State of Minnesota County Judicial District: Court File Number: Case Type: Family District Court In Re the Marriage of: Name of Petitioner and Affidavit in Support of Motion to Change Custody Name of Respondent STATE OF MINNESOTA COUNTY OF ) ) SS ) Instructions: If you are only asking the Court to change legal custody, answer questions 1 through 11, 36 and 37. If you are asking the Court to change physical custody or both physical and legal custody, answer all questions. My name is 1. and I state that: I am the (check one): Petitioner Respondent other in this case, and I make this Affidavit in support of my 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 child protection worker's name is Order is attached. County in the State of . The . A copy of the 3. An Order for Protection involving me and the other party and/or the child(ren) exists: YES NO. If YES, it is in and the file number is County in the State of . A copy of the CHC303 State ENG Rev 12/15 www.mncourts.gov/forms Page 1 of 17 American LegalNet, Inc. www.FormsWorkFlow.com Order for Protection is attached. The child(ren) currently live with: Petitioner Respondent who is the child(ren)'s: Mother is , State of 5. 6. , zip code Father Other relation to the children. The address of the child(ren) in the City of . 4. The current custody order which I am requesting be modified is dated __________________. 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 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. 9. Physical custody identifies the person(s) with whom the child(ren) will live. I do not want to change physical custody. I want to change physical custody to: Sole physical custody in favor of Joint physical custody to both parents , or 10. 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): CHC303 State ENG Rev 12/15 www.mncourts.gov/forms Page 2 of 17 American LegalNet, Inc. www.FormsWorkFlow.com  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 from Minnesota Statutes 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) . 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 minor 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 the date: . The child(ren) came to live with me because (describe the reason(s) the child(ren) came to live with you): The child(ren) has/have become integrated into my home in the following way: (give specific examples): CHC303 State ENG Rev 12/15 www.mncourts.gov/forms Page 3 of 17 American LegalNet, Inc. www.FormsWorkFlow.com  The child is living with me with the consent of the other parent. YES NO. If YES, the other parent has said or done the following to make me believe he or she agrees that the child should live permanently with me d. My child is in danger if s/he lives with the other parent.* The other parent is putting the child in danger by doing the following: (Give very specific facts and details): * If an extreme emergency exists, request an expedited hearing. e. The other parent has denied or interfered with my court-ordered parenting time/visitation. The following is a list of each date, in the past 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: 11. I understand that the court cannot change custody unless there is a change in the circumstances of the child or parents since the last custody order. The following is a description of the changes that are a basis for modifying the most recent custody order or parenting plan: CHC303 State ENG Rev 12/15 www.mncourts.gov/forms Page 4 of 17 American LegalNet, Inc. www.FormsWorkFlow.com 12. I understand that moving a child to a different family and home can be stressful for the child. 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: 13. 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 13, that I am giving the Judge information needed to make that decision. a. Describe the child(ren)'s physical, emotional, cultural, spiritual, and other needs: Describe how the custody and parenting time arrangements you are asking the Court to order will affect the child(ren)'s needs and development: b. Describe any special medical, mental health, or educational needs of the child(ren) that may require special parenting arrangements or access to recommended services: CHC303 State ENG Rev 12/15 www.mncourts.gov/forms Page 5 of 17 American LegalNet, Inc. www.FormsWorkFlow.com c. Describe the custody arrangement the child(ren) want (the court will decide if the chid(ren) is/are of sufficient ability, age, and maturity to state an independent and reliable opinion): d. There is/was is not/was not domestic abuse in my household