6.
I have been a party, witness, or otherwise involved in the following cases about custody or
visitation of the child(ren):
State
Court
Case No.
Date of Child Custody Determination
Attach the most recent court order for the above-referenced court cases.
7.
I know of the following people, not parties to this case, who have physical custody of, or
claim rights of legal custody or physical custody of, or visitation with the child(ren):
Name
Current Address
Name
Current Address
Name
Current Address
8.
The child(ren) are currently living with:
Name
9.
The child(ren) have lived in the following places, with the persons indicated during the last
five years:
Time Period
Place
Name(s)/Current Address of Person(s) with whom Child Lived
10.
It is in the best interests of the child(ren) that I have (check all that apply):
joint
sole physical custody of
.
Name of Children
joint
sole legal custody of
.
Name of Children
visitation with
.
Name of Children
11.
I
am
am not seeking alimony because
.
12.
(You do not have to complete paragraph 12 if you are not asking the court to make decisions
about your property). My spouse and/or I have the following property and debts (check all that
apply):
House(s)
Furniture
Bank account(s) and investment(s)
Pension(s)
Motor Vehicle(s)
Family Use Personal Property
Debts (attach list)
Other:
13.
My grounds for an absolute divorce are (check all that apply):
Twelve (12) Month Separation - From on or about
, my spouse and I
Month/Day/Year
have lived separate and apart from each other in separate residences, without interruption,
without sexual intercourse, for more than 12 months.
CC-DR 20 (Rev. 9/2013)
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