New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter A - Forms Authorized by Section 205.7 › Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Forms › Form UCCJEA-3 - Affidavit - UCCJEA

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. § 76-h Form UCCJEA-3
(Affidavit--UCCJEA)
8/2002
FAMILY COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of a Proceeding for
Custody Visitation under the
Uniform Child Custody Jurisdiction
						and
Enforcement Act Docket No.
AFFIDAVIT--UCCJEA
Petitioner
-against-
Respondent
________
STATE OF NEW YORK)
: ss:
COUNTY OF)
I [specify name]:, being duly sworn,
						deposes and states the following:
1. I reside am located at [specify address
						or indicate if ordered to be kept confidential pursuant to Family Court Act
						§ 154-b(2) or Domestic Relations Law § 254]:
I am the [specify relationship to
						child(ren); if foster parent, agency, institution or other relationship, so
						state]: and am the Petitioner Respondent in the above-entitled
						proceeding.
2. (Upon information and belief) Each
						child who is the subject of this proceeding resides at:
Name Date of Birth Address [FN1]
Form UCCJEA-3 Page 2
3. (Upon information and belief) During
						the last five years each child who is the subject of this proceeding resided
						at:
Name Address[FN2] Duration
						(from/to)
4. (Upon information and belief) The name
						and present address of the person(s) with whom each child resided during the
						past five years are as follows:
Name Address[FN3] Duration
						(from/to)
5. I [check applicable box(es)]:
a. have have not participated as a party
						in other litigation concerning the custody visitation of one or more of the
						same children in New York State another state, territory, tribal jurisdiction
						or country [specify]: [If so, specify court, jurisdiction, children involved,
						parties, case number, date of determination and status]:
b. have have not participated as a witness
						in other litigation concerning the custody visitation of one or more of the
						same children in New York State another state, territory, tribal jurisdiction
						or country [specify]: [If so, specify court, jurisdiction, custody or
						visitation, children involved, parties, case number, date of determination and
						status]:
c. have have not participated as a
						[specify other capacity]: in other litigation concerning the custody visitation
						of one or more of the same children in New York State another state, territory,
						tribal jurisdiction or country [specify]: [If so, specify court, jurisdiction,
						custody or visitation, children involved, parties, case number, date of
						determination and status]:
6. [Check applicable box(es)]:
a. (Upon information and belief) I have
						the following information regarding a custody proceeding concerning custody
						visitation of one or more of the same child(ren) that is pending in New York
						State another state, territory, tribal jurisdiction or country [specify court,
						jurisdiction, custody or visitation, children involved, parties, case number,
						date of determination, and status; if the order has been stayed, so state,
						including date of stay and expiration, if any]:
Form UCCJEA-3 Page 3
b. (Upon information and belief) an order
						of custody visitation or one or more of the same child(ren) has been registered
						in New York State another state, territory, tribal jurisdiction or country
						[specify court(s) and jurisdiction(s) in which order registered, date of
						registration(s), court and jurisdiction that issued the order, children covered
						by the order and date of order, if available]:
c. I have no information regarding any
						pending custody or visitation proceedings concerning one or more of the same
						child(ren).
7. a. The following person(s) not a party
						to the proceedings (has)(have) physical custody of the child(ren) affected by
						this proceeding [specify name(s), address(es), which child(ren) and
						relationship(s) to child(ren)]:
b. I know of no person(s) not a party to
						this proceeding who (has)(have) physical custody of any of the child(ren)
						affected by this proceeding.
c. The following person(s) not a party to
						the proceedings claim(s) to have custody or visitation rights with respect to
						the child(ren) affected by this proceeding [specify name(s), address(es), which
						child(ren) and relationship(s) to child(ren)]:
d. I know of no person(s) not a party to
						the proceedings who claim(s) to have custody or visitation rights with respect
						to the child(ren) affected by this proceeding.
______________
Signature of: Petitioner Respondent
______________
Print or Type Name
______________
Signature of Attorney, if any
______________
Attorney's Name (print or type)
________
______________
Attorney's Address and Telephone
						Number
Sworn to before me this day of,.
________
(Deputy) Clerk of the Court
Notary Public
[FN1] Specify address or indicate if
						ordered to be kept confidential pursuant to Family Court Act § 154-b(2) or
						Domestic Relations Law § 254.
[FN2] Specify address or indicate if
						ordered to be kept confidential pursuant to Family Court Act § 154-b(2) or
						Domestic Relations Law § 254.
[FN3] Specify address or indicate if
						ordered to be kept confidential pursuant to Family Court Act § 154-b(2) or
						Domestic Relations Law § 254.