Fill and Sign the Notice of Child Abduction Request for Return Minnesota Form

REQUEST FOR RETURN Hague Convention of 25 October 1980 on the Civil Aspects of International Child Abduction _____________ _____________ _____________ Requesting Central Authority or Applicant _____________ _____________ _____________ Requesting Authority Concerns the following child: _____________ _____________ who will attain the age of 16 on _____________ _____________ , 20 __ . and _____________ _____________ who will attain the age of 16 on _____________ _____________ , 20 __ . Note.--The following particulars should be completed insofar as possible. I --Identity of the Child and its Parents 1 Child Name and first names _____________ _____________ _____________ _____________ Date and place of birth _____________ _____________ _____________ __ _____________ _____________ ____________ _ _____________ ____________ ______ _____________ Passport or identity card No., if any _____________ ___________ _ FORMTEX T _____________ _ _ Description and photo, if possible (see annexes) _____________ ___ _____________ _____________ _____________ _____________ ___ _ FORMTEX T __________ __ FORMTE XT _____________ _ FORMTEX T ____________ _ FORMTEX T ____________ _ Name and first names _____________ _____________ _________ _ FORMTEX T _____________ ___ Date and place of birth _____________ _____________ _____________ ___ _____________ _____________ ___________ __ ___________ _____ _________ _ FORMTEX T _____________ ___ _ Passport or identity card No., if any _____________ ___________ _____________ __ Description and photo, if possible (see annexes) _____________ ____ _____________ _____________ _____________ _____________ ________ _ FORMTEXT FORMTE XT ___ FORMT EXT ____ ____ FORM TEXT _____________ _____ ______ _________ _ _ - 1 - 2 Parents 2.1 Mother: Name and first names _____________ _____________ _____________ ______ Date and place of birth _____________ __________ _____________ ___ _____________ ___________ _____________ ___ __________ _____ _ FORMTEX T _____________ FORMTEX T _____________ __ _ Nationality _____________ _____________ _____________ _____________ __ Occupation _____________ _____________ _____________ _____________ ___ Habitual-residence _____________ _____________ _____________ ________ Passport or identity card No., if any _____________ _____________ __ 2.2 Father: Name and first names _____________ _____________ _____________ ______ Date and place of birth _____________ _____________ _____________ ___ _____________ _____________ ___________ __ ___________ __ _ FORMTEX T _____________ __ _____________ _ Nationality _____________ _____________ _____________ _____________ __ Occupation _____________ _____________ _____________ _____________ ___ Habitual residence _____________ _____________ _____________ ________ Passport or identity card No., if any _____________ _____________ __ 2.3 Date and place of marriage _____________ _____________ ______ _ FORMTEX T _ FORMTE XT _____________ ____________ __ II --Requesting individual or institution (who actually exercised custody before the removal or retention) 3 Name and first names _____________ ________ _ FORMTEX T __ __ FORMTE XT _____________ _________ ____________ __ Nationality of individual applicant _____________ _____________ ___ Occupation of individual applicant _____________ _____________ ____ Address _____________ _____________ _____________ _____________ _____ Passport or identity card No., if any _____________ _____________ _ Relation to the child _____________ _____________ _____________ ____ Name and address of legal adviser, if any _____________ __________ _____________ _____________ _____________ _____________ ____ ______ _ FORMTEX T _ __ FORMTE XT _____ ___ FORMT EXT _____________ __ __________ __ III --Place Where the Child is Thought To Be 4.1 Information concerning the person alleged to have removed or retained the child Name and first names _____________ _____________ _________ _ FORMTEX T _ FORMTE XT - 2 - ____________ _____ ___ _____ Date and place of birth, if known _____________ __________ _ FORMTEX T _ FORMTE XT _____ ___ FORMT EXT _______ ___ ____________ __ _____ Nationality, if known _____________ _____________ _____________ ____ Occupation _____________ _____________ _____________ _____________ __ Last known address _____________ _____________ _____________ ____ _ FORMTEX T __ FORMTE XT ___ ___________ __ Passport or identity card No., if any _____________ _____________ _ Description and photo, if possible (see annexes) _____________ ___ _____________ _____________ _____________ _____________ ________ _ FORMTEX T _____ __ FORMTE XT _____ ___ FORMT EXT __ ____ FORM TEXT ______ _______ ____ _____ ____ 4.2 Address of the child _____________ _____________ _______ _ FORMTEX T ___ __ FORMTE XT _____________ _____ _____ 4.3 Other persons who might be able to supply additional information relating to the whereabouts of the child _____________ _____________ _____________ _____________ _____________ ________ _ FORMTEX T ______ __ FORMTE XT ____________ _ FORMTE X T _ FORMT EXT ____________ ____________ _ __ _ IV --Time, Place, Date and Circumstances of the Wrongful Removal or Retention _____________ _____________ _____________ _____________ ___ _____________ ___________ __ ___ _ FORMTEX T _____________ __ ___________ _____________ V --Factual or Legal Grounds Justifying the Request _____________ _____________ _____________ _____________ _____________ _____________ VI --Civil Proceedings in Progress _____________ __ _____________ _____________ _____________ _____________ ____________ VII --Child Is To Be Returned To: a. Name and first names _____________ _____________ _____________ __ Date and place of birth _____________ _____________ ___ ___ _____________ _____________ _____________ ________ _____ __________ _ FORMTEX T ___ __ FORMTE XT _____________ ________ __ _ Address _____________ _____________ _____________ _____________ ______ Telephone number _____________ _____________ _____________ __________ b. Proposed arrangements for return of the child _____________ ___ _____________ _____________ _____________ _____________ ___________ - 3 - __ _ _____________ _____________ _____________ _____________ _____________ _ VIII —Other Remarks _____________ _____________ _____________ _______ _____________ _____________ _______ ______ _____________ _____________ _ IX --List of Documents Attached _____________ _____________ _________ _____________ _____________ _____________ _____ ________ _____________ _ _____________ _____________ _____________ _____________ _____ ________ _ Date _____________ _____________ _____________ _______ _______________ Place _____________ _____________ _____________ _____________ ________ Signature and/or stamp of the requesting Central Authority or applicant _________ _____________ _____________ _____________ _____ - 4 -