Preview
IN THE CIRCUIT COURT OF Jasper County
(County where court is located. City of Saint Louis is conside:
MAY 23 2024
JASPER COUNTY CRCUT COURT
Dan eu even Aces Case
(First Name) \
(Middle Name) (Last Name)
Petitioner, (Enter your full legal name above)
(Jr/Sr All) Number 2YAP:
(Will be assigned when case is:filed)
(-COO33Y
Vv
Own c owonedt @ Division
th
(First Name) (Middle Name) (Last Name) (Ur/Sr All) Number
Respondent. (Enter the other parent's full legal name above) (Will be assigr {;when case is filed)
Petition for Child Custody and Su
The Parties
This Petition is for a parent to ask the court for an order for st and child support when there is
already a legal finding determining who is the father of th inor child(ren). A legal finding of paternity
may be a court judgment or an acknowledgment of paterni which is an affidavit signed by the parents
to get the father’s name on a child’s birth certificate. netic (DNA) testing or an administrative child
support order done by the Family Support Divisio hot legal findings of paternity.
If there is no legal finding of paternity, the Petitioner must file a petition asking for a paternity judgment. If
the parties already have a court judgment that decided paternity, support and/or custody, the Petitioner
must file a motion to modify. These forms are different from the Petition for Child Custody and Support,
but are also available on selfrepresent.mo.gov.
Throughout this case you will alw: be referred to as the Petitioner. The other parent will be referred to
as the Respondent.
4 Petitioner asks the uit to make custody and support orders for the following children:
add Citece (ounnery 7’
(First Name) (Middle Name) (Last Name) (Jr/Sr All) (Child's Age)
12,
1d) Aven Pounneds - Heed
(First (Middle Name) (Last Name) (Jr/Sr All) (Child's Age)
(First Name) (Middle Name) (Last Name) (Jr/Sr All) (Child's Age)
a
(First Name) (Middle Name) (Last Name) (Jr/SrAll) (Child’s Age)
(First Name) (Middle Name) (Last Name) (Jr/Sr All) (Child's Age)
f.
(First Name) (Middle Name) (Last Name) (Jr/Sr All) (Child’s Age)
Petition for Child Custody and Support Page 1 of 8
Form CAFC201 01/01/2019 This form is available for free at www.selfrepresent.mo.gov
Information about Petitioner Pare Helen M&cles
(Enter your name on the lines) (First Name) ) (Middle Name) (Last Name) Gr7Sr All)
2. What is your mailing address?
en
(Ou
ions area. mal f pi address th be
(203 5 Welker St
(Street)
\sebty CeHy (13 (FOF
(State)
CLF 34|— Ob CSLAEY WeLEAIEE Gud
ep
Son COWS
(Telephone Number with Area Code) (E-mail Address Optional)
What are the last four numbers of your social security number?
XXX-XX-
wi ‘ou over the age of eighteen? (Check one of the two boxes)
Yes [] No
ty
| live in Wine United States [] another country, which i
live in Missouri [J another state, which is \
te
| live in the county of _.2.cASie(~ “ye ss een
ou Oui
BS
What is your curre: employment statd (Check one of the three boxes)
0 Employed Unemployed élf-employed
If you are employed or self-e iployed where do you currently work?
pel
UF.
ere Berd thon. e Laat
(Employer's name. or type of self-employment)
Gali. PL s
(Street)
Mo be loY
(State) (Zip)
Petition for Child Custody and Support Page 2 of 8
Form CAFC201 01/01/2019 This form is available for free at www.selfrepresent.mo.gov
Information about Respondent
&
Dow
(First Name) (Middle Name)
ec
(Last Name)
Dorner 4
(r/Sr Mil)
(Enter the full legal name of Respondent on the lines above)
10. What is Respondent’s mailing address?
ddres
nter: oF
Bio WN Sky
(Street)
Do MO QUSo\
(City) (State)
OIF - 62U-CFH Oh. \50\
(Telephone Number with Area Code) (E-mail Address - Optional)
11 What are the last four numbers of Respondent's social security numb rs
xe
9 lal sec
XXX-XX-
12.
