Fill and Sign the Delaware Custody Form

Form 346 (Rev. 05/10) The Family Court of the State of Delaware In and For New Castle Kent Sussex County CUSTODY SEPARATE STATEMENT Petitioner v. Respondent Name Name File Number                   1. What type of petition are you filing?       2. Who is the child(ren) named in your petition? ( Please provide full name and date of birth ) Child’s Name Date of Birth (mm/dd/yyyy)                                                 3. Have al l the children listed above continually resided with one another? Yes No If you answered “No,” the children have not continually resided with one another; please complete a Custody Separate Statement for each child. 4. During the past five years, where have the child(ren) lived? List addresses from the most recent to the oldest beginning with the address where the child(ren) currently lives. If the child(ren) is under the age of five years old, end with the first address where the child lived.CURRENT ADDRESS Address where child(ren) currently resides City State Zip Code                       Name of person(s) child(ren) is living with Relationship to child(ren)             ADDRESS 2 Address where child(ren) previously resided City State Zip Code                       Date(s) child(ren) lived there Name of person(s) child(ren) lived with Relationship to child(ren)       to                   Person’s current address City State Zip Code                       ADDRESS 3 Address where child(ren) previously resided City State Zip Code                       Date(s) child(ren) lived there Name of person(s) child(ren) lived with Relationship to child(ren)       to                   Person’s current address City State Zip Code                       ADDRESS 4 Address where child(ren) previously resided City State Zip Code                       Date(s) child(ren) lived there Name of person(s) child(ren) lived with Relationship to child(ren)       to                   Person’s current address City State Zip Code                       ADDRESS 5 Address where child(ren) previously resided City State Zip Code                       Date(s) child(ren) lived there Name of person(s) child(ren) lived with Relationship to child(ren)       to                   Person’s current address City State Zip Code                       1 of 3 Form 346 (Rev. 05/10) 5. Check ONE and complete as directed. No one other than the parties have physical custody, legal custody or visitation rights with the child(ren). A person(s) other than the parties have physical custody, legal custody or visitation rights with the child(ren). If you check this box, complete the information below. Attach additional sheets if necessary. PERSON 1 Name of person(s) with physical custody, legal custody or visitation Relationship to child(ren)             Person’s current address City State Zip Code                       PERSON 2 Name of person(s) with physical custody, legal custody or visitation Relationship to child(ren)             Person’s current address City State Zip Code                       6. Select all that apply and complete as directed. I have not been involved in any other court action for custody and/or visitation of this child(ren). I have been involved in another court action for custody and/or visitation of this child(ren). If you check this box, complete the information below. Attach additional sheets if necessary. ACTION 1 Type of Action (e.g. Custody, Visitation, Other) Person (who filed the action) State                 Court Case Number Date Filed                   Result Date of Order             ACTION 2 Type of Action (e.g. Custody, Visitation, Other) Person (who filed the action) State                 Court Case Number Date Filed                   Result Date of Order             ACTION 3 Type of Action (e.g. Custody, Visitation, Other) Person (who filed the action) State                 Court Case Number Date Filed                   Result Date of Order             7. Check ONE and complete as directed. I do not know of any other court action such as, Protection From Abuse, Termination of Parental Rights, Guardianship, Adoption or Paternity involving myself, the other party or the child(ren) that could affect this petition. I, the other party or the child(ren) have been and/or are currently involved in another court action such as, Protection From Abuse, Termination of Parental Rights, Guardianship or Adoption, that could affect this petition. If you check this box, complete the information below. Attach additional sheets if necessary. Type of Action (e.g. PFA, TPR, Guardianship, Other) Person (who filed the action) State 2 of 3 Form 346 (Rev. 05/10)ACTION 1                 Court Case Number Date Filed                   ACTION 2 Type of Action(e.g. PFA, TPR, Guardianship, Other) Person (who filed the action) State                 Court Case Number Date Filed                   Petitioner Sworn to subscribed before me this ______ day of ______________________, _________ Clerk of Court/Notary Public 3 of 3