INSTRUCTIONS FOR FILING AN APPLICATION TO DETERMINE CUSTODY **PLEASE NOTE YOU MUST MAKE YOUR OWN COPIES BEFORE YOU FILE YOUR PAPER WORK AT THE CLERK’S OFFICE** If you are requesting the court not to disclose your address or that of the child/ren because the health, safety, or liberty of yourself and/or the child/ren would be jeopardized if the information was disclosed, do not complete the portions of the Affidavit: UCCJEA and Application to Determine Custody that requires yours or the children’s address. Please check confidential where appropriate. All applications must include the following: 1. Application Packet (filled out completely). 2. Forms to be notarized prior to filing them at the court. Pages 1 and 5 should be notarized. 3. $105.00 filing fee. Make checks and money orders out to the Juvenile Court. 4. Proof of Paternity for each child. Proof can be through marriage license, established at CSEA or the court or Paternity Acknowledgement registry number that can be obtained by calling 1-888-810-6446. 5. COPY of each child’s birth certificate. 6. COPY of each child’s social security card or letter of refusal. 7. Custody Intake sheet. **If your filing is incomplete, your filing may be dismissed by the judge or magistrate.** Return this packet to Custody Intake for review with the following: 1. Original Application packet (notarized) with copies of he motion, birth certificate(s), social security information, proof of paternity and filing fee. 2. Bring the completed original packet + Department for review before filing. 3. Our address is: copies = to the Intake Custody Intake 1910 Carnegie Avenue Cleveland, Ohio 44115 216-443-3149 Office hours are 9:00 a.m. to 1:00 p.m. and 2:00 p.m. to 4:00 p.m.. No Appointment necessary. American LegalNet, Inc. www.FormsWorkflow.com IN THE COURT OF COMMON PLEAS COUNTY OF CUYAHOGA JUVENILE DIVISION In the Matter of: ___________________________D.O.B. ____________ ___________________________D.O.B. ____________ ___________________________D.O.B. ____________ Case Number(s): ___________________ ___________________ ___________________ ___________________ APPLICATION TO DETERMINE CUSTODY Name of Mother: _______________________ Confidential Address: ____________________________ ____________________________________ Phone:_______________________________ Name of Father #1:____________________ Confidential Address: ____________________________ ____________________________________ Phone:______________________________ Name of Father #2:________________________ Confidential Address:______________________________ _____________________________________ Phone __________________________________ Now comes, ___________________________________, applicant in the above entitled action and makes application to the Court to determine the custody of the child(ren) herein pursuant to Section 2151.23(A)(2) of the Ohio Revised Code. Applicant Signature:_________________________ AFFIDAVIT The applicant being duly sworn says: 1. The child(ren) last known or present address in Cuyahoga County is/was: ________________________________________________________ Confidential. 2. That it is in the best interest of said child(ren) for the Court to determine his/her/their custody as will be more fully set forth at the hearing of this matter. 3. That the child(ren) is/are not ward(s) of any other Court of this State. 4. That a Uniform child custody jurisdiction and enforcement act affidavit is being filed with this matter and is incorporated herein as though fully rewritten. _______________________________________ Applicant Signature Sworn to before me this _______ day of ______________ 20_____ . _______________________________________ Notary Public American LegalNet, Inc. www.FormsWorkflow.com