13.
i spondent over the age of eighteen? (Check one of the two boxes)
Yes [] No
Respondent lives in des United States [] angrier ‘country, which is
oe
14 Respondent lives in Ws issouri [] anoth “State, which is
15. dent Ii the co 0 es
if Respo int:
ue
16 Respondent is currently ployed [_] unemployed [] self-employed [] employment unknown.
(Check one of the four
17. If Respondent is empl or self-employed, where do they currently work?
sf
~hy of Joplin Recyet’ At) COM
(Employersiname or type of self-employment)
IDlo WwW A St
(Street)
“ool WY £10 Of Fol
(State) (Zip)
18. Respondent [] is not on active duty in the military. (Check “is” or not’)
iveve { for uy
nt
Petition for Child Custody and Support Page 3 of 8
Form CAFC201 01/01/2019 This form is available for free at www.selfrepresent.mo.gov
Information about Children
19. Has any court, in the State of Missouri or elsewhere, issued a judgment determining paternity of the
child(ren), but not ordering child support or custody? This could be a divorce judgment listing the
child(ren) bor f the marriage, but not ordering custody or support. An administrative child
support or r from the Family Support Division is not a court judgment. (Check one of the two
boxes)
0 Yes No
If yes, enter the name of the case, the case number and the location of the court. (For example:
John Doe v. Jane Doe, 12BA-DR3456, Boone County, Missouri.)
gi!
eee
Ys"
eH
If yes, you must also attach a copy of the court judgment with th etition.
20. An acknowledgment of paternity is an affidavit that the parents signto put a father on a child’s birth
certificate. id you and the other parent sign an acknowledgment of paternity for the child(ren) listed
tres is Petition at the hospital or at any other time? (Check he; >of the two boxes)
NOWJO. oi Addaliyrs
If yes, who listed himself as the father on the acknowledgment of paternity or birth certificate?
Sohn
(First Name)
lErype
(Middle Name)
If yes, you must attach a copy of th
Mater
(Last Name)
BS
(dr /SrAl)
For \oemtte
acknowledgment of paternity or birth certificate with
J
this Petition.
21 List the name of the parent or guafdian with whom the children have lived and the address where
said children have lived during.t past five years. Enter the dates at each address. If the child(ren)
have lived at more than three addresses iin the past five years, attach an additional page to this
Petition listing the informatio In requested in question 21 for each additional address.
(1) elm \ALCAS (Je /SrAl)
‘irst Name) (Middle Name) (Last Name)
«
(Street)
(State) (Zip) (Dates)
i
(First Name) (Middle Name) (Last Name) (Jr/Sr Ml)
(Street)
(City) (State) (Zip) (Dates)
Petition for Child Custody and Support Page 4 of 8
Form CAFG201 01/01/2019 This form is available for free at www.selfrepresent.mo.gov
3
(First Name) (Middle Name) (Last Name) (Jr/Sr All)
(Street)
(City) (State) (Zip) (Dates)
22 Do you know of anyone other than you or the other parent who has physical custody of any of the a
children or claims to have custody or visitation rights with respect to any of the children? (Check.
ihe boxes)
one of the
O Yes
23. Do you have information about any other custody proceeding concerning any of th ifdren
pending in 4
urt of this or any other state? (Check one of the two boxes)
0 Yes No
24. Have you participated in other litigation concerning the custody of any o hildren in this or any
other state? heck one of the two boxes)
O Yes No
Whe
25 Have any ofthe children been a victim of abuse or neglect? (Chet aR one of the two boxes)
0 Yes «
26. If you answered “Yes” to questions 22, 23, 24 or 25, pléasé explain.
ye
27. Has the Family Support Divisions ed a child support case for any child(ren) listed in this
Petition? (C) ck one of the boxes)
J Yes No es
If yes, list the eight d B number(s).
If yes, has t! amil Support Division issued a child support order? (Check one of the two boxes)
OJ Yes No.
List the judici: case number(s).
28. Do any. children listed in this Petition currently receive Temporary Assistance for Needy
he
Fait S (TAI benefits through the Family Support Division, or have they received TANF benefits
in the past?(Check one of the two boxes)
No
If yes, you must serve the Family Support Division with a copy of your Petition for Child Custody
and Support and other forms filed with this Petition. Instructions on how to serve the Family
Support Division are listed on page 7 of this Petition.
