Fillable Printable Uniform Child Custody Jurisdiction and Enforcement Act Affidavit - Wisconsin
Fillable Printable Uniform Child Custody Jurisdiction and Enforcement Act Affidavit - Wisconsin
Uniform Child Custody Jurisdiction and Enforcement Act Affidavit - Wisconsin
PRINT in BLACK ink
GF-150, 10/06 Uniform Child Custody Jurisdiction and Enforcement Act Affidavit §822.29, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 1 of 2
Enter the name of the
county in which you are
filing this case.
STATE OF WISCONSIN, CIRCUIT COURT,
COUNTY
For Official Use
In the box to the right,
enter the name of the case
exactly as it is shown on
other papers from the
same case.
Case Caption:
Uniform Child Custody
Jurisdiction and
Enforcement Act
Affidavit
Case No.
Note:Enter case number
if one has been assigned;
otherwise, leave case
number blank. The clerk
will add this.
UNDER OATH I STATE:
Enter the name(s) of the
child(ren) and their current
address. If they currently
reside at separate addresses,
provide those addresses on
an add’l sheet.
1.
The child(ren)’s name and present address are:
Name(s):
Present Address:
See attached
2.
The child(ren) have lived in the following places over the last 5 years:
Enter any previous
addresses at which the
child(ren) have lived in the
past 5 years. Attach
additional sheet, if
necessary.
See attached
Enter the names and
current address of each
person with whom the
child(ren) have lived in the
last 5 years.
If space is insufficient, or
if individual children have
lived at different address
from others, attach an
additional sheet and
explain.
3.
The name and present address of each person(s) with whom the child(ren) have lived over
the last 5 years is:
Name:
Present Address:
Time Period:
Name:
Present Address:
Time Period:
Name:
Present Address:
Time Period:
Name:
Present Address:
Time Period:
See attached
Check yes or no. If yes,
enter the name of the court,
the case number assigned to
it, and the date the court
order was entered. Attach
an additional sheet, if
necessary.
4.
I have participated as a party, witness or in any other capacity in any other proceeding
concerning the custody, physical placement, or visitation with the child(ren).
Yes No If Yes, identify court, case number and date of any determination:
See attached
Uniform Child Custody Jurisdiction and Enforcement Act Affidavit Page 2 of 2Case No.____________
GF-150, 10/06 Uniform Child Custody Jurisdiction and Enforcement Act Affidavit §822.29, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additionalmaterial.
Page 2 of 2
Check yes or no.
If yes, enter the name of
the court, the case number
assigned to it, and the
nature of the case (that is,
what the case was about).
5.
I have information of other proceedings concerning the child(ren) pending in Wisconsin or
any other state, including enforcement, domestic violence, protective orders, termination of
parental rights and adoption.
Yes No If Yes, identify court, case number and nature of proceedings:
Check yes or no.
If yes, enter the name of
and address of each
person.
6.
I know of persons not a party to this proceeding who have physical custody of the child(ren)
or claim to have custody, physical placement, or visitation rights with respect to the
child(ren).
Yes No If Yes, give name and address of each person:
7.
I understand that I have a duty to inform the court if I learn in the future of any proceeding
concerning the child in Wisconsin or any other state.
STOP!
Take this document to a Notary Public BEFORE you sign it.
After you have been
sworn by a Notary Public,
sign and print your name
and date the document in
front of the Notary Public.
Signature
Print or Type Name
Date
Have the Notary Public
sign, date, and seal the
document.
State of
County of
Subscribed and sworn to before me on
Notary Public/Court Official
Name Printed or Typed
My commission/term expires:
)
