Form 346, Delaware Custody Separate Statement

In the case of wanting to legally enforce a custody separation, the following statement has to be completed and submitted.

Extracted Text for Proper Search

Form 346	 	Rev. (01/13)	 	
1 of 3 	
The Family Court of the State of Delaware	 	
In and For 	 New Castle  	 Kent  	 Sussex County	 	
CUSTODY 	SEPARATE STATEMENT	 	
Petitioner	 	v. Respondent	 	 	 	
1. What type of petition are you filing? 	      	
2. Who is the child(ren) named in your petition? (	Please provide full name and date of birth	) 	
Child’s Name	 	Date of Birth (mm/dd/yyyy)	 	
      	      	
      	      	
      	      	
      	      	
3. Have all the children listed above continually resided with one another?  	 Yes   	No 	 	
If  you  answered  “No,”  the  children  have  not  continually  resided  with  one  another;  please  complete  a 
Custody Separate Statement for each child.	 	
CURRENT ADDRESS
 	Address where child(ren) 	currently 	resides  	 ** If the 	address where the child(ren) currently resides is a confidential address in Family Court, DO NOT provide the address on this form.  Instead, please mark the fields as CONFIDENTIAL	. 	
 Date(s) Child(ren) lived here	 	    State	 	
    Zip Code	 	
                       	to present	 	
 City	 	
      	      	    	      	
Name of person(s) child(ren) is living with	 	Relationship to child(ren)	 	
      	      	 	 	 	
4. 	During the 	past five years	,  where have the child(ren) lived? 	List addresses from the most recent to the 	oldest	.  	
If the child(ren) is under the age of five years old, end with the first address where the child lived.	 	 	
PRIOR 
ADDRESS 
 	Address where child(ren) 	previously	 reside	d 	City	 	State	 	Zip Code	 	
      	      	    	      	
Date	(s) child(ren) lived there	 	Name of person(s) child(ren) lived	 with	 	Relationship to child(ren)	 	
            	 	to       	      	      	
Person’s current 	 address	 	City	 	State	 	Zip Code	 	
      	      	    	      	
 PRIOR 
ADDRESS 
 	Address where child(ren) previously resided	 	City	 	State	 	Zip Code	 	
      	      	    	      	
Date(s) child(ren) lived there	 	Name of person(s) child(ren) lived	 with	 	Relationship to child(ren)	 	
            	 	to       	      	      	
Person’s current 	 address	 	City	 	State	 	Zip Code	 	
      	      	    	      	
PRIOR 
ADDRESS
 	Address where child(ren) previously resided	 	City	 	State	 	Zip Code	 	
      	      	    	      	
Date(s) child(ren) lived there	 	Name of person(s) child(ren)	 lived	 with	 	Relationship to child(ren)	 	
            	 	to       	      	      	
Person’s current 	 address	 	City	 	State	 	Zip Code	 	
      	      	    	      	
PRIOR 
ADDRESS
 	Address where child(ren) previously resided	 	City	 	State	 	Zip Code	 	
      	      	    	      	
Date(s) child(ren) lived there	 	Name of person(s) child(ren)	 lived	 with	 	Relationship to child(ren)	 	
            	 	to       	      	      	
Person’s current	  address	 	City	 	State	 	Zip Code	 	
      	      	    	      	
Name	 	 Name	 	 	File Number

Form 346	 	Rev. (01/13)	 	
2 of 3 	
 	
5. Check 	ONE	 and complete as directed.	 	
 	 No one other than the parties have physical custody, legal custody or visitation rights with the 
child(ren).	 	
 	 A perso	n(s) other than the parties have physical custody, legal custody or visitation rights with 	
the child(ren). 	If you check this box, complete the information below. Attach additional sheets if 	
necessary.  	 	
PERSON
 1 	Name of person(s) 	with physical custody, 	legal custody or visitation	 	Relationship to child(ren)	 	
      	      	
Person’s current address	 	City	 	State	 	Zip Code	 	
      	      	    	      	
PERSON
 2 	Name of person(s) 	with physical custody, legal custody or visitation	 	Relationship to child(ren)	 	
      	      	
Person’s current address	 	City	 	State	 	Zip Code	 	
      	      	    	      	
 
 
 	
6. Select all that apply	 and complete as directed.	 	
 I have not been involved in any other court action for custody and/or visitation of this child(ren).	 	
 I have been involv	ed in another court action for custody and/or visitation of this child(ren). 	If you 	
check this box, complete the information below. Attach additional sheets if necessary.	 	
ACTION 1
 	
Type of Action	 (e.g.	 Custody, Visitation, Other	) 	Person	 (who filed the action)	 	State	 	
      	      	    	
Court	 	Case Number	 	Date Filed	 	
      	      	      	
Result	 	Date of Order	 	
      	      	
ACTION 2
 	
Type of Action	 (e.g. Custody, Visitation, Other)	 	Person	 (who filed the action)	 	State	 	
      	      	    	
Court	 	Case Number	 	Date Filed	 	
      	      	      	
Result	 	Date of Order	 	
      	      	
ACTION 3
 	
Type of Action	 (e.g. Custody, Visitation, Other)	 	Person	 (who filed the action)	 	State	 	
      	      	    	
Court	 	Case Number	 	Date Filed	 	
      	      	      	
Result	 	Date of Order

Form 346	 	Rev. (01/13)	 	
3 of 3 	
 
 
 
 	
7. Check 	ONE	 and complete as directed.	 	
 I do not know of any other court action such as, Protection From Abuse, Termination of Parental 
Rights, Guardianship, Adoption or Paternity involving myself, the other party or the child(ren) that	 	
could affect this petition.	 	
 I, the other party or the child(ren) have been and/or are currently involved in another court action 
such as, Protection From Abuse, Termination of Pa	rental Rights, Guardianship or Adoption, that 	
could affect this petition. 	If you check this box, complete the information below. Attach additional 	
sheets if necessary.	 	
 
 
 
 
   	
ACTION 1
 	Type of Action	 (e.g.	 PFA	, TPR	, Guardianship, Other	) 	Person	 (who filed the action)	 	State	 	
      	      	    	
Court	 	Case Number	 	Date Filed	 	
      	      	      	
ACTION 2
 	Type of Action	(e.g. PFA, 	TPR, Guardianship, Other)	 	Person	 (who filed the action)	 	State	 	
      	      	    	
Court	 	Case Number	 	Date Filed	 	
      	      	      	
 
 
 
 
 
 
 
 	
 	Petitioner	 	
Sworn to 	subscribed before me this ______ day of ______________________, _________	 	
 	
 	Clerk of Court/	Notary Public