Petition for Child Custody and Support Page 5 of 8
Form CAFC201 01/01/2019 This form is available for free at www.selfrepresent mo.gov
Request for Relief
| want the court to do the following: (Check all that apply)
Child Custody should be as set forth in Part A of the attached Parenting Plan marked Exhibit
The custody arrangement that is in the best interests of the children is set forth in Part A of the
attached Parenting Plan marked Exhibit
Child Support should be as set forth in Part B of the attached Parenting Plan marked Exhibit
(1 Other (Please state the other request(s))
tea
ye
oe
“ys
poy
A
Petition for Child Custody and Support Page 6 of 8
Form CAFC201 01/01/2019 This form is available for free at www.selfrepresentmo.gov
Directions for Service on Respondent
If you do not know the location of Respondent and you have no way of contacting them, you must attempt to
serve them at their last known address or place of employment. Once you make an honest and reasonable
effort to personally serve them and are still unable to get service, then you may file a Request for Service by
Publication asking the court to publish notice of your petition in the local newspaper. The Request for Service
by Publication is available on the Representing Yourself website at selfrepresent.mo.gov. If you have service
by publication, you are not entitled to obtain any kind of money judgment for such thin: gs as child | \
support. This option should only be used as a last resort. oy SS
Check one of the following service options: “~
(Respondent has signed a verified Respondent's Answer to Petition for Child Custody alld .
Support which is being filed with the Petition for Child Custody and Support. There redo not
issue a summons. »
pais
aS
oO Respondent shall be served math a summons at their home:
pencice i isi
ae lave
CU
ER
uy
(Street)
ws
f (City)
Respondent shall be served with
(State)
a Summons at
Zip)
v lace of employmen'
red. m
Syde
2:Pa2C\IC
ay
YO hes ow wees
(Employer's\Name)
IZlo \N A Se 2 PVE
(Street)
AoOliw, “yno b4S5O|
(City) (State) (Zip)
Respondent cannot rved in Missouri. Therefore, service by registered mail is requested. A copy
of the Affidavit for Serv by Mail is attached to this form. See Missouri Supreme Court Rule
54.12(b).
Service on Fam ly Support Division (if necessary)
If any child. ted in this Petition receives Temporary Assistance for Needy Families (TANF) benefits, you
must se the Family Support Division with a copy of your Petition and Parenting Plan.
(1 Fhe'child(ren) receive TANF benefits through the Family Support Division. The Family Support
saS
Division shall be served at the following address:
AGS Director, Family Support Division, 615 Howerton Court, Jefferson City, Missouri 65102
If you request a summons to be served outside of the county where you filed this Petition, the
court may require you to deliver the summons to the sheriff of the county where the summons will
be served. You must also pay the appropriate service fee to that sheriff. For further instructions,
please contact the circuit clerk in the county where your petition is filed.
Petition for Child Custody and Support Page 7 of 8
Form CAFC201 01/01/2019 This form is available for free at www.selfrepresent.mo.gov
Sign Below in the Presence of a Notary Public
Petitioner, of lawful age, being duly sworn on his or her oath, states that he or she is the Petitioner
named above and that the facts stated in the Petition for Child Custody and Support are true
accol rding to his or her best knowledge, information and belief.
Crops
(Sign above in the-pgesénce of a Notary Public)
AsSuven
(Print your name aboye)
HIEss
ot
The following information must be completed by a notary public.
STATEOF MUSSOUG <
“_)SS
COUNTY OF 5Des Ver )
On this day of , 20.
, before me:personally appeared
‘son described in and who
, to me known to be the:6
executed the foregoing instrument and acknowledged that he/she executed dthe same as his/her free act
and deed. “ee
to
IN WITNESS WHEREOF, | have hereunto set my hand and afi dey Official seal in the County and
State aforesaid, the day and yearfirst above written.
Se
Be
.*
Notary Public
? County, State of Missouri
Ne
My commission expires: iz
'
Attorney Information
saan
Do this
have assiste itioner in the preparation of these pleadings, but | am not entering my appearance
on behalf of Petitioner.
Be
8%
(Attorney - Sigh above) (Missouri Bar Number)
(Attorney’- int your name above)
tory
(Sitreet)
a.
