Fill and Sign the For Responding to a Motion to Change Child Custody Form

Page 1 of 3 DR -150 ( 9/17 ) (cs) AS 25.30.380 Child Custody Jurisdiction Affidavit If disclosure of the information on this form could harm the he alth, safety or liberty of you or your children , then you are not required to give a copy of this form to the other party. Instead, file this form at the court with form DR -151 which is available online or from the court clerk. AS 25.30.380(e). IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT ) ) ) ) CASE NUMBER: ) ) CHILD CUSTODY ) JURISDICTION AFFIDAVIT I am the person making this affidavit. My name is: First Name Middle Name Last Name 1. These children are the subject of the current custody proceedings: CHILD 1 First Name Middle Name Last Name Date of Birth Place of Birth Gender Male Female Current Address (since ____/____/____) Who has custod y? Relationship Past Addresses (last 5 years) City and State Who did this child live with then? (name and current address) Relationship From To CHILD 2 First Name Middle Name Last Name Date of Birth Place of Birth Gender Male Female Current Address (since ____/____/____) Who has custody? Relationship Past Addresses (last 5 years) City and State Who did this child live with then? (name and current address) Relationship From To Page 2 of 3 DR -150 ( 9/17 ) (cs) AS 25.30.380 Child Custody Jurisdiction Affidavit CHILD 3 First Name Middle Name Last Name Date of Birth Place of Birth Gender Male Female Current Address (since ____/____/____) Who has custody? Relationship Past Addresses (last 5 years) City and State Who did this child live with then? (name and current address) Relationship From To CHILD 4 First Name Middle Name Last Name Date of Birth Place of Birth Gender Male Female Current Address (since ____/____/____) Who has custody? Relationship Past Addresses (last 5 years) City and State Who did this child live with then? (name and current address) Relationship From To CHILD 5 First Name Middle Name Last Name Date of Birth Place of Birth Gender Male Female Current Address (since ____/____/____) Who has custody? Relationship Past Addresses (last 5 years) City and State Who did this child live with then? (name and current address) Relationship From To [Attach extra pages if there are more than 5 children.] Page 3 of 3 DR -150 ( 9/17 ) (cs) AS 25.30.380 Child Custody Jurisdiction Affidavit 2. Have you participated as a party, witness, or in another capacity in another proceeding about t he custody of any of the children listed above or about visitation with them? Ye s No If yes, describe the other custody proceeding: Name of the court Case number Date Court’s decision 3. Do you know of a proceeding that could affect this proceeding (such as a proceeding about domestic violence, protective orders, child -in-need -of -aid, termination of parental rights, adoption, or enforcement of a court order )? Yes No If yes, identify t he court Case number Type of the proceeding 4. Do you know of anybody who is not a party to this proceeding who has physical custody of any of the children listed above, or claims they have a right to physical custody, legal custody, or visitation? Yes No If yes, list each person’s name , address , and what the person claims I say on oath or affirm under penalty of perjury that my statements in this Affidavit are true to the best of my knowledge and belief. Signature (sign in front of a notary) Subscribed and sworn to or affirmed before me at (city and state) on this date . Clerk of Court, Notary Public, or other person authorized to administer oaths My commission expires I certify that on date a copy of this Affidavit was mailed to the other party in this case (list name below) Signature NOTE: All parties have a continuing duty to tell the court of any other court proceeding in Alaska or any other state concerning the children listed above.