Use this form when six to ten children are involved with this case. Use CP50 for one child and CP56 for two to five children. Judge or Division: Petitioner: Protected Child 1: Age of Protected Child: Sex: F M Race: Protected Child 2: Age of Protected Child: Sex: F M Race: Protected Child 3: Age of Protected Child: F M Race: Sex: Protected Child 4: Age of Protected Child: Sex: F M Race: Protected Child 5: Age of Protected Child: F M Race: Sex: Protected Child 6: Age of Protected Child: Sex: F M Race: Protected Child 7: Age of Protected Child: F M Race: Sex: Protected Child 8: Age of Protected Child: Sex: F M Race: Protected Child 9: Age of Protected Child: F M Race: Sex: Protected Child 10: Age of Protected Child: F M Race: Sex: Case Number: Court ORI Number: MSHP Number: Responsible Law Enforcement ORI: (Date File Stamp) Related Cases: Protected Child's Relationship to Respondent pursuant to 18 U.S.C. §§ 921(a)(32) and 922(g)(8) determination: Protected Child's Relationship to Respondent (Child 1): Child Step-Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify) ____________________________________________ Protected Child's Relationship to Respondent (Child 2): Child Step-Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify) ____________________________________________ Protected Child's Relationship to Respondent (Child 3): Child Step-Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify) ____________________________________________ Protected Child's Relationship to Respondent (Child 4): Child Step-Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify) ____________________________________________ Protected Child's Relationship to Respondent (Child 5): Child Step-Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify) ____________________________________________ Protected Child's Relationship to Respondent (Child 6): Child Step-Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify) ____________________________________________ Protected Child's Relationship to Respondent (Child 7): Child Step-Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify) ____________________________________________ vs. Respondent: Alias/Nicknames: Respondent's DOB: SSN (if known, last four digits): Race: Protected Child's Relationship to Respondent (Child 8): Child Step-Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify) ____________________________________________ Protected Child's Relationship to Respondent (Child 9): Child Step-Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify) ____________________________________________ Protected Child's Relationship to Respondent (Child 10): Child Step-Child or Former Step-Child Parent is Unmarried, Intimate Residing/Resided with Respondent Other (specify) ____________________________________________ Respondent's Home Address: IN THE ________ JUDICIAL CIRCUIT, _______________________________, MISSOURI Affidavit of Changes in Circumstance and Motion to Modify Judgment/Full Order of Protection - Child Sex: F M Home Phone Number: Respondent's Work Address: Work Phone Number: Work Hours: American LegalNet, Inc. www.FormsWorkFlow.com OSCA (02-16) CP53 1 of 2 455.523, 455.528, 455.530 RSMo A Judgment/Full Order of Child Protection was entered in __________________________________ (County/City of St. Louis), Missouri, on ____________________________ (date). A change has occurred in the circumstances of the child(ren) or his/her/their custodian and the modification is necessary to serve the best interests of the child(ren). Below are the specific facts, including dates and times, which petitioner respondent Guardian ad Litem Court Appointed Special Advocate believes forms grounds for modification of the court's judgment: I request that the court find grounds for modification of: (check the box that applies) Installments of maintenance or support. Custody. Visitation. Other (specify): The specific modification that I am requesting is: Conditions regarding communication. Conditions regarding contact. I swear /affirm under penalty of perjury that these facts are true according to my best knowledge and belief. _________________________________________ Date _________________________________________________ Your Signature _________________________________________________ NOTICE: Section 455.510.3, RSMo, provides that a Petitioner seeking protection under the Child Protection Orders Act is not required to reveal any current address or place of residence of the child(ren) on this petition. Do not provide this information if doing so will endanger the child(ren). In witness thereof: ___________________________________ Date Your Street Address _________________________________________________ City State Your Telephone Number Zip _________________________________________________ ______________________________________________ Clerk Witnessing Signature Subscribed and sworn to before me on this ________________________________ (date). (Seal) My commission expires: __________________ Date _______________________________ Notary Public Directions for Completing This affidavit must be completed and signature witnessed by a court clerk or notary before filing it with the court. OSCA (02-16) CP53 2 of 2 455.523, 455.528, 455.530 RSMo American LegalNet, Inc. www.FormsWorkFlow.com