(City) (State) (Zip)
(Telephone Number with Area Code) (Fax Number with Area Code) (E-mail Address - Optional)
Petition for Child Custody and Support Page 8 of 8
Form CAFC201 01/01/2019 This form is available for free at www.selfrepresent.mo.gov
Preview
IN THE CIRCUIT COURT OF Jasper County (County where court is located. City of Saint Louis is conside: MAY 23 2024 JASPER COUNTY CRCUT COURT Dan eu even Aces Case (First Name) \ (Middle Name) (Last Name) Petitioner, (Enter your full legal name above) (Jr/Sr All) Number 2YAP: (Will be assigned when case is:filed) (-COO33Y Vv Own c owonedt @ Division th (First Name) (Middle Name) (Last Name) (Ur/Sr All) Number Respondent. (Enter the other parent's full legal name above) (Will be assigr {;when case is filed) Petition for Child Custody and Su The Parties This Petition is for a parent to ask the court for an order for st and child support when there is already a legal finding determining who is the father of th inor child(ren). A legal finding of paternity may be a court judgment or an acknowledgment of paterni which is an affidavit signed by the parents to get the father’s name on a child’s birth certificate. netic (DNA) testing or an administrative child support order done by the Family Support Divisio hot legal findings of paternity. If there is no legal finding of paternity, the Petitioner must file a petition asking for a paternity judgment. If the parties already have a court judgment that decided paternity, support and/or custody, the Petitioner must file a motion to modify. These forms are different from the Petition for Child Custody and Support, but are also available on selfrepresent.mo.gov. Throughout this case you will alw: be referred to as the Petitioner. The other parent will be referred to as the Respondent. 4 Petitioner asks the uit to make custody and support orders for the following children: add Citece (ounnery 7’ (First Name) (Middle Name) (Last Name) (Jr/Sr All) (Child's Age) 12, 1d) Aven Pounneds - Heed (First (Middle Name) (Last Name) (Jr/Sr All) (Child's Age) (First Name) (Middle Name) (Last Name) (Jr/Sr All) (Child's Age) a (First Name) (Middle Name) (Last Name) (Jr/SrAll) (Child’s Age) (First Name) (Middle Name) (Last Name) (Jr/Sr All) (Child's Age) f. (First Name) (Middle Name) (Last Name) (Jr/Sr All) (Child’s Age) Petition for Child Custody and Support Page 1 of 8 Form CAFC201 01/01/2019 This form is available for free at www.selfrepresent.mo.gov Information about Petitioner Pare Helen M&cles (Enter your name on the lines) (First Name) ) (Middle Name) (Last Name) Gr7Sr All) 2. What is your mailing address? en (Ou ions area. mal f pi address th be (203 5 Welker St (Street) \sebty CeHy (13 (FOF (State) CLF 34|— Ob CSLAEY WeLEAIEE Gud ep Son COWS (Telephone Number with Area Code) (E-mail Address Optional) What are the last four numbers of your social security number? XXX-XX- wi ‘ou over the age of eighteen? (Check one of the two boxes) Yes [] No ty | live in Wine United States [] another country, which i live in Missouri [J another state, which is \ te | live in the county of _.2.cASie(~ “ye ss een ou Oui BS What is your curre: employment statd (Check one of the three boxes) 0 Employed Unemployed élf-employed If you are employed or self-e iployed where do you currently work? pel UF. ere Berd thon. e Laat (Employer's name. or type of self-employment) Gali. PL s (Street) Mo be loY (State) (Zip) Petition for Child Custody and Support Page 2 of 8 Form CAFC201 01/01/2019 This form is available for free at www.selfrepresent.mo.gov Information about Respondent & Dow (First Name) (Middle Name) ec (Last Name) Dorner 4 (r/Sr Mil) (Enter the full legal name of Respondent on the lines above) 10. What is Respondent’s mailing address? ddres nter: oF Bio WN Sky (Street) Do MO QUSo\ (City) (State) OIF - 62U-CFH Oh. \50\ (Telephone Number with Area Code) (E-mail Address - Optional) 11 What are the last four numbers of Respondent's social security numb rs xe 9 lal sec XXX-XX- 12. 13. i spondent over the age of eighteen? (Check one of the two boxes) Yes [] No Respondent lives in des United States [] angrier ‘country, which is oe 14 Respondent lives in Ws issouri [] anoth “State, which is 15. dent Ii the co 0 es if Respo int: ue 16 Respondent is currently ployed [_] unemployed [] self-employed [] employment unknown. (Check one of the four 17. If Respondent is empl or self-employed, where do they currently work? sf ~hy of Joplin Recyet’ At) COM (Employersiname or type of self-employment) IDlo WwW A St (Street) “ool WY £10 Of Fol (State) (Zip) 18. Respondent [] is not on active duty in the military. (Check “is” or not’) iveve { for uy nt Petition for Child Custody and Support Page 3 of 8 Form CAFC201 01/01/2019 This form is available for free at www.selfrepresent.mo.gov Information about Children 19. Has any court, in the State of Missouri or elsewhere, issued a judgment determining paternity of the child(ren), but not ordering child support or custody? This could be a divorce judgment listing the child(ren) bor f the marriage, but not ordering custody or support. An administrative child support or r from the Family Support Division is not a court judgment. (Check one of the two boxes) 0 Yes No If yes, enter the name of the case, the case number and the location of the court. (For example: John Doe v. Jane Doe, 12BA-DR3456, Boone County, Missouri.) gi! eee Ys" eH If yes, you must also attach a copy of the court judgment with th etition. 