Affecting The Family Relationship Form PDF Details

In the intricate landscape of family law, the "Information on Suit Affecting the Family Relationship" form emerges as a pivotal document, designed to comprehensively capture the essence of legal proceedings that impact the familial bonds, excluding adoptions. Its structured sections and mandatory fields ensure the systematic collection of vital details, which range from general information about the legal proceeding to specific data concerning divorces or annulments, whether they involve children or not. This form also delves into the establishment or modification of court jurisdictions over children’s matters, including paternity, conservatorship, child support, or termination of parental rights, and even the sensitive subject of changing a child's name. Each section meticulously records the identities, places of birth, and race of the parties involved, alongside the granular specifics of minors affected by the case, including their names, dates of birth, and prior names, if applicable. Critical to both the legal framework it supports and the lives it touches, this document functions not only as a legal requirement but also as a means to ensure the proper adjudication and record-keeping of changes within the family unit. With mandatory reporting to the State Vital Statistics Unit, it embodies a blend of legal precision and the profound understanding of family dynamics, underscored by strict adherence to the Texas Penal Code regarding the accuracy and truthfulness of the information provided.

QuestionAnswer
Form NameAffecting The Family Relationship Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesvs form 165, texas vital statistics form vs 165, vital statistics form vs 165, form information family

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INFORMATION ON SUIT AFFECTING THE FAMILY RELATIONSHIP

(EXCLUDING ADOPTIONS)

SECTION I GENERAL INFORMATION (REQUIRED) STATE FILE NUMBER

1a. COUNTY __________________________ 1b. COURT NO. ________________________

1c. CAUSE NO. ________________________ 1d. DATE OF ORDER (mm/dd/yyyy) _________

2. TYPE OF ORDER (CHECK ALL THAT APPLY):

DIVORCE/ANNULMENT WITH CHILDREN (SeC. 1, 2 AND 3)

DIVORCE/ANNULMENT WITHOUT CHILDREN (Sec 1 AND 2)

ESTABLISHMENT OF COURT OF CONTINUING JURISDICTION (SEC 1 AND 3)

(Court Order Establishing Paternity, Conservatorship, Child Support or Termination of Parental Rights)

CHANGE IN THE NAME OF THE CHILD (SEC 1 AND 3)

(PROVIDE PRIOR AND NEW NAME OF CHILD IN SECTION 3)

TRANSFER OF COURT OR CONTINUING JURISDICTION (SEC1, 3 AND INFORMATION BELOW) TRANSFER TO: COUNTY __________ COURT NO. ________ STATE COURT ID# ______________

3a. NAME OF ATTORNEY FOR PETITIONER

3b. TELEPHONE NUMBER (including area code)

3c. CURRENT MAILING ADDRESS (STREET AND NUMBER OR P.O BOX, CITY, STATE, ZIP)

SECTION 2 (IF APPLICABLE) REPORT OF DIVORCE OR ANNULMENT OF MARRIAGE

 

 

 

4. NAME (FIRST MIDDLE LAST SUFFIX)

 

 

 

 

 

 

5. MAIDEN LAST NAME (NAME BEFORE 1ST MARRIAGE)

 

ETITIONERP

 

 

 

 

 

 

 

 

 

 

 

 

6. PLACE OF BIRTH (CITY AND STATE OR FOREIGN COUNTRY)

 

 

7. RACE

 

8. DATE OF BIRTH (mm/dd/yyyy)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9. USUAL RESIDENCE

STREET NAME & NUMBER

 

CITY

STATE

 

ZIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RESPONDENT

 

10. NAME (FIRST MIDDLE LAST SUFFIX)

 

 

 

 

 

 

11. MAIDEN LAST NAME (NAME BEFORE 1ST MARRIAGE)

 

 

 

 

 

 

 

 

 

 

 

 

 

12. PLACE OF BIRTH (CITY AND STATE OR FOREIGN COUNTRY)

 

 

13. RACE

 

14. DATE OF BIRTH (mm/dd/yyyy)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15. USUAL RESIDENCE (STREET AND NUMBER CITY, STATE, ZIP)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16. NUMBER OF MINOR CHILDREN

17. DATE OF MARRIAGE (mm/dd/yyyy)

18. PLACE OF MARRIAGE (CITY AND STATE OR FOREIGN COUNTRY)

 

 

 

 

 

 

 

 

 

 

 

 

SECTION 3 (IF APPLICABLE) CHILDREN AFFECTED BY THIS SUIT

 

 

 

 

 

 

 

19a. CHILD CURRENT NAME (FIRST MIDDLE LAST SUFFIX)

 

 

 

 

 

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

19b. DATE OF BIRTH (mm/dd/yyyy)

 

19c. SEX

19d. BIRTHPLACE (CITY, COUNTY AND STATE)

 

CHILD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

19e. PRIOR NAME OF CHILD (FIRST MIDDLE LAST SUFFIX) – IF APPLICABLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20a. CHILD CURRENT NAME (FIRST MIDDLE LAST SUFFIX)

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

20b. DATE OF BIRTH (mm/dd/yyyy)

 

20c. SEX

20d. BIRTHPLACE (CITY, COUNTY AND STATE)

 

CHILD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20e. PRIOR NAME OF CHILD (FIRST MIDDLE LAST SUFFIX) – IF APPLICABLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21a. CHILD CURRENT NAME (FIRST MIDDLE LAST SUFFIX)

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

21b. DATE OF BIRTH (mm/dd/yyyy)

 

21c. SEX

21d. BIRTHPLACE (CITY, COUNTY AND STATE)

 

CHILD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21e. PRIOR NAME OF CHILD (FIRST MIDDLE LAST SUFFIX) – IF APPLICABLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDITIONAL CHILDREN LISTED ON BACK OF THIS FORM.

