Fill and Sign the Affidavit Minor Form

STATE OF NORTH CAROLINA       County  Court File No.       In The General Court Of Justice District Court Division Name And Address Of Plaintiff                   AFFIDAVIT AS TO STATUS OF MINOR CHILD G.S. 50A-9VERSUS Name And Address Of Defendant                   Name Of Minor Child       Date Of Birth       Birthplace       I, the undersigned affiant, being first duly sworn, say that during the past five (5) years the above named minor child has lived as follows: Period Of Residence Address Name Of Person Lived With Present Address Of Person From To       Present                                                                                                             I further say that: (Check those that apply) I have participated in litigation concerning the custody of the above named child. Capacity As Participant       Date Of Action       Name And Address Of Court       Details       I have information of a custody proceeding concerning the above named child pending in a court in this or another state. Name And Address Of Court                   Details                   I know of a person as listed below, who has physical custody or claims to have custody or visitation rights with respect to the above named child. Name And Address Of Person                   Physical Custody Claimed Custody Visitation Rights SWORN AND SUBSCRIBED TO BEFORE ME Date       Date       Signature Of Person Authorized To Administer Oaths Signature Of Affiant Deputy CSC Assistant CSC Clerk Of Superior Court Name Of Affiant (Type Or Print)       SEAL Notary Date Commission Expires       Relationship To Above Named Child       AOC-CV-609, Rev. 6/2000 © 2000 Administrative Office of the Courts