REV 1/2019 JCB 1 UCCJEA DECLARATION 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 On the lines below: Provide the information requested regarding each minor child born to or adopted by, the parents at any time during their relationship. You MUST LIST where the child currently lives, where the child has lived for the PAST 5 YEARS, and the name(s) and current address(es) of the person(s) with whom the child lived at each address. If there is more than one child, and the information is the same for each child, please write 223same as above224 in the space provided. You must still provide information regarding each child222s name, date of birth, and gender. Plaintiff / Petitioner / Joint Petitioner, Defendant / Respondent / Joint Petitioner. Code: 3385 Name: Address: Telephone: Email: Self-Represented Litigant IN THE FAMILY DIVISION OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF WASHOE , Case No. vs. Dept. No. , / DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) I declare as follows: A. American LegalNet, Inc. www.FormsWorkFlow.com REV 1/2019 JCB 2 UCCJEA DECLARATION 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 If more room is needed, attach additional sheets. // // // Child222s Name: Date of Birth: Male Female Date Child Moved Here Child222s Address (Street Address, City, State) Person(s) With Whom Child Lived With (Name and Current Address) Relationship To Child Child222s Name: Date of Birth: Male Female Date Child Moved Here Child222s Address (Street Address, City, State) Person(s) With Whom Child Lived With (Name and Current Address) Relationship To Child Child222s Name: Date of Birth: Male Female Date Child Moved Here Child222s Address (Street Address, City, State) Person(s) With Whom Child Lived With (Name and Current Address) Relationship To Child Child222s Name: Date of Birth: Male Female Date Child Moved Here Child222s Address (Street Address, City, State) Person(s) With Whom Child Lived With (Name and Current Address) Relationship To Child American LegalNet, Inc. www.FormsWorkFlow.com REV 1/2019 JCB 3 UCCJEA DECLARATION 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 B. 1. Please identify any other court case in which you have participated as a party, witness, or in any other way concerning the custody of or visitation with the child(ren) listed above. If there are no other court cases, please check this box . Name(s) of child(ren) involved: Court: Case number: Date of custody determination: 2. Please identify any court case that could affect this case, including any case relating to domestic violence, protective orders, termination of parental rights, adoptions, guardianships, dependency, and paternity actions. If there are no other court cases, please check this box . Name(s) of child(ren) involved: Court: Type of case: Case number: Date of last order: 3. Please identify the name(s) and address(es) of any person(s) not a party to this court case who claim(s) a right to legal custody, physical custody or visitation with the child(ren). If this is not applicable, please check this box . Name(s) of child(ren) involved: Name(s) and address(es) of person(s) claiming custody or visitation rights: If more room is needed, attach additional sheets. This document does not contain the personal information of any person as defined by NRS 603A.040. I declare under penalty of perjury under the law of the State of Nevada that the foregoing statements are true and correct. Date: Your Signature: Print Your Name: American LegalNet, Inc. www.FormsWorkFlow.com