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Get NV CC13 - Clark County 2005-2024

CC13 Name Firm Name Bar No* Address City/State/Zip Telephone Attorney for DISTRICT COURT CLARK COUNTY NEVADA Plaintiff s -vs- Defendant s CASE NO. Case No* DEPT. NO. Dept. No* DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION ACT NRS 125A.385 1. There is/are child ren of the parties subject to this proceeding. The name place of birth birth date and sex of each child the present address periods of residence and places where each child has lived within the last five 5 years and the name s present address and relationship to the child of each person with whom the child has lived during that time are listed in the table on the following page . . . Declaration UCCJ*doc/04/04 Child s Name Place of Birth Birth Date Sex Person Child Lived With Relationship Period of Residence to present to A. B. Name Current Address D. C. E* NOTE Attach information about additional children or additional information on children listed above on attached sheet s . Attached sheet s MUST be same size as this form* -2- I have/ have not check one participated as a party witness or in any other capacity in any other litigation or custody proceeding in this or any other state concerning custody of a child involved in this proceeding. If you checked have above please supply the following information about the other proceeding s a* Name of each child involved b. Your role in other proceeding s c* Court state and case number of other proceeding s d. Date of court order or judgment in other proceeding s . I do/ do not check one know of any proceeding that could affect the current proceeding including proceedings for enforcement and proceedings related to domestic violence protective orders termination of parental rights and adoptions pending in a court of this or any other state concerning a child involved in this proceeding other than that set out in item 1 above. If you have checked do above please supply the following information about the has physical custody or claims to have custody or visitation rights with respect to any child subject to this proceeding. appropriate lines on the following page -3- a* Name and address of person s Person named has physical custody of name of child NOTE Attach additional sheet s same size as this form if more room is needed for answers above. Affiant s Your Signature STATE OF NEVADA ss COUNTY OF CLARK Print or type your name being first duly sworn deposes and says Affiant has read the foregoing statement and knows the contents thereof that the same is true and complete to the best of Affiant s own knowledge. SUBSCRIBED AND SWORN to before me this day of 20 . Notary Public in and for said County and State -4-.

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