Petition - Custody Or Visitation UCCJEA {UCCJEA-1}

DRL Art. 5-A Form UCCJEA-1 (Petition-Custody, VisitationUCCJEA) 10/2004 FAM IL Y COURT OF THE STATE OF NEW YORK COUNTY OF ........................................................................ ............. In The Matter of a Proceeding for Custody Visitation under the Uniform Custody Docket No.Jurisdiction and Enforcement Act Petitioner PETITIONUCCJEA CUSTODY VISITATION -against- Respondent ........................................................................ ............... TO THE FAMIL Y COURT: The undersigned Petitioner respectfully alleges upon information and belief that: 1. I am [specify relationship to child; if foster parent, agency, institution or other relationship, so state]: and am seeking an order of [check applicable box(es)]: custody visitation regarding [specify childs name]: I [check applicable box]: 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]: 2. Respondent [specify name]: is [specify relationship to child; if foster parent,agency, institution or other relationship, so state]: Respondent [check applicable box]: resides is located at [specify address or indicate if ordered tobe kept confidential pursuant to Family Court Act 154-b(2) or Domestic Relations Law 254]: 3. The name, present address and date of birth of each child who is the subject of this proceedingare as follows [specify address or indicate if ordered to be kept confidential pursuant to Family Court Act 154-b(2) or Domestic Relations Law 254] : Name Address Date of Birth 4. This Court has jurisdiction to issue a child custody or visitation order pursuant to Section 76(1) of the Domestic Relations Law on the following ground(s) [check all applicable box(es)]: a. this state is the home state of the child on the date of the filing of this petition; this state was the home state of the child within six months before the filing of this petition; and the child is absent from this state but the following parent or American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 Form UCCJEA-1 Page 2 person acting as a parent continues to live in this state [specify]: ; OR b. the child and the childs parents, or the child and at least one parent or a person acting as a parent, have a significant connection with this state other than mere physical presence; and substantial evidence is available in this state concerning the childs care, protection, training, and personal relationships; and EITHER [check applicable box]: a court of another state does not have home state jurisdiction under paragraph (a); OR a court of the home state of the child [check applicable box]: has declined should decline to exercise jurisdiction on the ground that this state is the more appropriate forum under Domestic Relations L aw 76-f or 76-g, because [specify]: OR c. all courts having jurisdiction under paragraph (a) or (b) of this subdivision [check applicable box]: have declined should decline to exercise jurisdiction on the ground that a court of this state is the more appropriate forum to determine the custody of the child under Domestic Relations Law 76-f or 76-g, because [specify]: OR d. no court of any other state would have jurisdiction under the criteria specified in paragraph (a), (b) or (c). 5. This Court should exercise temporary, emergency jurisdiction, pursuant to Domestic Relations Law 76-c, because the child is presently in this State and [check one or both boxes]: the child has been abandoned [specify facts or circumstances]: it is necessary in an emergency to protect the child, a sibling or parent of the child [specify facts or circumstances]: 6. [Delete if inapplicable] : An order was issued by Court, County,State of , referring the issue of custody visitation to the Family Court of the State ofNew York in and for the County of [specify]: 7. Check applicable box(es): No proceeding has been commenced that could affect this action. The following proceeding(s) have been commenced that could affect this action, [specify jurisdiction, court, docket or index number, type and status of proceeding]: (Upon information and belief) an order of custody visitation of one or moreof 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 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 3 Form UCCJEA-1 Page 3order, if available]: 8. [Check applicable box(es). Delete inapplicable provisions]: a. The father of the child(ren) who (is)(are) the subject(s) of this proceeding is [specify]: . The father was married to the child(ren)s mother at the time of the conception or birth. An order of filiation was made on [specify date and court and attach true copy]: An acknowledgment of paternity was signed on [specify date]: by [specify who signed a n d a t t a c h a t r u e co p y ] : The father is deceased. b. The father of the child(ren) who (is)(are) the subject(s) of this proceeding has not been legally established. c. A paternity agreement or compromise was approved by the Family Court of County on , , concerning [name parties to agreement or compromise and child(ren) and attach a true copy]: 9. [Applicable to cases in which mother is not a party]: The name and address of the mother is [indicate if deceased or if address ordered to be kept confidential pursuant to Family Court Act 154- b(2) or Domestic Relations Law 254]: 10. During the last five years, each child who is the subject of this proceeding resided at: [specify address or indicate if ordered to be kept confidential pursuant to Family Court Act 154-b(2) or Domestic Relations Law 254]: Name Address Duration (from/to) 11. The name and present address of the person(s) with whom each child resided during the past five years are as follows [specify address or indicate if ordered to be kept confidential, pursuant to Family Court Act 154-b(2) or Domestic Relations Law 254]: Name Address Duration (from/to) 12. Petitioner has has not participated as a party witness other [specify]: in other litigation concerning the custody of the same child(ren) in New York State OtherState or other jurisdiction [specify]: . If so, specify type ofcase, capacity of participation, court, location and status of case: