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Non Disclosure Addendum Uniform Child Custody Jurisdiction Act Form. This is a Virginia form and can be use in District Court Statewide.
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Tags: Non Disclosure Addendum Uniform Child Custody Jurisdiction Act, DC-621, Virginia Statewide, District Court
THIS IS CONFIDENTIAL INFORMATION
NON-DISCLOSURE ADDENDUM
Case No.
........................................................................................
Commonwealth of Virginia
[ ] PROTECTIVE ORDER
IN PROTECTIVE ORDER CASES, THIS INFORMATION SHALL NOT BE RELEASED EXCEPT BY COURT ORDER OR
WHEN NECESSARY FOR USE BY LAW ENFORCEMENT.
[ ] UCCJEA AFFIDAVIT
IN CASES IN WHICH A UCCJEA AFFIDAVIT IS REQUIRED AND A PERSON REQUESTS THAT INFORMATION BE
KEPT CONFIDENTIAL, THIS INFORMATION SHALL NOT BE RELEASED EXCEPT BY ORDER OF THE COURT.
[ ] PETITION FOR SUPPORT [ ] MOTION TO AMEND [ ] MOTION FOR SHOW CAUSE
IN SUPPORT CASES WHERE A PERSON REQUESTS THAT INFORMATION BE KEPT CONFIDENTIAL, THE
INFORMATION SHOULD NOT BE RELEASED EXCEPT BY ORDER OF THE COURT.
SHERIFF/PROCESS SERVER: THE INFORMATION CONTAINED IN THIS DOCUMENT IS CONFIDENTIAL AND
MAY NOT BE DISCLOSED TO THE PARTIES OR TO THE PUBLIC.
In re: ...................................................................................................................................................................................................................................................................
CHILD
v.
..............................................................................................................................
..............................................................................................................................
...............................................................................................................................................................................................................................................................................
NAME AND ADDRESS OF PERSON WHOSE INFORMATION IS TO BE PROTECTED
...............................................................................................................................................................................................................................................................................
..............................................................................................................................
..............................................................................................................................
HOME TELEPHONE NUMBER
WORK TELEPHONE NUMBER
PROTECTIVE ORDER CASES ONLY Information for each protected person or each person requested to be protected.
NAME (LAST, FIRST, MIDDLE)
SUPPORT CASES ONLY
DCSE ID No.
D.O.B.
Va. Code § 20-60.3
SEX
Include this information for the person whose information is to be protected.
Driver’s License No. and State:
...........................................................................................
Social Security No. ................................................................................
UCCJEA AFFIDAVIT USE ONLY
RACE
Date of Birth:
.........................................................................
.............................................................................................................
Va. Code § 20-146.20E
In addition to above, complete only the information that has been omitted from the DC-620, AFFIDAVIT form:
1.
The child presently resides at:
..................................................................................................................................................................................................
ADDRESS
The child commenced residing there on
........................................................................
and has resided there continuously to this date.
DATE
2.
The other places where and persons with whom this child has lived during the last five (5) years include:
................................................................................................................................................................................................................................................................
3.
I know of a person who is not already named as a party in this proceeding who has physical custody of this child or who claims
to have custody or visitation rights with respect to the child. The name and address of that person is:
4.
Anything else from the affidavit not contained above:
................................................................................................................................................................................................................................................................
................................................................................................................................................................................................................................................................
FORM DC-621 REVISED 07/09
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