Affidavit of Child Custody

Making a sworn statement in a child custody case by an affiant requires the execution of the following affidavit.

Extracted Text for Proper Search

Form 88


AFFIDAVIT OF CHILD CUSTODY(Use one form per child)

1. My name is

2. My relationship to the child named above is: 
Parent with legal custody before juvenile case began

Legal guardian

Custodian

  Other (describe):

3. During the last five years the child has lived at the following addresses and with the following 
household members:
(Begin with the child's residence just before this Juvenile proceeding started and list all addresses for

the past five years.)

Use an additional page if  you need more space.

4. If the current address of any household member listed in the last column is different from the 
address listed above, please provide a current address for that person:

5. Please answer the following questions by circling the appropriate answer. If you answer "yes" 
to any question, please explain your answer on another page.
A. I have participated as a party, witness, or in some other capacity in court proceedings
concerning the custody of this child in Vermont or another state:
B. I have information about a custody proceeding concerning this child that is currently pending
in a Vermont court or a court in another state:
C. I have knowledge concerning a person who is not a party to these juvenile proceedings who

has physical custody of this child or who claims to have custody or visitation rights with respect

to this child:

I hereby swear or affirm that the foregoing information is true to the best of my knowledge

and belief. 
Date:

Signature:

,20

Subscribed and sworn to before me: 
Expiration Date:
Date: Signature of Notary Public:
Notice: During this proceeding, you must inform the court if you learn of any other
custody proceeding concerning the child.

7/10 SML

                                                                         STATE OF VERMONT

SUPERIOR COURT                                                                                                 FAMILY DIVISION
                                 Unit                                                                                           Docket No.



 In Re:  DOB

        /          / 
Address

Include street, city and state 
Dates

From when to when 
Names of all persons residing in the

household with the child 
Yes

No

Yes No

Yes 
No