State of Minnesota County Judicial District: Court File Number: Case Type: District Court Family In Re the Marriage of: Name of Petitioner and Affidavit in Response to and Motion to Change Custody Name of Respondent STATE OF MINNESOTA COUNTY OF (County where Affidavit signed) ) ) SS ) My full name is that: I am the (check one): Petitioner Respondent Other and I state 1. in this case, and I make this Affidavit in response to the other party's Motion to Change Custody. My relationship to the child(ren) is: . 2. A child protection case involving any or all of the children in this case is open: YES NO. If YES, this case is in and the file number is worker's name is A copy of the Order is attached. . County in the State of The . child protection 3. An Order for Protection involving me and the other party and/or the child(ren) exists: Yes No. If YES, it is in County in the State of American LegalNet, Inc. www.FormsWorkFlow.com CHC403 State ENG Rev 12/15 www.mncourts.gov/forms Page 1 of 17 , and the file number is Order for Protection is attached. Petitioner . A copy of the 4. The child(ren) currently live with: Respondent, who is the child(ren)'s: Mother Father Other relation to the child(ren). The address of the child(ren) is: in the State of The child(ren) have lived at this address since the date of in the City of and zip code . . 5. The current custody order is dated: . 6. The current order grants legal custody of the child(ren) as follows: Sole legal custody to: Petitioner Respondent Other Joint legal custody to: Both Parties Other 7. Legal custody identifies which parent(s) have the right to make decisions regarding the upbringing of the child(ren) including education, health care and religious training. I do not want to change legal custody. I want to change legal custody to: Sole legal custody in favor of Joint legal custody to both parents , or 8. The current order grants physical custody of the child(ren) as follows: Sole physical custody to: Petitioner Respondent Other Joint physical custody to: Both Parties Other 9. Physical custody identifies with whom the child(ren) will live. I do not want to change physical custody. I want to change physical custody to (check one): Sole physical custody in favor of Joint physical custody to: Both Parties Other , or American LegalNet, Inc. www.FormsWorkFlow.com CHC403 State ENG Rev 12/15 www.mncourts.gov/forms Page 2 of 17 10. I want to respond to the other party's statements in paragraph 10 of his/her Affidavit, in support of a request to change physical or legal custody. My response is: ________________________________________________________________________. If you need more space, attach another full sheet of paper and mark it "Exhibit A." 11. I want to change physical and/or legal custody, or modify a parenting plan provision specifying the child's primary residence, because (check all that apply): a. A change of custody is in the best interests of the child(ren) and the parties previously agreed, in a writing approved by a court, to apply the best interests standard in section 518.17 or 257.025 (Attach a copy of the court order approving the agreement) and either: (check one) i. Each party was represented by an attorney when the agreement was approved by the court OR ii. The court made a finding in the Order approving the agreement that the parties were fully informed, the agreement was voluntary, and the parties were aware of its implications. The change of primary residence is in the best interests of the child(ren) because: (Explain in detail) American LegalNet, Inc. www.FormsWorkFlow.com CHC403 State ENG Rev 12/15 www.mncourts.gov/forms Page 3 of 17  b. Both parties have agreed that it is in the best interests of the minor child(ren) to change custody. Attached is our signed and notarized agreement. (Note: The Agreement MUST do more than just state that a change of custody is in the best interests of the child(ren). It MUST explain in detail HOW and WHY the change will be in the child(ren)'s best interests). c. The child(ren) has/have been living with me since (mo/day/year): The child(ren) came to live with me because (describe the reasons(s) the child(ren) came to live with me): The child(ren) has/have become integrated into my home in the following way(s) (give specific examples): The child is living with me with the consent of the other parent (check one): YES NO. If YES, the other parent has said or done the following to make me believe that (s)he agrees that the child(ren) should live permanently with me (be specific): d. My child(ren) is/are in danger if (s)he/they live(s) with the other parent.* The other parent is putting the child(ren) in danger of physical or emotional harm by doing the following (give very specific facts and details): American LegalNet, Inc. www.FormsWorkFlow.com CHC403 State ENG Rev 12/15 www.mncourts.gov/forms Page 4 of 17 *If an extreme emergency exists, request an expedited hearing. e. The other parent has persistently and willfully denied or interfered with my Court-ordered parenting time. The following is a list of each date, in the past six (6) months, that I was denied parenting time, and an explanation of exactly what the other parent did on each date to stop my parenting time: 12. I understand that the Court cannot change custody unless there is a change in the circumstances of the child(ren) or the parents since the last custody Order. (Check one of the following): a. The other party states at paragraph 11 of his/her Affidavit that there has been a change of circumstances. My response to that is: b. I am asking the Court to order a change in custody. The following is a description of the changes that are a basis for modifying the most recent custody Order (be specific): American LegalNet, Inc. www.FormsWorkFlow.com CHC403 State ENG Rev 12/15 www.mncourts.gov/forms Page 5 of 17 13. I understand that moving a child to a different family and home can be stressful for the child. (Check one of the following): a. The other party is asking the Court to move the child(ren) to another family and home. My response is: b. I want the Court to change physical custody from the other party to me. I believe that living with the other parent is more harmful to my child(ren) than the stress of moving to a new home and family because: 14. I understand that the Judge must decide custody based on what is best for my child(ren), and that by filling in (a) through (k) of this paragraph 14, that I am givin