IN THE CIRCUIT COURT OF THE EIGHTH JUDICIAL CIRCUIT IN AND FOR ALACHUA COUNTY, FLORIDA ____________________________________ Petitioner, vs. ____________________________________ Respondent. AFFIDAVIT OF CHILDREN BORN/NOT BORN DURING THE MARRIAGE CASE NO.: ________________ DIVISION: ________________ I, ___________________________________ certify that the following statements are true (check all that apply): _____ a. No children were born during the marriage. _____ b. The following children are of Husband and Wife: Name: _________________________ d.o.b.: ____/____/____ Name: _________________________ d.o.b.: ____/____/____ Name: _________________________ d.o.b.: ____/____/____ Name: _________________________ d.o.b.: ____/____/____ Name: _________________________ d.o.b.: ____/____/____ ____ c. The following children were born to the Wife during the marriage but are not the biological children of the Husband: Name: _________________________ d.o.b.: ____/____/____ Name: _________________________ d.o.b.: ____/____/____ ____ d. There is/are an ongoing case(s) involving the children listed in paragraph b or c: ___________________County Case No._________________ ___________________County Case No._________________ Note: A Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit must be filed as to each child to which a custody determination must be made. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this affidavit and that punishment for knowingly making a false statement includes fines and/or imprisonment. Date: _______________ ______________________________________ Signature of Party Printed Name: __________________________ Address: ______________________________ City, State, Zip _________________________ Telephone: ____________________________ STATE OF FLORIDA COUNTY OF _________________ Sworn to or affirmed and signed before me on ___________ by _____________________________ Type of Identification:___________________________ _________________________________________ NOTARY PUBLIC or DEPUTY CLERK _________________________________________ Print, type, or stamp commissioned name of notary or deputy clerk American LegalNet, Inc. www.USCourtForms.com