Uniform Child Custody Jurisdiction and Enforcement Act Forms

PETITION–UCCJEA CUSTODY / VISITATION

DRL Art. 5-A Form UCCJEA-1 (Petition-Custody, Visitation–UCCJEA) 3/2009

FAMILY COURT OF THE STATE OF NEW YORK

COUNTY OF

In The Matter of a Proceeding for Custody Visitation under the Uniform Custody Jurisdiction and Enforcement Act

Docket No.

Petitioner

against

Respondent

TO THE FAMILY COURT:

The undersigned Petitioner respectfully alleges upon information and belief that:

1. a. I am and am seeking an order of custody visitation regarding

b. I reside am located at

c. [Applicable when Petitioner is on active military duty or has recently returned from active military service]:

Petitioner is on active duty, deployed or temporarily assigned to military service.

Petitioner returned from active duty, deployment or temporary assignment to military service.

2. a. Respondent is

b. Respondent resides is located at

c. [Applicable when Respondent is on active military duty or has recently returned from active military service]:

Respondent is on active duty, deployed or temporarily assigned to military service.

Respondent returned from active duty, deployment or temporary assignment to military service.

3. The name, present address and date of birth of each child who is the subject of this proceeding are as follows:

4. This Court has jurisdiction to issue a child custody or visitation order pursuant to Section 76(1) of the Domestic Relations Law on the following ground(s):

this state is the home state of the child on the date of filing.

this state was the home state within six months before filing.

significant connection / substantial evidence basis.

5. This Court should exercise temporary, emergency jurisdiction because the child is presently in this State and:

the child has been abandoned.

it is necessary in an emergency to protect the child, a sibling or parent.

6. Order referring the issue of custody/visitation to the Family Court of the State of New York:

7. Check applicable box(es):

No proceeding has been commenced that could affect this action.

The following proceeding(s) have been commenced:

8. Parentage / paternity information:

Father identified:

Father was married to the mother at conception or birth.

Order of filiation was made on

Acknowledgment of paternity was signed on

Father is deceased.

9. The name and address of the mother:

10. The name and present address of the person(s) with whom each child resided during the past five years:

11. Petitioner has participated in other litigation concerning custody of the same child(ren):

has participated

has not participated

12. Persons not party to these proceedings who claim custody or visitation rights:

There are persons who have claimed custody or visitation rights.

I know of no such persons.

13. The custody or visitation of the child(ren) has been determined or agreed upon in the following instruments:

14. Petitioner / Respondent obtained custody of the child(ren) on:

15. Child protective petition or permanency hearing report filed regarding the children:

Child protective petition filed.

Permanency report filed.

Birth mother consented.

Birth father consented.

Foster parent(s) consented.

Local department of social services consented.

Attorney for the child(ren) consented.

16. Best interests of the child(ren):

custody visitation

17. Circumstances changed since entry of the order / judgment:

18. Order of Protection / Temporary Order of Protection:

against Respondent

against me

19. Petitioner requests a Temporary Order of Protection because:

20. Native-American child / Indian Child Welfare Act notice:

The subject child is a Native-American child.

21. No previous application has been made, except:

WHEREFORE, Petitioner respectfully requests this Court to issue:

A. An order awarding custody / visitation of the above-named child(ren) to the Petitioner as follows:

B. An order directing the Respondent to appear before the Court immediately with the child(ren) for a hearing.

C. A warrant for the Respondent to appear with the children.

D. Temporary, emergency measures to protect the child, a parent or sibling:

E. Measures necessary to ensure the safety of the child and any person ordered to appear:

F. Respondent to pay attorney’s fees and costs, including reasonable and necessary travel expenses.

G. A temporary order of protection containing the following conditions:

H. Such other and further relief as the Court may determine to be just and proper.

Dated:

VERIFICATION

STATE OF NEW YORK )

COUNTY OF ) :ss:

being duly sworn, says that (s)he is the Petitioner in the above-named proceeding and that the foregoing petition is true to (his)(her) own knowledge, except as to matters therein stated to be alleged on information and belief and as to those matters (s)he believes it to be true.

Sworn to before me this day of