Fill and Sign the Uniform Child Custody Jurisdiction and Enforcement Act Forms

Inapplicable if Petitioner is based at a permanent duty station or has had a permanent reassignment 1of station.DRL Art. 5-A Form UCCJEA-1 (Petition-Custody, Visitation–UCCJEA) 3/2009FAMILY COURT OF THE STATE OF NEW YORKCOUNTY OF.....................................................................................In The Matter of a Proceeding for Custody Visitation under the Uniform CustodyDocket No.Jurisdiction and Enforcement ActPetitionerPETITION–UCCJEA CUSTODY VISITATION-against-Respondent....................................................................................... TO THE FAMILY COURT: The undersigned Petitioner respectfully alleges upon information and belief that: 1. a. I am [specify relationship to child; if foster parent, agency, institution or other relationship, so state]: and am seeking an order of [check applicable box(es)]: custody visitation regarding [specify child’s name]: b. I [check applicable box]: reside am located at [specify address or indicate if orderedto be kept confidential pursuant to Family Court Act §154-b(2) or Domestic Relations Law §254]: c. [Applicable when Petitioner is on active military duty or has recently returned from activemilitary service; DELETE if inapplicable]: “ Petitioner is on active duty, deployed or temporarily assigned to military service asfollows [specify type of service, military branch or National Guard unit, anticipated dates and location of dutyand how duty is likely to affect custody or visitation, if at all]:1 “ Petitioner returned from active duty, deployment or temporarily assignment tomilitary service as follows [specify date of return, type of service, military branch or National Guard unit,anticipated dates and location of duty and how duty is likely to affect custody or visitation, if at all]: 2. a. Respondent [specify name]: is [specify relationship to child; if foster parent,agency, institution or other relationship, so state]: b. Respondent [check applicable box]: resides is located at [specify address or indicate ifordered to be kept confidential pursuant to Family Court Act §154-b(2) or Domestic Relations Law §254]: Form UCCJEA-1 Page 2 Inapplicable if Respondent is based at a permanent duty station or has had a permanent 2reassignment of station. c. [Applicable when Respondent is on active military duty or has recently returned from activemilitary service; DELETE if inapplicable]: “ Respondent is on active duty, deployed or temporarily assigned to military service as follows[specify type of service, military branch or National Guard unit, anticipated dates and location of duty andhow duty is likely to affect custody or visitation, if at all]:2 “ Respondent returned from active duty, deployment or temporarily assignment to military service asfollows [specify date of return, type of service, military branch or National Guard unit, anticipated dates andlocation of duty and how duty is likely to affect custody or visitation, if at all]:3. The name, present address and date of birth of each child who is the subject of this proceedingare as follows [specify address or indicate if ordered to be kept confidential pursuant to Family Court Act§154-b(2) or Domestic Relations Law §254] :Name Address Date of Birth4. This Court has jurisdiction to issue a child custody or visitation order pursuant to Section76(1) of the Domestic Relations Law on the following ground(s) [check all applicable box(es)]: a. this state is the home state of the child on the date of the filing of this petition; this state was the home state of the child within six months before the filing of thispetition; and the child is absent from this state but the following parent or person acting as a parent continues to live in this state [specify]: ;OR b. the child and the child’s parents, or the child and at least one parent or a person actingas a parent, have a significant connection with this state other than mere physicalpresence; and substantial evidence is available in this state concerning the child’s care,protection, training, and personal relationships; and EITHER[check applicable box]: a court of another state does not have home statejurisdiction under paragraph (a); OR a court of the home state of the child [check applicablebox]: has declined should declineto exercise jurisdiction on the ground that this state is themore appropriate forum under Domestic Relations Law§§76-f or 76-g, because [specify]:ORc. all courts having jurisdiction under paragraph (a) or (b) of this subdivision [checkapplicable box]: have declined “ should decline to exercise jurisdiction on theground that a court of this state is the more appropriate