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Application Form Cooperation For The Children Form. This is a Minnesota form and can be use in Ramsey Local County.
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Tags: Application Form Cooperation For The Children, Minnesota Local County, Ramsey
STATE OF MINNESOTA
DISTRICT COURT
SECOND JUDICIAL DISTRICT
COUNTY OF RAMSEY
FAMILY COURT DIVISION
________________________________________________________________________
Petitioner,
Application Form
Cooperation for the Children
and
Court File No.:
Respondent.
INSTRUCTIONS: Complete this questionnaire to the best of your ability. Please
use black ink pen for clear copies.
PERSONAL INFORMATION:
You
Other Parent
Name:
Mailing
Address:
Home
Telephone:
When Available To
Receive Calls:
Employer:
Address:
Work
Telephone:
When Available To
Receive Calls:
Gross Income: $
Birth Date:
Age
Age
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Children who will be affected by this legal action: (If you need more room continue on
back page.)
Full Name
Birth Date
Age
Living With
REVIEW QUESTIONS AND CHECK OFF THE TYPE OF HELP YOU ARE
ASKING FOR FROM THE COOPERATION FOR THE CHILDREN
PROGRAM:
1. Please explain what brought you to court:
2. With respect to the child(ren) Please check those that apply:
I currently have
I am seeking
Sole Legal Custody
Joint Legal Custody
Sole Physical Custody
Joint Physical Custody
Visitation
3. If you want to establish or change visitation, please explain the visitation schedule
below:
Weekends:
Holidays:
Summer:
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School:
Telephone Contacts:
Other:
4. Has the other parent of your child(ren) ever accused you of physical or emotional
abuse?
Yes
No
5. Has the other parent of your child(ren) physically assaulted you by doing any of
the following within the past five years? Slapping, pushing, hitting, kicking,
choking, forcing sex, throwing something at you, using a knife or gun to assault
or threaten you? (Circle those that apply.)
Yes
No
6. Have you ever physically assaulted the other parent of your child(ren) by doing
the following within the past five years? Slapping, pushing, hitting, kicking,
choking, forcing sex, throwing something at him/her, using a knife or gun to
assault or threaten him/her? (Circle those that apply.)
Yes
No
7. Have you, the other parent, or your children ever left home because of violence or
Yes
No
threat of violence?
8. Have you or the other parent of your child(ren) ever filed an Order for
Yes
No.
Protection?
If yes, list county(s)
9. I have concerns about the other parent’s use of drugs/alcohol?
Yes
No
10. Have you or the other parent of your child(ren) ever been diagnosed with a mental
Yes
No
illness?
11. I can, without fear or hesitation, negotiate with the other parent of our child(ren)
in the presence of a neutral third person?
Yes
No
12. Date you completed this form:
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2001 © American LegalNet, Inc.