Declaration Under Uniform Child-Custody Jurisdiction And Enforcement Act (Uccjea) Pursuant To 750 Ilcs 36/209 Page 2
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24. The child(ren) now live(s) with:
me
the other parent
both of us
other: _________________________________________________
(Describe the child(ren)’s living situation)
Check the following statements that are true:
5. a. The child(ren) over the age of 6 months have lived in Illinois for at least the last 6 months.
b. The child(ren) under the age of 6 months have lived in Illinois since birth.
6. a. On information and belief, there are no other legal proceedings or court orders involving the custody of, or
visitation with my child(ren), and I have not participated in any other case(s) involving custody of, or visitation
with my child(ren) in this, or any other state OR
b. On information and belief, the only legal proceedings, court orders, or cases that I have participated in
involving the custody of, or visitation with my child(ren), in this, or any other state, are those listed below:
_________________________________________
_________________
_______________________
Case Name
County/State
Date of last court order
_________________________________________
_________________
_______________________
Case Name
County/State
Date of last court order
_________________________________________
_________________
_______________________
Case Name
County/State
Date of last court order
7. Other than the parties to this case, no other person claims to have rights of custody and/or visitation with the
child(ren) except: ______________________________________________________________________________ .
8. I understand that I have a continuing duty to inform the court of any proceeding in this or any other state, that could
affect the current proceedings.
Certification
Under penalties provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned
certifies that the statements set forth in this instrument are true and correct, except as to matter therein stated to be on
information and belief and as to such matters the undersigned certifies as aforesaid that s/he verily believes the same to
be true.
Date: _________________________________
___________________________________________
Signature
Page 2 of 2
171-145 (Rev. 06/13)
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