Affidavic Uccjea (Page 2 of 4) in pdf

Affidavic Uccjea Page 2

Form UCCJEA-3

Page

subject of this proceeding resided at:

Name

Address

Duration (from/to)

4. (Upon information and belief) The name and present address of the person(s)

with whom each child resided during the past five years are as follows;

Name

Address

Duration (from/to)

5. I [check applicable box(es)]:

a. “ have “ have not participated as a party in other litigation concerning the

“ custody “ visitation of one or more of the same children in “ New York State

“ another state, territory, tribal jurisdiction or country [specify]:

[If

so, specify court, jurisdiction, children involved, parties, case number, date of determination

and status]:

b. “ have

“ have not participated as a witness in other litigation concerning

the “ custody “ visitation of one or more of the same children in “ New York State

“ another state, territory, tribal jurisdiction or country [specify]:

[If so, specify court, jurisdiction, custody or visitation, children involved, parties, case

number, date of determination and status]:

c. “ have “ have not participated as a [specify other capacity]:

in other litigation concerning the “ custody “ visitation of one or more of the same

children in “ New York State “ another state, territory, tribal jurisdiction or country

[specify]:

[If so, specify court, jurisdiction, custody or visitation, children involved,

parties, case number, date of determination and status]:

6. [Check applicable box(es)]:

a. “ (Upon information and belief) I have the following information regarding a

custody proceeding concerning “ custody “ visitation of one or more of the same

child(ren) that is pending in “ New York State “ another state, territory, tribal jurisdiction

Specify address or indicate if ordered to be kept confidential pursuant to Family Court Act

§154-b(2) or Domestic Relations Law §254.

Specify address or indicate if ordered to be kept confidential pursuant to Family Court Act

§154-b(2) or Domestic Relations Law §254.

Affidavic Uccjea Page 2