Family Court Affidavit Form #3 - Greene County, Missouri
Family Court Affidavit Form #3 - Greene County, Missouri
Family Court Affidavit Form #3 - Greene County, Missouri
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IN THE CIRCUIT COURT OF GREENE COUNTY, MISSOURI<br />
FAMILY COURT DIVISION<br />
_______________________ [name of minor child] )<br />
by Next Friend __________________________ )<br />
SSN: ___________________ )<br />
and )<br />
_________________________, individually, )<br />
SSN: ____________________ )<br />
Plaintiff(s), )<br />
)<br />
vs. ) Case No.________________<br />
)<br />
_________________________, )<br />
SSN: ____________________ )<br />
and )<br />
______________________ [name of minor child] )<br />
SSN: ____________________ )<br />
by Next Friend _________________ )<br />
SSN: ___________________ )<br />
Defendant(s) )<br />
AFFIDAVIT IN SUPPORT OF JUDGMENT<br />
PURSUANT TO THE UNIFORM PARENTAGE ACT<br />
(<strong>Form</strong> <strong>#3</strong>)<br />
The undersigned, having first been sworn upon his/her oath, hereby swears/affirms pursuant to local<br />
rule 2.3 that the following testimony is true:<br />
1. My name is ___________________ and I am the (Plaintiff)(Defendant) in the above action for the<br />
determination of parent-child relationship.<br />
2. I currently reside at _____________________ [street address] in ____________ <strong>County</strong>, State of<br />
______________. I (am)(am not) acting as Next Friend for the minor child.<br />
3. The minor child is a (male)(female) who was born on _______________ [date] in _____________,<br />
_____________ [city & state] and the birth of the child is recorded in the Bureau of Vital Statistics<br />
of the State of <strong>Missouri</strong>.<br />
4. (Plaintiff)(Defendant) is the biological mother of the child and resides at<br />
______________________ [address] in ___________ <strong>County</strong>, ____________ [state].<br />
5. The minor child is presently residing with (Plaintiff)(Defendant) at _________________,<br />
________________ [city & state] and has lived in the state of <strong>Missouri</strong> for six (6) months<br />
preceding the filing of the Petition.<br />
6. Neither Plaintiff nor Defendant has participated in any capacity in any other litigation concerning<br />
______/_______<br />
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the custody of the minor child in this or any other state. I do not have any information of any other<br />
custody proceeding concerning the minor child pending in any court of this state or any other state<br />
and I am unaware of any other person not a party to this proceeding who has physical custody or<br />
claims to have custody or visitation rights with respect to the minor child.<br />
7. That the (Plaintiff)(Defendant) and I engaged in sexual intercourse with each other during the<br />
months of ______________________ [months & years] and as a result of such intercourse,<br />
(Plaintiff)(Defendant) gave birth to the child at issue herein on _______________ [date] in<br />
_______________ [city], <strong>Missouri</strong>.<br />
8. This <strong>Court</strong> has personal jurisdiction in this action because (circle those applicable):<br />
1. the parties had sexual intercourse in this state and submit to the jurisdiction of the <strong>Court</strong>, or<br />
2. by personal service of the summons outside of the state, or<br />
3. by certified mail with proof of actual receipt, or<br />
4. other method allowed by court rule or statute consistent with the requirements of the<br />
constitution of the State of <strong>Missouri</strong> and/or the constitution of the United States.<br />
9. <strong>Greene</strong> <strong>County</strong> is the proper venue for this action because (circle those applicable);<br />
1. the child resides in <strong>Greene</strong> <strong>County</strong>, or<br />
2. the mother resides in <strong>Greene</strong> <strong>County</strong>, or<br />
3. the father resides in <strong>Greene</strong> <strong>County</strong> or may be found in <strong>Greene</strong> <strong>County</strong>.<br />
10. The father named herein is presumed to be the father of the minor child because (circle those<br />
applicable):<br />
1. the father and mother were married and the child was born during the marriage or within<br />
300 days after the marriage was terminated by death, annulment, declaration of invalidity, or<br />
dissolution of marriage, or<br />
2. the father and mother attempted to marry before the birth of the child although the attempted<br />
marriage is or may be declared invalid, or<br />
3. the father and mother married or attempted to marry after the child was born and the father<br />
acknowledged paternity of the child in writing and filed the same with the Bureau of Vital<br />
Statistics, or<br />
