Children

a. General Information

Number of Minor Children. The parties have (number) ______ minor children in common. Enter how many children under 18 you and the other parent have together.

b. Children's Basic Information

Child's Name: Write the full name of your first child. Date of Birth Enter the date this child was born. State of Residence: Write the state where this child currently lives. Child's Name: Write the full name of your second child. Date of Birth Enter the date this child was born. State of Residence: Write the state where this child currently lives. Child's Name: Write the full name of your third child. Date of Birth Enter the date this child was born. State of Residence: Write the state where this child currently lives. Child's Name: Write the full name of your fourth child. Date of Birth Enter the date this child was born. State of Residence: Write the state where this child currently lives. Child's Name: Write the full name of your fifth child. Date of Birth Enter the date this child was born. State of Residence: Write the state where this child currently lives. The current custody order was filed on (date of your current custody order) Write the date your current custody order was filed with the court. You can find this date stamped on your order. The court order says on page Write the page number of the court order where it explains your time with the children. line/paragraph number Write the line or paragraph number on that page that lists your time with the children. that I am supposed to have time with the child(ren) on the following days/times: (describe when the order states you are to have time with the children) Describe the exact days and times you are supposed to have the children, just as the order states. The other party was served with a copy of the court order on (date the party was served with the order) Check this box if the other parent was formally handed or delivered a copy of the court order. The other party was served with a copy of the court order on (date the party was served with the order) Write the date the other parent was given a copy of the court order. The other party knows about the court order(s) because (explain how the other party is aware of the court order) Check this box if the other parent knows about the order even though they were not formally served a copy. The other party knows about the court order(s) because (explain how the other party is aware of the court order) Explain how you know the other parent is aware of the court order, such as being in court when it was made.

c. Possession & Access

There are no other court orders that affect the custody and visitation order. Check this box if no other court orders affect custody or visitation in your case. There is another court order that may affect the custody and visitation order. (Give details about what court issued the order, when, what the order says, etc.) Check this box if there is another court order that affects custody or visitation. There is another court order that may affect the custody and visitation order. (Give details about what court issued the order, when, what the order says, etc.) Give details about the other order, such as which court made it, the date, and what it says. Denial of Custody / Visitation. The other parent is violating the custody / visitation order in the following ways (explain when you last saw the children, your attempts to see the children, and any known reasons why the other parent will not let you see the children): Describe how the other parent is breaking the custody or visitation order. Include the last time you saw your children, how you tried to see them, and why you think the other parent won't let you. No, I have not contacted the police about this situation. Check this box if you have not called or reported this problem to the police. Yes, I contacted the police about this situation. (Give details about when you contacted police, the police report, what action the police took, etc.): Check this box if you did call or report this problem to the police. Yes, I contacted the police about this situation. (Give details about when you contacted police, the police report, what action the police took, etc.): Explain when you called the police, whether a report was made, and what the police did about it. No, I have not contacted CPS about this situation. Check this box if you have not contacted Child Protective Services about this problem. Yes, I contacted CPS about this situation. (Give details about when you contacted CPS, any action CPS took, the caseworker's name, etc.): Check this box if you did contact Child Protective Services about this problem. Yes, I contacted CPS about this situation. (Give details about when you contacted CPS, any action CPS took, the caseworker's name, etc.): Explain when you contacted CPS, what they did, and the name of the caseworker you spoke with.