IN THE ______ JUDICIAL CIRCUIT COURT, ___________________________, MISSOURI Judge or Division: Petitioner: SSN (last four digits): vs. Respondent: SSN (last four digits): Respondent's Address: Case Number: Petitioner's Address: (Date File Stamp) Response to Motion for Family Access Order I, _______________________________________________________________, state that: (Check each box that applies) (Your Name) I have not denied or interfered with custody, visitation or third party custody under the judgment of dissolution, legal separation, paternity or modification. I had good cause to deny or interfere with custody, visitation or third party custody under the judgment of dissolution, legal separation, paternity or modification. I am without knowledge or information to admit or deny the facts stated to be a violation of the judgment of dissolution, legal separation, paternity or modification. (Please provide the specific facts, including dates and times, which show compliance or good cause for noncompliance with the court's judgment.) I request to participate in Alternative Dispute Resolution to assist in resolving the problems that caused the filing of the Motion for Family Access Order. I swear/affirm under penalty of perjury that these facts are true to my best knowledge and belief. _______________________________ Date ____________________________________________________ Your Signature ____________________________________________________ Your Street Address ____________________________________________________ City State Zip ____________________________________________________ Your Telephone Number Instructions Upon completion, send the original of this Response to the Circuit Clerk of ___________________ (County/City of St. Louis), Missouri, at _____________________________________________________________ (address) and a copy to the person who filed the Motion for Family Access Order. Please keep a copy of this Response to bring with you to any scheduled hearing or alternative dispute resolution. OSCA (07-13) FA35 1 of 1 452.400 RSMo American LegalNet, Inc. www.FormsWorkFlow.com