4. the father was named with his consent as the father on the child's birth certificate, or<br />
5. scientific testing indicates the father is not excluded as such and that probability of paternity<br />
is 98% or higher.<br />
11. The father (has)(has not) signed an acknowledgement of paternity and upon the signing of the<br />
acknowledgement thereafter filed the same with the Bureau of Vital Statistics.<br />
12. The Plaintiff and Defendant have agreed to a Parenting Plan concerning custody and visitation and<br />
no domestic violence has occurred and the minor child at issue herein has not been a victim of a<br />
sexual offense as defined under Chapter 566 of the Revised Statutes of <strong>Missouri</strong> or any offense<br />
defined under Chapter 568 RSMo. concerning violence against family members and the attached<br />
Parenting Plan is in the best interests of the minor child.<br />
13. More than 30 days have elapsed since Defendant was duly served with process or voluntarily<br />
entered his/her appearance in the case.<br />
______/_______<br />
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14. Defendant is in default or the parties have entered into a written settlement.<br />
15. It is in the best interest of the minor child that custody be awarded as follows (check one):<br />
___ That the parties be awarded joint legal custody and that (Plaintiff)(Defendant) be awarded<br />
primary physical custody in accordance with the terms of the Parenting Plan attached hereto.<br />
___ That the parties be awarded joint legal and physical custody in accordance with the terms of the<br />
Parenting Plan attached hereto.<br />
16. Support for the minor child is required and has been calculated according to <strong>Form</strong> 14 and a<br />
Parenting Plan and <strong>Form</strong> 14 calculation are attached hereto as exhibits ___________.<br />
(check one of the following):<br />
___ The presumed amount of child support based on the <strong>Form</strong> 14 calculation is not rebutted as<br />
unjust or inappropriate and that presumed amount of child support is set forth in the proposed<br />
Judgment.<br />
___ The presumed amount of child support based on the <strong>Form</strong> 14 calculation is rebutted as unjust or<br />
inappropriate and the <strong>Court</strong> should depart (upward/downward) from the <strong>Form</strong> 14 presumed amount<br />
to that amount set forth in the proposed Judgment for the following reason(s):<br />
_____________________________________________________________________________<br />
______________________________________________________________________________<br />
17. The parties have agreed that (Plaintiff)(Defendant) is to provide medical, dental, prescription,<br />
counseling and optical coverage for the minor child and the parties have further agreed that<br />
(Plaintiff)(Defendant) shall pay ____% of all amounts not covered for medical, dental, prescription,<br />
counseling, and optical expenses not covered by insurance (including any co-payments) and<br />
(Plaintiff)(Defendant) shall pay the other ____% of said uncovered expenses.<br />
18. The birth certificate of the minor child needs to be amended by the Bureau of Vital Statistics to<br />
reflect that (Plaintiff)(Defendant) is the father of the minor child. [strike this paragraph if not<br />
applicable]<br />
19. The name of the minor child should be changed to ___________________. [strike if not applicable<br />
or desired]<br />
20. (Plaintiff)(Defendant) has agreed to pay the court costs of this action and/or scientific testing and/or<br />
guardian ad litem fees.<br />
21. Both parents have completed a court-approved parent education program and have filed their<br />
certificates of completion with the <strong>Court</strong>.<br />
22. At least one of the parties hereto is represented by legal counsel.<br />
______/_______<br />
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_______________________<br />
Plaintiff<br />
STATE OF MISSOURI )<br />
) ss.<br />
COUNTY OF GREENE )<br />
Subscribed and sworn before me this ____ day of ________, 20___.<br />
My commission expires:<br />
Notary Public<br />
_________________________<br />
Attorney for Plaintiff (if any)<br />
___________________________<br />
Defendant<br />
STATE OF MISSOURI )<br />
) ss.<br />
COUNTY OF GREENE )<br />
Subscribed and sworn before me this ____ day of _____, 20____.<br />
My commission expires:<br />
Notary Public<br />
__________________________<br />
Attorney for Defendant (if any)<br />
Submitted to the <strong>Court</strong> this _________ day of ____________________, 20_____.<br />
_______________________<br />
Circuit Judge<br />
C:\My Documents\<strong>Family</strong> <strong>Court</strong> <strong>Affidavit</strong> <strong>Form</strong> <strong>#3</strong>.doc<br />
______/_______<br />
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form last revised February 26, 2013