 

 

 

 

 

 

I CERTIFY THAT THE ABOVE ORDER WAS GRANTED ON THE DATE AND PLACE AS STATED.

_____________________________________

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE OF THE CLERK OF THE COURT

WARNING: This is a governmental document. Texas Penal Code, Section 37.10, specifies penalties for making false entries or providing false information in this document. VS-165 REV 07/2017

Texas Department of State Health Services - Vital Statistics

VS-165 REV 07/2017

1

 

 

ADDITIONAL CHILDREN AFFECTED BY THIS SUIT FROM SECTION 3 (IF APPLICABLE)

 

23a. CHILD CURRENT NAME (FIRST MIDDLE LAST SUFFIX)

 

4

 

 

 

23b. DATE OF BIRTH (mm/dd/yyyy)

23c. SEX

23d. BIRTHPLACE (CITY, COUNTY AND STATE)

CHILD

 

 

 

 

23e. PRIOR NAME OF CHILD (FIRST MIDDLE LAST SUFFIX) – IF APPLICABLE

 

 

 

 

24a. CHILD CURRENT NAME (FIRST MIDDLE LAST SUFFIX)

 

5

 

 

 

24b. DATE OF BIRTH (mm/dd/yyyy)

24c. SEX

24d. BIRTHPLACE (CITY, COUNTY AND STATE)

CHILD

 

 

 

 

24e. PRIOR NAME OF CHILD (FIRST MIDDLE LAST SUFFIX) – IF APPLICABLE

 

 

 

 

25a. CHILD CURRENT NAME (FIRST MIDDLE LAST SUFFIX)

 

6

 

 

 

25b. DATE OF BIRTH (mm/dd/yyyy)

25c. SEX

25d. BIRTHPLACE (CITY, COUNTY AND STATE)

CHILD

 

 

 

 

25e. PRIOR NAME OF CHILD (FIRST MIDDLE LAST SUFFIX) – IF APPLICABLE

 

 

 

 

Instructions for Completing the Suit Affecting Parent Child Relationship Form

GENERAL REQUIREMENT:

All divorces/annulments (with or without children) and all suits affecting the parent-child relationship must be reported through the clerk of the court to the State Vital Statistics Unit (VSU).

Consolidated reporting by petitioners, attorneys, and the courts is designed to make mandatory reporting more efficient, timely, and improve the quality of reporting. However, this reporting system is only as good or timely as you make it; therefore, your attention in completing and filing this report is critical.

Legal basis for this reporting is contained in Health and Safety Code §194.002 and Texas Family Code §§108.001-.002 and 108.004.

For information concerning reporting or questions about this form, contact field services at fieldservices@dshs.texas.gov or by phone at 512- 776-3010.

The VSU-165 form must be printed double-sided (one sheet not two).

For information on the court of continuing jurisdiction of a child, contact VSU at (888) 963-7111 ext. 2529. Inquiries should be addressed to VSU, 1100 West 49th Street, Austin, Texas, 78756-3191; inquiries may also be faxed to (512) 776-7164 .

SECTION 1 GENERAL INFORMATION (REQUIRED)

This section must be completed for each report filed.

1a – d. Enter the required information to identify the court proceeding.

2. Check the type of suit being reported. This determines also which sections of the form must be completed. If more than one type of order applies, check all that apply. Transfers from one jurisdiction to another must be reported in this section (if court number is unknown, specify “unknown”).

3a – c. Complete the attorney information to assist in questions or follow up. If case was pro se, please enter the information of the person completing this form.

SECTION 2 (IF APPLICABLE) REPORT OF DIVORCE OR ANNULMENT OF MARRIAGE

All divorces/annulments must be reported, even if there were no minor children. All information is required.

4-9. Report the Petitioner’s information including maiden name (if applicable).

10-15. Report the Respondent’s information, including maiden name (if applicable).

16. Report the number of minor children affected by this divorce; if none, record “0.” This number must correspond to the listing of children in Section 3.

17-18. Enter the date and place of the marriage being dissolved.

SECTION 3 (IF APPLICABLE) CHILDREN AFFECTED BY THIS SUIT

Every child affected by the suit being reported must be listed, and all items concerning that child must be completed. If more than three children are affected, check the “additional children listed on back of form” box, and continue to list the additional children. If more than 6 children complete section 3 on another form, label it “continuation” and attached the continuation form to the original form.

Texas Department of State Health Services - Vital Statistics

VS-165 REV 07/2017

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How to Edit Affecting The Family Relationship Form Online for Free

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2. Once the last segment is finished, you should add the necessary details in R E N O T T E P, USUAL RESIDENCE, STREET NAME NUMBER, CITY, STATE, ZIP, NAME FIRST MIDDLE LAST SUFFIX T N, PLACE OF BIRTH CITY AND STATE OR, USUAL RESIDENCE STREET AND NUMBER, MAIDEN LAST NAME NAME BEFORE ST, RACE, DATE OF BIRTH mmddyyyy, NUMBER OF MINOR CHILDREN, DATE OF MARRIAGE mmddyyyy, and PLACE OF MARRIAGE CITY AND STATE so you can progress further.

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