IN THE DISTRICT COURT OF COUNTY STATE OF OKLAHOMA IN THE MATTER OF: DOB: DOB: DOB: DOB: DOB: DOB: DOB: Alleged Deprived Child(ren) under 18 years ) ) ) ) Case No. ) Judge ) ) DECLARATION OF KINSHIP PERSONS I,___________________ pursuant to 10A O.S. §1-4-203(4) submit the names and contact information concerning the following relatives (grandparents, aunts, uncles, brothers and sisters, half-siblings and first cousins) and a comment about whether the relative might be willing and appropriate to provide a home for my child(ren). In case there are no appropriate relatives, then I submit the names and contact information of any appropriate non-relative persons who have a substantial relationship with my child(ren) and a comment about whether the person might be appropriate and able to provide a home for my child(ren). I know it is important for my child(ren) to stay connected to important people in his or her life/lives while in the care of the Oklahoma Department of Human Services and I understand that the information I am providing here will also be used to plan visitation, contact, and possible placement for my child(ren). Person's name completing this form Your relationship to the child(ren) Declaration of Kinship Persons OK-J-UF-0010 Page 1 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Child #1 Child's full legal name Child's mother's name Child #2 Child's full legal name Child's mother's name Child #3 Child's full legal name Child's mother's name Child #4 Child's full legal name Child's mother's name Child #5 Child's full legal name Child's mother's name Date of birth Child's father's name Date of birth Child's father's name Date of birth Child's father's name Date of birth Child's father's name Date of birth Child's father's name Declaration of Kinship Persons OK-J-UF-0010 Version 1.1.16.2 Page 2 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Grandparents Grandparent's name Street address Work phone Related to: mother City Age/DOB father State Zip Home phone Spouse's name Cell phone Employer and address Yes No Age/DOB father State Zip Home phone Cell phone Spouse's name Would this person be an appropriate placement for the child? If no, please explain: Grandparent's name Street address Work phone Related to: mother City Employer and address Yes No Age/DOB father State Zip Home phone Cell phone Spouse's name Would this person be an appropriate placement for the child? If no, please explain: Grandparent's name Street address Work phone Related to: mother City Employer and address Yes No Would this person be an appropriate placement for the child? If no, please explain: Declaration of Kinship Persons OK-J-UF-0010 Version 1.1.16.2 Page 3 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Grandparent's name Street address Work phone Related to: mother City Age/DOB father State Zip Home phone Spouse's name Cell phone Employer and address Yes No Would this person be an appropriate placement for the child? If no, please explain: Adult aunts, uncles, brothers, sisters, half-siblings, first cousins, and other adult relatives or persons with whom the child has had a substantial relationship Name Street address Work phone Related to: mother City Relationship father State Zip Home phone Cell phone Age/DOB Spouse's name Employer and address Yes No Age/DOB Home phone Spouse's name Cell phone Would this person be an appropriate placement for the child? If no, please explain: Name Street address Work phone Related to: mother City father State Relationship Zip Employer and address Yes No Would this person be an appropriate placement for the child? If no, please explain: Declaration of Kinship Persons OK-J-UF-0010 Version 1.1.16.2 Page 4 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Name Street address Work phone Related to: mother City Relationship father State Zip Age/DOB Home phone Spouse's name Cell phone Employer and address Yes No Age/DOB Spouse's name Would this person be an appropriate placement for the child? If no, please explain: Name Street address Home phone Employer and address Would this person be an appropriate placement for the child? If no, please explain: Name Street address Home phone Employer and address Would this person be an appropriate placement for the child? If no, please explain: Related to: mother City Cell phone father State Related to: mother City Cell phone father State Relationship Zip Work phone Yes No Age/DOB Spouse's name Relationship Zip Work phone Yes No Declaration of Kinship Persons OK-J-UF-0010 Version 1.1.16.2 Page 5 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Name Street address Work phone Related to: mother City Relationship father State Zip Age/DOB Home phone Spouse's name Cell phone Employer and address Yes No Age/DOB Home phone Spouse's name Cell phone Would this person be an appropriate placement for the child? If no, please explain: Name Street address Work phone Related to: mother City father State Relationship Zip Employer and address Yes No Age/DOB Spouse's name Would this person be an appropriate placement for the child? If no, please explain: Name Street address Home phone Employer and address Would this person be an appropriate placement for the child? If no, please explain: Related to: mother City Cell phone father State Relationship Zip Work phone Yes No Declaration of Kinship Persons OK-J-UF-0010 Version 1.1.16.2 Page 6 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Name Street address Work phone Related to: mother City Relationship father State Zip Age/DOB Home phone Spouse's name Cell phone Employer and address Yes No Age/DOB Home phone Spouse's name Cell phone Would this person be an appropriate placement for the child? If no, please explain: Name Street address Work phone Related to: mother City father State Relationship Zip Employer and address Yes No Would this person be an appropriate placement for the child? If no, please explain: nnnnnnnnnnnn DECLARATION UNDER PENALTY OF PERJURY I, _________________________state under penalty of perjury under the laws of Oklahoma that the foregoing information concerning relatives and non-relatives of my child(ren) is true and correct to the best of my information and belief. SUBSCRIBED on this _____ day of _________________, 20____ at _____________, Oklahoma. ________________________________________ Declarant's Signature Declaration of Kinship Persons OK-J-UF-0010 Version 1.1.16.2 Page 7 of 7 American LegalNet, Inc. www.FormsWorkFlow.com