Ocaj 1 Form – Fill Out and Use This PDF

READ BEFORE COMPLETING AFFIDAVIT

A. WHAT IS AN “AFFIDAVIT DISCLOSING CARE OR CUSTODY PROCEEDING”?

It is a document signed under the penalties of perjury which lists information required by Trial Court Rule IV concerning children involved in a care or custody proceeding.

B. WHO MUST FILE THIS AFFIDAVIT?

The party to a petition (including a modification petition) or complaint involving the care,

custody, visitation, or change of name of a child pursuant to G.L. c. 119 (except delinquency actions under G.L. c. 201, G.L. c. 207, G.L. c. 208, G.L. c. 209, G.L. c. 209A, G.L. c. 209C, G.L. c. 210, or any other provision of law concerning the care or custody of a child must file this affidavit.

This affidavit must be signed by the party unless the party is under 18 years of age or has been adjudged incompetent in which case the attorney or record must sign this affidavit on behalf of the juvenile or incompetent party.

C. WHEN MUST THIS AFFIDAVIT BE FILED?

The person filing the petition or complaint must file this affidavit at the time of filing and the other party must file this affidavit with the first pleading.

This affidavit should be filed upon issuance of a CHINS petition pursuant to G.L. c. 119, not upon application for such a petition. This affidavit need not be filed if the petition or complaint is for support only.

D. WHERE MUST THIS AFFIDAVIT BE FILED?

The completed affidavit must be filed, in person or by mail, with the Clerk-Magistrate or Register of Probate in the court in which this action is being brought.

E. WHEN MUST A REVISED AFFIDAVIT BE FILED?

A revised affidavit must be filed with the Clerk-Magistrate or Register of Probate if new information is discovered subsequent to the filing of ths affidavit.

F. WHAT MUST BE FILED AS PART OF THIS AFFIDAVIT?

Certified copies of each pleading and of any determination entered in a foreign county or in a state other than Massachusetts must be filed with this affidavit unless these documents are on file with the court in this case, or an extension has been granted by the court for filing these documents.

INSTRUCTIONS FOR COMPLETING AFFIDAVIT

When completing this affidavit if additional space is needed for any of the sections, attach a separate sheet which includes your name (printed), the docket number and the sections to which you are referring. You must also sign and date the sheet.

The party filing this affidavit must complete the section entitles “Name of Case” and indicate the Court Department and Division in which the case is being brought. The docket number should be also be listed, if known.

DO NOT COMPLETE SECTIONS 2, 3, 4, 8 AND 10 IF THIS IS AFFIDAVIT IS BRING FILED WITH A PETITION FOR ADOPTION.

Section 1 You must print your first and last name. If this affidavit is filed by an attorney on behalf of an incompetent person or a juvenile, the name of the party on which behalf this affidavit is being completed must be listed.

Section 2List the names of all child(ren) involved in this care or custody proceeding. All future references to the child(ren) listed in this section should be with the letter in front of the child’s name (e.g. If John Smith is listed next to the letter A, all references to John Smith will be as Child A).

Section 3Check the box if this section applies to you. If this box is checked, do not complete Sections 4 and 5. You must complete Sections 10 and 11 on the reverse side of page 1.

Sections 4 & 5 List the present and all prior addresses during the last two years of the above-named child(ren) and your present address. If legal custody of a child has been awarded to a social service agency, list the name and address of the agency with legal custody.

Section 6Check the appropriate box.

Section 7 List all pending or concluded proceedings which you have participated in or know of involving the care or custody of the child(ren) named in this affidavit. Indicate the letter of the child; the court in which the case was heard, the docket number, the person(s) to whom custody was awarded, and the date of the award, and the nature of your participation in the proceeding by listing “W” for witness, “P” for party, “O” for other or “N” for none. If specific information required in this section is not known, you or your attorney should contact the court where the case was heard to obtain such information.

	In the case of a petition for adoption, list all information except the person(s) to whom custody was awarded, the
	date of the award and the nature of your participation. Under the heading “Status of Case”, indicate type of case.
Section 8	List the name(s) and current residential address(es), if known, otherwise the last known address(es) of parties to care or
	custody proceedings or persons claiming a legal right to the above named child(ren) during the last two years. Do not
	include yourself.
Section 9	Check this box if this affidavit discloses the adoption of a child and you are requesting the court to impound this affidavit.
	If this provision is applicable, you should contact the Clerk-Magistrate or Register of Probate for assistance concerning the
	appropriate motion to be filed.
Section	COMPLETE ONLY IF YOU CHECKED THE BOX IN SECTION 3.
10 & 11	List the present and all prior addresses during the last two years of the child(ren) listed in Section 2 of this affidavit and your
	present address. If legal custody of a child has been awarded to a social service agency, list the name and address of the
	agency with legal custody.
Section 12	List the attorneys and guardians ad litem/investigators previously appointed in Section 7.

SignatureThe party listed in Section 1 must date and sign this affidavit except for an incompetent or juvenile, in which case the attorney of record on behalf of the juvenile or incompetent party must date and sign this affidavit and print his/her name and address. TH S AFFID AV IT M U S T

B E FILE D W ITH TH E C O U R T AN D A C O PY FU R NIS HE D B Y TH E P AR TY FILIN G IT TO ALL O TH ER PAR TIE S TO TH E AC TIO N .