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Fill and Sign the Form 346

Fill and Sign the Form 346

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Form 346(Rev. 6/05) Page 1 of 3 The Family Court of the State of Delaware In and For New Castle Kent Sussex County CUSTODY SEPARATE STATEMENT IN COMPLIANCE WITH TITLE 13, SECTION 1928 OF THE DELAWARE CODE PetitionerRespondentFile No.: 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) 3.Have all 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 aCustody Separate Statement for each child.4.Where is the child(ren) living as of today’s date? 555 Street AddressCityStateZip Code Name of person(s) child(ren) is living withRelationship to child(ren)5.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.Address where child(ren) currently residesCityStateZip Code 555 Date child(ren) lived thereName of person(s) child(ren) is living withRelationship to child(ren) Person’s current addressCityStateZip Code 555 Address where the child(ren) lived before that.CityStateZip Code 555 Date child(ren) lived thereName of person(s) child(ren) is living withRelationship to child(ren) Person’s current addressCityStateZip Code 555 Address where the child(ren) lived before that.CityStateZip Code 555 Date child(ren) lived thereName of person(s) child(ren) is living withRelationship to child(ren) Person’s current addressCityStateZip Code 555 Form 346(Rev. 6/05) Page 2 of 3 Address where the child(ren) lived before that.CityStateZip Code 555 Date child(ren) lived thereName of person(s) child(ren) is living withRelationship to child(ren) Person’s current addressCityStateZip Code 555 6.Check ONE 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.TYPE OF ACTION(custody, visitation or modification) PERSON who filed action STATE action was filed in COURT where the action was filed 555 DATE action was filed CASE NUMBERRESULT of actionDATE OF ORDER TYPE OF ACTION(custody, visitation or modification) PERSON who filed action STATE action was filed in COURT where the action was filed 555 DATE action was filed CASE NUMBERRESULT of actionDATE 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(PFA, TPR, Guardianship, Adoption) PERSON who filed action STATE action was filed in COURT where the action was filed 555 DATE action was filed CASE NUMBER TYPE OF ACTION (PFA, TPR, Guardianship, Adoption) PERSON who filed action STATE action was filed in COURT where the action was filed 555 DATE action was filed CASE NUMBER Form 346(Rev. 6/05) Page 3 of 3 8.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. Name of person(s) child(ren) is living withRelationship to child(ren) 555 Address of person(s) where child(ren) resideCityStateZip Code Name of person(s) child(ren) is living withRelationship to child(ren) 555 Address of person(s) where child(ren) resideCityStateZip CodeSWORN TO AND SUBSCRIBED before me this date, Petitioner Notary Public

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