STATE OF MICHIGAN COUNTY OF OAKLAND SIXTH JUDICIAL CIRCUIT FAMILY DIVISION 1200 N. Telegraph, Pontiac, MI REQUEST FOR CHILD CUSTODY DETERMINATION/REGISTRATION UNDER THE UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT Case No. ____________________ PETITIONER name, address, and telephone no. RESPONDENT name, address, and telephone no. PETITIONER attorney name, bar no., address, and telephone no. RESPONDENT attorney name, address, and telephone no. PETITIONER states as follows in support of the Request to Register Child Custody Determination: 1. That there is a child custody determination as to the following minor child(ren): Child's full name________________________________Age_________DOB___________ Child's full name________________________________Age_________DOB___________ Child's full name________________________________Age_________DOB___________ (Attach a separate sheet if necessary) 2. That petitioner requests that this court register the attached child custody determination under the Uniform Child Custody Jurisdiction and Enforcement Act, MCL 722.1101 et seq. 3. That the petitioner has attached two copies one of which is a certified copy of the child custody determination, which consists of all judgments; decrees; and temporary, initial, and modification orders issued to date. 4. That the petitioner has attached a statement under the penalty of perjury affirming to the best of his/her knowledge and belief that the child custody determination are attached has not been modified other than shown in the attached documents. 5. That the respondent is a parent or a person acting as a parent who has been awarded custody or parenting time in a child custody determination. The respondent's full name and address are set forth above. 6. That the full names and addresses of persons other than the petitioner and respondent who are either parents or persons acting as a parent who has been awarded custody or parenting time in a child custody determination are: (Attach a separate sheet if necessary.) 7. That the petitioner does not request that his/her address remain confidential OR That the petitioner requests his/her address remain confidential. The alternate address to be used for services is _______________________________________________________________________. I have attached a separate sheet for the Court's records with my residential information. The petitioner requests that this court register the attached child custody determination. Under the penalty of perjury, I declare that the statements made are true to the best of my belief and knowledge and that the child custody determination has not been modified. DATE: __________________________________ DATE: __________________________________ UCCJEA FORM 1 6/8/2009 American LegalNet, Inc. www.FormsWorkFlow.com _______________________________________ Petitioner ________________________________________ Attorney for Petitioner