Fill and Sign the Lien Request Missouri Courts Form

OSCA (07-13) FA35 1 of 1 452.400 RSMo IN THE ______ JUDICIAL CIRCUIT COURT, ___________________________, MISSOURI Judge or Division: Case Number: (Date File Stamp) Petitioner: SSN (last four digits): Petitioner’s Address: vs. Respondent: SSN (last four digits) : Responde nt’s Address: Response to Motion for Family Access Order I, _______________________________________________________________, state that: (Your Name) (Check each box that applies) I have not denied or interfered with custody, visitation or third party c ustody under the judgment of dissolution, legal separation, paternity or modification . I had good cause to deny or interfere with custody, visitation or third party custody under the judgment of dissolution, legal separa tion, paternity or modification. I am without knowledge or information to admit or deny the facts stated to be a violation of the judgment of dissolution, legal separation, paternity or modification. (Please provide the specific facts, including dates and times, which sho w compliance or good cause for noncompliance with the court’s judgment.) I request to participate in Alternative Dispute Resolution to assist in r esolving the problems that caused the filing of the Motion for Family Access Order. I swear/affirm under penalty of perjury that these facts are true to my best knowledge and belief. _______________________________ ____________________________________________________ Date Your Signature ____________________________________________________ Your Street Address ____________________________________________________ C ity State Zip ____________________________________________________ Your Telephone Number Instructions Upon completion, send the original of this Response to the Circuit Clerk of ___________________ (County /City of St. Louis), Missouri , at _____________________________________________________________ (address) and a copy to the person who filed the Motion for Family Access Order. Please keep a copy of this Response to bring with you to any scheduled hearing or alternative dispute re solution.