§ Petition for Child Custody
Petition for Child Custody
[Publisher's note: Referenced interactive forms can be accessed at www.selfrepresent.mo.gov]
In what Missouri county will In the Circuit Court of
this case be filed? MISSOURI
If this is an amended petition, what is the case Case Number Division Number
number of the pending case?
Answer all questions on this form completely.
Your Information 1. My full name is: (You are the “ Petitioner” in this case.)
_____________ ______________ __________________ ____________
(First Name) (Middle Name) (Last Name) (Jr./Sr./III)
2. [ ] This is the first petition I have filed in this case. (Original Petition)
[ ] This is the second petition I have filed in this case.
[ ] This is the third petition I have filed in this case.
3. [ ] I am the Mother
[ ] I am the Father
4. The last four numbers of my Social Security Number are: XXX-XX-
____________________________________________________________
5. My mailing address is:
____________________________________________________________
(Street)
_____________________________ _________________ ___________
(City) (State) (Zip)
____________________________ _______________________________
(Telephone Number) (E-Mail Address)
Other Party's
Information 6. The full name of the other party is: (He or she is the “Respondent” in this case.)
_____________ ______________ __________________ ____________
(First Name) (Middle Name) (Last Name) (Jr./Sr./III)
7. The last four numbers of the other party's Social Security Number are:
XXX-XX-__________
8. The other party's mailing address is:
____________________________________________________________
(Street)
_____________________________ _________________ ___________
(City) (State) (Zip)
____________________________ _______________________________
(Telephone Number) (E-Mail Address)
Petition for Child Custody--Page 1 of 5
Form CAFC201-7/1/ This form is available for free at www.selfrepresent.mo.gov
2010
Service
Information
9. [ ] The other party has signed a verified “Answer to Petition for Determination of Custody” which
is being filed with this motion. Therefore, do not issue a summons.
[ ] The other party should be served at his or her residence.
____________________________________________________________
(Street)
______________________ ______________ ______________________
(City) (State) (Zip)
[ ] The other party should be served at his or her place of employment.
____________________________________ _______________________
(Employer's Name--if applicable) (Hours of Employment)
____________________________________________________________
(Street)
______________________ ______________ ______________________
(City) (State) (Zip)
[ ] Service by publication. I don't know where the other party is and I have no way of locating him
or her. Therefore, I am requesting that he or she be served by publication. I have filed an Affidavit
for Service by Publication and a Notice of Publication.
[ ] Other method of service:
____________________________________________________________
10. [ ] The parent receiving support is not receiving Temporary Assistance for Needy Families (TANF).
[ ] The parent receiving support is receiving TANF and therefore the State of Missouri must be
served. Summons to issue to be served on:
Director, Family Support Division
615 Howerton Court
Jefferson City, Missouri 65102
11. I am entitled to ask for custody because:
Case Information [ ] Paternity was acknowledged by both parties and father's name appears on the birth
certificate of each child listed in this petition. Copies of these birth certificates are attached
to this petition.
[ ] An administrative order was entered that determined paternity. A copy of this administrative
order is attached to this petition.
[ ] Father and Mother were married at the time of the birth of each child listed in this petition
and there are no existing custody judgments.
[ ] Other _________________________________________________________
(Explain)
Petition for Child Custody--Page 2 of 5
Form CAFC201-7/1/ This form is available for free at www.selfrepresent.mo.gov
2010
Military
Information 12. [ ] The other party is NOT on active duty in the United States military.
[ ] The other party is on active duty in the United States military.
13. [ ] I am self-employed
Employment [ ] I am unemployed
Information [ ] I am employed at:
____________________________________________________________
(Name of Employer)
____________________________________________________________
(Street)
_____________________________ _________________ ___________
(City) (State) (Zip)
14. [ ] The other party is self-employed
[ ] The other party is unemployed
[ ] I don't know the other party's employment status
[ ] The other party is employed at:
____________________________________________________________
(Name of Employer)
____________________________________________________________
(Street)
_____________________________ _________________ ___________
(City) (State) (Zip)
Children's
Information 15. There is/are __________ child(ren) who is/are the subject of this proceeding as listed below.
Child's Full Name Child's Age
Petition for Child Custody--Page 3 of 5
Form CAFC201-7/1/ This form is available for free at www.selfrepresent.mo.gov
2010
Additional
Information abou
tthe Children 16. State all addresses at which the children have resided during the past six months and the name of theperson with whom said children resided.
____________________________________________________________
___________________________________________________________
____________________________________________________________
17. Do you know of anyone other than you or the other parent that has physical custody of any of the childrenor claims to have custody or visitation rights with respect to any of the children?
[ ] Yes--State the name(s) and address(es) of these people in Paragraph 19.
[ ] No
18. Do you have any information of any other custody proceeding concerning any of the children pending in
a court of this or any other state?
[ ] Yes--Attach a copy of the petition or judgment from all other cases.
[ ] No
19. Have you participated in any other litigation concerning the custody of any of the children in this or any
other state?
[ ] Yes--Attach a copy of the petition or judgment from all other cases.
[ ] No
20. Have any of the child(ren) been a victim of abuse or neglect?
[ ] Yes
[ ] No
21. If you answered “Yes” to questions 17, 18, 19 or 20 please explain.
________________________________________________________________
________________________________________________________________
________________________________________________________________
Proposed
Parenting Plan
22. The custody arrangement that is in the best interests of the minor children is set forth in Part A of the
attached parenting plan marked Exhibit 1. (You must attach a completed copy of Parenting Plan Form
CAFC501 to this petition.)
Request for Relief THEREFORE, I want the court to enter a judgment concerning custody as per Part A of the attached
parenting plan marked Exhibit 1.
I also request the following relief:
[ ] Child support should be set as set forth in Part B of the attached parenting plan marked Exhibit 1.
[ ] I am without sufficient funds to pay for my attorney and I request that the other party pay my
attorney's fees for this case.
[ ] Other (Please state the other requests)
_________________________________________________________
Petition for Child Custody--Page 4 of 5
Form CAFC201-7/1/ This form is available for free at www.selfrepresent.mo.gov
2010
Petitioner, being of lawful age and duly sworn on his or her oath, states that he or she is the petitioner named above and that the facts stated in this Petition to Determine Child Custody are true according to his or her best knowledge and belief.
_____________________________________________ ___________________________
SIGN HERE (Sign this in front of a Notary Public) PRINT YOUR NAME HERE
Subscribed and sworn to this ______ day of _______________, 20 ___.
_________________________________________________
Notary Public
My Commission Expires:
_________________________________________________
ATTORNEY INFORMATION (To be completed by your attorney) Do not enter any information here if
you are filing this case
___________________________ _____________________ without the
Attorney--SIGN HERE Missouri Bar Number assistance of a lawyer.
__________________________________________________ This information should be
Attorney for Movant--PRINT YOUR NAME HERE completed by your attorney.
__________________________________________________
(Street)
_______________________________ ___________ _____ [ ] I have assisted Petitioner in
(City) (State) (Zip) the preparation of these
pleadings, but I am not entering
________________ ____________ ___________________ my appearance on behalf of
(Telephone Number) (Fax Number) (Email Address) Petitioner.
Petition for Child Custody - Page 5 of 5
Form CAFC201-7/1/ This form is available for free at www.selfrepresent.mo.gov
2010
[Publisher's note: Referenced interactive forms can be accessed at www.selfrepresent.mo.gov]