forum to determine the custodyof the child under Domestic Relations Law §§76-f or 76-g, because [specify]:ORd. no court of any other state would have jurisdiction under the criteria specified inparagraph (a), (b) or (c). Form UCCJEA-1 Page 35. This Court should exercise temporary, emergency jurisdiction, pursuant to Domestic RelationsLaw §76-c, because the child is presently in this State and [check one or both boxes]: the child has been abandoned [specify facts or circumstances]: it is necessary in an emergency to protect the child, a sibling or parent of thechild [specify facts or circumstances]:6. [Delete if inapplicable]: An order was issued by Court, County, Stateof , referring the issue of custody visitation to the Family Court of the State of NewYork in and for the County of [specify]: 7. Check applicable box(es): No proceeding has been commenced that could affect this action. The following proceeding(s) have been commenced that could affect this action, [specify jurisdiction, court, docket or index number, type and status of proceeding]: (Upon information and belief) an order of custody visitation of one or more ofthe same child(ren) has been registered in New York State another state, territory, tribal jurisdictionor country [specify court(s) and jurisdiction(s) in which order registered, date of registration(s), court andjurisdiction that issued the order, children covered by the order and date of order, if available]: 8. [Check applicable box(es). Delete inapplicable provisions]: a. The father of the child(ren) who (is)(are) the subject(s) of this proceeding is [specify]: . The father was married to the child(ren)’s mother at the time of the conception or birth. An order of filiation was made on [specify date and court and attach true copy]: An acknowledgment of paternity was signed on [specify date]: by [specify who signed and attach a t r u e c o p y ] : The father is deceased. b. The father of the child(ren) who (is)(are) the subject(s) of this proceeding has not been legally established. c. A paternity agreement or compromise was approved by the Family Court of County on , , concerning [name parties to agreement or compromise and child(ren) and attach a true copy]: 9. [Applicable to cases in which mother is not a party]: The name and address of the mother is[indicate if deceased or if address ordered to be kept confidential pursuant to Family Court Act §154-b(2) orDomestic Relations Law §§76-h(5), 254]: 10. The name and present address of the person(s) with whom each child resided during the pastfive years are as follows [indicate if address was ordered to be kept confidential pursuant to Family CourtAct §154-b(2) or Domestic Relations Law §254]:Name Address Duration Name of Person Current Address of Form UCCJEA-1 Page 4 (from/to) With Whom Child the Person With Resided Whom Child Resided 11. Petitioner has has not participated as a party witness other [specify]: in other litigation concerning the custody of the same child(ren) in New York State Other State orother jurisdiction [specify]: . If so, specify type of case; whetherparty, witness or other; court, location, index or docket #, if known, and status of case: 12. [Check applicable box]: The following person(s) not party to these proceedings have claimed physical custody or visitation rights to the child(ren) as follows: I know of no person(s) not a party to the proceedings who claim(s) to have custody orvisitation rights with respect to the child(ren) affected by this proceeding. 13. The custody or visitation of the child(ren) has been determined or agreed upon in thefollowing instruments [specify court, if any, and date and attach true copy of instrument(s)]: Custody order of [specify court and location]: , dated [specify]: Stipulation of settlement in [specify court and location]: , dated [specify]: Judgment of Divorce of [specify court and location]: , dated [specify]: Separation Agreement, dated [specify]: Custody or Guardianship Agreement confirmed by [specify court and location]: , dated [specify]: 14. Petitioner Respondent obtained custody of the child(ren) on [specify date]: , as follows: 15. [Applicable to cases in which child protective petition or permanency hearing reporthas been filed regarding the children and in which petitioner is a relative or other non-parent; deleteif inapplicable]: a. G A child protective petition, Docket # [specify]: , was filed in FamilyCourt, [specify county]: on [specify date]: alleging that [specify names ofrespondents on that petition]:neglected or abused the above-named child(ren). The petition resulted in [specify whether finding was madeand, if so, the disposition; if the disposition has been adjourned pending a consolidated hearing