Fillable Printable Uniform Child Custody Jurisdiction and Enforcement Act Affidavit - Wisconsin

Uniform Child Custody Jurisdiction and Enforcement Act Affidavit - Wisconsin

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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.

The child(ren)’s name and present address are:

Name(s):

Present Address:

See attached

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.

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.

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 2 Case 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 additional material.

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).

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.

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:

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:

)