Fill and Sign the Form Uccjea 14 New York State Unified Court

1 Do not include address if ordered to be kept confidential pursuant to Domestic Relations Law §§76-h, 254 or Family Court Act §154-b. An application for address confidentiality, General Form 21, available at www.courts.state.ny.us (Family Court forms), may be filed with this affidavit, if disclosure would place the health or safety of a party or child unreasonably at risk. DRL §77-d Form UCCJEA-14 Affidavit Application for Registration of an Custody or Visitation Order – UCCJEA 8/2002 FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF ................................................................................. In the Matter Of The Registration Of An Out-Of-State GCustody G Visitation Order AFFIDAVIT APPLICATION FOR Under the Uniform Child Custody Jurisdiction REGISTRATION OF AN and Enforcement ActOUT-OF-STATE G CUSTODY G VISITATION ORDER– UCCJEA Petitioner, against Respondent. .................................................................... STATE OF NEW YORK ) )ss.: COUNTY OF ) 1. I [specify name]: am the Petitioner in this application to register the attached out-of-state order of [check applicable box(es)]: 9custody 9visitation, that had been issued by [specify court, state or other jurisdiction and date]: 2. The child(ren) who (is) (are) the subject of the attached order (is) (are): Name(s) Date(s) of Birth 3. I reside at [specify address or, if ordered to be kept confidential pursuant to Domestic Relations Law §§76-h, 254 or Family Court Act §154-b, the name and address of the agent designated for service of process and papers]: 4. The Respondent [specify name]: resides at [specify last- known address or, if ordered to be kept confidential pursuant to Domestic Relations Law §§76-h, 254 or Family Court Act §154-b, the name and address of the agent designated for service of process and papers]: 5. The name(s) and address(es) of any person(s) who were awarded custody or visitation in the order sought to be registered are as follows [specify]: 1 Name(s) Relationship to Child(ren) Address Form UCCJEA-14 Page 2 6. To the best of my knowledge and belief, the attached order that I am seeking to register is in effect and has not been stayed or modified. 7. a. This order has been registered in the following other jurisdictions [specify]: b. Registration of this order was denied in the following jurisdiction(s) [specify and indicate date]: c. An application for registration of this order is pending in the following jurisdiction(s) [specify and indicate status of application]: WHEREFORE, for the reasons stated above, I am requesting this Court to register the above-mentioned order in accordance with Section 77-d of the Uniform Child Custody Jurisdiction and Enforcement Act [Domestic Relations Art. 5-A]. Sworn to before me this ____day of , _________________________________ Name ______________________ (Deputy) Clerk of Court Notary Public NOTICE : Attach two copies of the order sought to be registered, at least one of which is certified. A sworn, notarized letter, containing the above information may be submitted instead of this affidavit. A “child custody or visitation determination” eligible for registration under Domestic Relations Law §77-d includes a “judgment, decree, or other order of a court providing for the legal custody, physical custody, or visitation with respect to a child,” including a “permanent, temporary, initial and modification order,” but not including an order relating to child support or other monetary obligations. See Domestic Relations Law §75-a (3). The order may have been entered in a “proceeding for divorce, separation, neglect, abuse, dependency, guardianship, paternity, termination of parental rights, and protection from domestic violence,” but does not include a juvenile delinquency, person in need of supervision or contractual emancipation enforcement proceeding or a proceeding to enforce an out-of-state custody or visitation order . See Domestic Relations Law §75-a (4).