with thispetition, pursuant to F.C.A. §1055-b, so indicate and give next court date]: b. G A permanency report, Docket # [specify]: , pursuant to Article 10-A of theFamily Court Act, was filed in Family Court, [specify county]: on [specify date]: indicating a permanency plan of custody of the child(ren) with Petitioner in this proceeding. Thepermanency hearing was adjourned to [specify date]: pending a consolidated hearing with thispetition, pursuant to F.C.A. §1089-a. c. The child’s birth mother Q has Q has not consented to the award of custody to thePetitioner. If not, the following extraordinary circumstances support Petitioner’s standing to seek custody of Form UCCJEA-1 Page 5the child(ren) [specify]: d. The child’s legally-established birth father Q has Q has not consented to the award ofcustody to the Petitioner. If not, the following extraordinary circumstances support Petitioner’s standing toseek custody of the child(ren) [specify]: e. The child has been living with the following foster parent(s)[specify]:since [specify date]:The foster parent(s) G has/have G has/have not consented to the award of custody to the Petitioner. [If unaware whether theyhave consented, so state]: f. The local department of social services [specify]: in the related Q child abuse or neglect Q permanency proceeding Q has Q has not consented to the award of custody tothe Petitioner. [If unaware whether they have consented, so state]: g. The attorney for the child(ren) [specify]: in the related Q childabuse or neglect Q permanency proceeding Q has Q has not consented to the award of custody to thePetitioner. [If unaware whether they have consented, so state]: 16. It would be in the best interests of the child(ren) for Petitioner to have Q custody Q visitation for the following reasons [specify]: 17. The following circumstances have changed since entry of the order judgment other [specify]: of custody visitation [specify]: 18. An Order of Protection or Temporary Order of Protection was issued [check applicablebox(es]: against Respondent against me in the following criminal, matrimonial or Family Court proceeding(s) [specify the court, docket or indexnumber, date of order, next court date and status of case, if available]:The Order of Protection Temporary Order of Protection expired or will expire on [specify]: 19. Petitioner requests a Temporary Order of Protection pursuant to Family Court Act §655because [specify]: 20. [Applicable where government agency is a party]: The subject child is is not a Native-American child, who is subject to the Indian Child Welfare Act of 1978 (25 U.S.C. §§ 1901-1963). If so,the following have been notified [check applicable box(es)]: parent/custodian [specify name and give notification date]: tribe/nation [specify name and give notification date]: United States Secretary of the Interior [give notification date]: 21. No previous application has been made to any court or judge for the relief herein requested,except [specify; delete if inapplicable]: WHEREFORE, Petitioner respectfully requests this Court to issue: A. An order awarding custody visitation of the above-named child(ren) to the Petitioner as Form UCCJEA-1 Page 6follows [specify]: B. An order directing the Respondent to appear before the Court immediately with the above-named child(ren) for a hearing; C. A warrant for the Respondent to appear with the above-named children; D. An order directing the following temporary, emergency measures to protect the child, a parentor sibling [specify]: E. An order directing the following measures necessary to ensure the safety of the child and anyperson ordered to appear [specify]: F. An order directing the Respondent to pay Petitioner’s attorneys’ fees and costs, includingreasonable and necessary travel expenses, for the prosecution of this proceeding; and G. A temporary order of protection containing the following condition(s) [specify]: H. An order directing such other and further relief as the Court may determine to be just andproper.Dated: _________________________Petitioner_____________________________Print or Type Name_____________________________Signature of Attorney, if any______________________________ Attorney’s Name (print or type)______________________________Attorney’s Address and Telephone Number VERIFICATIONSTATE OF NEW YORK ) :ss:COUNTY OF )being duly sworn, says that (s)he is the Petitioner in the above-named proceeding and that the foregoing petition istrue to (his)(her) own knowledge, except as to matters therein stated to be alleged on information and belief and as tothose matters (s)he believes it to be true.__________________________ PetitionerSworn to before me this day of (Deputy) Clerk of the Court Notary Public