Form MC 416 at a glance
What it is: Form MC 416 is the Uniform Child Custody Jurisdiction Enforcement Act Affidavit of the State of Michigan.
Who signs: The affiant fills in the Signature of affiant, the Name of affiant (type or print), the Address of affiant and the Date.
A filled-in Form MC 416 example: a mother files for her daughter
How to fill out Form MC 416, box by box
The court, the plaintiff and the defendant
Enter the Case Number, the Judge, the Court telephone number, the Court address, the Plaintiff's name, the Defendant's name and In the matter of.
Boxes 1 to 3: the children, where they lived and the custodians
In Box 1, enter the name and present address of each child (under 18) in this case.
In Box 2, enter the Cities/States/Countries the child(ren) have lived in during the last 5 years along with the dates the child(ren) lived there (include addresses if available).
In Box 3, enter the name(s) and present address(es) of custodians with whom the child(ren) has/have lived within the last 5 years.
Box 4: other court proceedings
Box 4: I do not know of, and have not participated (as a party, witness, or in any other capacity) in any other court decision, order, or proceeding (including divorce, separate maintenance, separation, neglect, abuse, dependency, guardianship, paternity, termination of parental rights, and protection from domestic violence) concerning the custody or parenting time of the child(ren), in this state or any other state, except: specify case name and number, court name and address, and date of child custody determination, if one.
Box 5: pending proceedings
Box 5: I do not know of any pending proceeding that could affect the current child custody proceeding, including a proceeding for enforcement or a proceeding relating to domestic violence, a protective order, termination of parental rights, or adoption, in this state or any other state, except: specify case name and number, court name and address, and nature of the proceeding.
If that proceeding is continuing or has been stayed by the court, mark that box.
If temporary action by this court is necessary to protect the child(ren) because the child(ren) has/have been subjected to or threatened with mistreatment or abuse or is/are otherwise neglected or dependent, mark that box and attach explanation.
Box 6: other persons with custody claims
Box 6: I do not know of any person who is not already a party to this proceeding who has physical custody of, or who claims rights of legal or physical custody of, or parenting time with, the child(ren), except: state name(s) and address(es) of each person.
Boxes 7 and 8: home state and risk
7. The child(ren)'s “home state” is
Mark Box 8 to state that a party's or child's health, safety, or liberty would be put at risk by the disclosure of this identifying information.
Signing before a notary
By signing, you say you have filled this form out completely, and you acknowledge a continuing duty to advise the court of any proceeding in this state or any other state that could affect the current child-custody proceeding.
After Subscribed and sworn to before me on, the Deputy clerk/Notary public: Deputy Clerk/Notary signature, with Name (type or print), Notary public, State of Michigan, County of, and My commission expires on.
If this notarial act was performed using an electronic notarization system or a remote electronic notarization platform, mark that box.
Common questions about Form MC 416
Where do I file it?
Distribute form to: Court, FOC (if applicable), Defendant/Respondent, Plaintiff/Petitioner.
Sources
[1] Form MC 416 (Rev. 7/22), Uniform Child Custody Jurisdiction Enforcement Act Affidavit, Michigan State Court Administrative Office (the Official source link on this page).
