Court
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1Lorain County Probate Court
Clear Form
Judge James T. Walther
IN THE MATTER OF THE GUARDIANSHIP OF _________________________________
CASE NO. _______________________
AFFIDAVIT
[R.C. 3109.27]
State of Ohio, County of ______________________________________________s.s.
(To be filed only when guardianship of the person of a minor is sought)
Affiant being first duly sworn, deposes and says:
1. That the child's present address, the places where the child has lived with the last five years,
and the names and present address of the person(s) with whom the child has lived during that period are:
2. That affiant has (not) participated as a party, witness, or in any other capacity in any litigation
concerning the custody of the child(ren) in this or any other state.
3. That affiant has (no) information of any custody proceeding concerning the child(ren)
pending in a Court of this or any other state.
4. That affiant has (no) knowledge of any person not a party to the proceedings who has
physical custody of the child(ren) or claims to have custody or visitation rights with respect to the
child(ren).
If 2, 3, or 4 is answered in the affirmative, and the space afforded is insufficient for full
explanation, please attach and incorporate herein any necessary information.
Affiant realizes that ___ he has a continuing duty to inform the Court of any custody proceedings
concerning the child(ren) in this or any other state of which affiant obtains information during the
pendency of this proceeding.
____________________________________
Sworn to before me and subscribed in my presence this ________ day of ___________________,
20___.
____________________________________
Notary Public
16.1 AFFIDAVIT
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