IN THE CIRCUIT COURT OF JACKSON COUNTY, MISSOURI - PROBATE DIVISION AT IN THE ESTATE OF ESTATE NUMBER , Minor. AFFIDAVIT The following information is submitted pursuant to section 452.480, RSMo in support of the petition forguardianship of the above named minor. 1. Said minor is presently living with at . 2. Said minor has lived with the following persons at the following addresses within the past 6 months: 3. I (have) (have not) participated in other litigation concerning the custody of this child in this or anotherstate. (If affirmative explain in detail). 4. I (have) (have no) information of any custody proceeding concerning the child pending in a court ofthis or any other state. (If affirmative explain in detail). 5. I (have) (have no) knowledge of any person, not party to these proceedings, who has physical custodyof the child or claims to have custody or visitation rights with respect to the child. (If affirmative explain in detail.) The undersigned swears that the matters set forth in the foregoing affidavit are true and correct to theundersigneds best knowledge and belief, subject to penalty for making a false affidavit or declaration. Dated: . Petitioner