Form Cafc201 – Fill Out and Use This PDF

In what Missouri county will this case be filed?

If this is an amended petition, what is the case number of the pending case?

In the Circuit Court of

MISSOURI

Case Number		Division Number

Your Information

1.My full name is: (You are the “Petitioner” in this case.)

__________________	______________	_____________________________	________
(First Name)	(Middle Name)	(Last Name)	(Jr./Sr./III)

2. This is the first petition I have filed in this case. (Original Petition)

This is the second petition I have filed in this case.

This is the third petition I have filed in this case.

3. I am the Mother

I am the Father

4.The last four numbers of my Social Security Number are: XXX-XX-_______________

5.My mailing address is:

___________________________________________________________________________________

(Street)

_____________________________________		______________________	_______________
(City)		(State)	(Zip)
_________________________	___________________________________________________
(Telephone Number)	(E-Mail Address)

Other Party’s Information

6.The full name of the other party is: (He or she is the “Respondent” in this case.)

__________________	______________	_____________________________	________
(First Name)	(Middle Name)	(Last Name)	(Jr./Sr./III)

7.The last four numbers of the other party’s Social Security Number are: XXX-XX-_______________

8.The other party’s mailing address is:

___________________________________________________________________________________

(Street)

_____________________________________		______________________	_______________
(City)		(State)	(Zip)
_________________________	___________________________________________________
(Telephone Number)	(E-Mail Address)

Service Information

Case Information

Form CAFC201-7/1/2010

9. The other party has signed a verified “Answer to Petition for Determination of Custody” which is being filed with this motion. Therefore, do not issue a

summons.

The other party should be served at his or her residence.

___________________________________________________________________________________

(Street)

_____________________________________	______________________	_______________
(City)	(State)	(Zip)

The other party should be served at his or her place of employment.

______________________________________________________	_______________________
(Employer’s Name - if applicable)	(Hours of Employment)

___________________________________________________________________________________

(Street)

_____________________________________	______________________	_______________
(City)	(State)	(Zip)

Service by publication. I don’t know where the other party is and I have no way of locating him or her. Therefore, I am requesting that he or she be served by publication. I have filed an Affidavit for Service by Publication and a Notice of Publication.

Other method of service: ____________________________________________________

10. The parent receiving support is not receiving Temporary Assistance for Needy Families (TANF).

The parent receiving support is receiving TANF and therefore the State of Missouri must be served. Summons to issue to be served on:

Director, Family Support Division

615 Howerton Court

Jefferson City, Missouri 65102

11.I am entitled to ask for custody because:

Paternity was acknowledged by both parties and father’s name appears on the birth certificate of each child listed in this petition. Copies of these birth certificates are attached to this petition.

An administrative order was entered that determined paternity. A copy of this administrative order is attached to this petition.

Father and Mother were married at the time of the birth of each child listed in this petition and there are no existing custody judgments.

Other __________________________________________________________

(Explain)

Petition for Child Custody – Page 2 of 5

This form is available for free at www.selfrepresent.mo.gov

Military Information

Employment Information

12. The other party is NOT on active duty in the United States military. The other party is on active duty in the United States military.

13.	I am self-employed
	I am unemployed
	I am employed at:
	___________________________________________________________________________________
	(Name of Employer)
	___________________________________________________________________________________
	(Street)
	_____________________________________	______________________	_______________
	(City)	(State)	(Zip)
14.	The other party is self-employed
	The other party is unemployed
	I don’t know the other party’s employment status
	The other party is employed at:
	___________________________________________________________________________________
	(Name of Employer)
	___________________________________________________________________________________
	(Street)
	_____________________________________	______________________	_______________
	(City)	(State)	(Zip)

Children’s Information

Form CAFC201-7/1/2010

15.There is/are ____________ child(ren) who is/are the subject of this proceeding as listed below.

Child’s Full Name	Child’s Age

Petition for Child Custody – Page 3 of 5

This form is available for free at www.selfrepresent.mo.gov

Additional Information about the Children

Proposed

Parenting

Plan

Request for Relief

Form CAFC201-7/1/2010

16.The child(ren) have lived with the following persons at the following address(es) during the past five years. (State the dates at each address)

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

17.Check all boxes that apply to your case.

Someone other than me or the other parent has physical custody of one or more of the child(ren) or claims to have custody or visitation rights with respect to one or more of the child(ren).

There are other custody proceeding(s) concerning one or more of the child(ren) pending in a court of this or another state.

I have participated in other litigation concerning the custody of one or more of the child(ren) in this or another other state.

One or more of the child(ren) has been a victim of abuse or neglect.

18.Explanation: (If you checked any of the boxes in paragraph 17, please explain in detail here.)

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

19.The custody arrangement that is in the best interests of the minor children is set forth in Part A of the attached parenting plan marked Exhibit 1. (You must attach a completed copy of Parenting Plan Form CAFC501 to this petition.)

THEREFORE, I want the court to enter a judgment concerning custody as per Part A of the attached parenting plan marked Exhibit 1.

I also request the following relief:

Child support should be set as set forth in Part B of the attached parenting plan marked Exhibit 1.

I am without sufficient funds to pay for my attorney and I request that the other party pay my attorney’s fees for this case.

Other (Please state the other requests)

_________________________________________________________________

Petition for Child Custody – Page 4 of 5

This form is available for free at www.selfrepresent.mo.gov

________________________
Notary Public	Sign this in front of a
My Commission Expires:	Notary Public
_____________________

This should only be completed if a lawyer helped you with this form

ATTORNEY INFORMATION (To be completed by your attorney)

______________________________________________	___________________
Attorney – SIGN HERE	Missouri Bar Number

_____________________________________________________________________

Attorney for Movant – PRINT YOUR NAME HERE

______________________________________________________________________________

(Street)

______________________________________		______________________	__________
(City)		(State)	(Zip)
__________________	_______________	_____________________________________
(Telephone Number)	(Fax Number)	(Email Address)

Do not enter any information here if you are filing this case without the assistance of a lawyer.

This information should be completed by your attorney.

I have assisted Petitioner in the preparation of these pleadings, but I am not entering my appearance on behalf of Petitioner.