20. An acknowledgment of paternity is an affidavit that the parents signto put a father on a child’s birth certificate. id you and the other parent sign an acknowledgment of paternity for the child(ren) listed tres is Petition at the hospital or at any other time? (Check he; >of the two boxes) NOWJO. oi Addaliyrs If yes, who listed himself as the father on the acknowledgment of paternity or birth certificate? Sohn (First Name) lErype (Middle Name) If yes, you must attach a copy of th Mater (Last Name) BS (dr /SrAl) For \oemtte acknowledgment of paternity or birth certificate with J this Petition. 21 List the name of the parent or guafdian with whom the children have lived and the address where said children have lived during.t past five years. Enter the dates at each address. If the child(ren) have lived at more than three addresses iin the past five years, attach an additional page to this Petition listing the informatio In requested in question 21 for each additional address. (1) elm \ALCAS (Je /SrAl) ‘irst Name) (Middle Name) (Last Name) « (Street) (State) (Zip) (Dates) i (First Name) (Middle Name) (Last Name) (Jr/Sr Ml) (Street) (City) (State) (Zip) (Dates) Petition for Child Custody and Support Page 4 of 8 Form CAFG201 01/01/2019 This form is available for free at www.selfrepresent.mo.gov 3 (First Name) (Middle Name) (Last Name) (Jr/Sr All) (Street) (City) (State) (Zip) (Dates) 22 Do you know of anyone other than you or the other parent who has physical custody of any of the a children or claims to have custody or visitation rights with respect to any of the children? (Check. ihe boxes) one of the O Yes 23. Do you have information about any other custody proceeding concerning any of th ifdren pending in 4 urt of this or any other state? (Check one of the two boxes) 0 Yes No 24. Have you participated in other litigation concerning the custody of any o hildren in this or any other state? heck one of the two boxes) O Yes No Whe 25 Have any ofthe children been a victim of abuse or neglect? (Chet aR one of the two boxes) 0 Yes « 26. If you answered “Yes” to questions 22, 23, 24 or 25, pléasé explain. ye 27. Has the Family Support Divisions ed a child support case for any child(ren) listed in this Petition? (C) ck one of the boxes) J Yes No es If yes, list the eight d B number(s). If yes, has t! amil Support Division issued a child support order? (Check one of the two boxes) OJ Yes No. List the judici: case number(s). 28. Do any. children listed in this Petition currently receive Temporary Assistance for Needy he Fait S (TAI benefits through the Family Support Division, or have they received TANF benefits in the past?(Check one of the two boxes) No If yes, you must serve the Family Support Division with a copy of your Petition for Child Custody and Support and other forms filed with this Petition. Instructions on how to serve the Family Support Division are listed on page 7 of this Petition. Petition for Child Custody and Support Page 5 of 8 Form CAFC201 01/01/2019 This form is available for free at www.selfrepresent mo.gov Request for Relief | want the court to do the following: (Check all that apply) Child Custody should be as set forth in Part A of the attached Parenting Plan marked Exhibit The custody arrangement that is in the best interests of the children is set forth in Part A of the attached Parenting Plan marked Exhibit Child Support should be as set forth in Part B of the attached Parenting Plan marked Exhibit (1 Other (Please state the other request(s)) tea ye oe “ys poy A Petition for Child Custody and Support Page 6 of 8 Form CAFC201 01/01/2019 This form is available for free at www.selfrepresentmo.gov Directions for Service on Respondent If you do not know the location of Respondent and you have no way of contacting them, you must attempt to serve them at their last known address or place of employment. Once you make an honest and reasonable effort to personally serve them and are still unable to get service, then you may file a Request for Service by Publication asking the court to publish notice of your petition in the local newspaper. The Request for Service by Publication is available on the Representing Yourself website at selfrepresent.mo.gov. If you have service by publication, you are not entitled to obtain any kind of money judgment for such thin: gs as child | \ support. This option should only be used as a last resort. oy SS Check one of the following service options: “~ (Respondent has signed a verified Respondent's Answer to Petition for Child Custody alld . Support which is being filed with the Petition for Child Custody and Support. There redo not issue a summons. » pais aS oO Respondent shall be served math a summons at their home: pencice i isi ae lave CU ER uy (Street) ws f (City) Respondent shall be served with (State) a Summons at Zip) v lace of employmen' red. m Syde 2:Pa2C\IC ay YO hes ow wees (Employer's\Name) IZlo \N A Se 2 PVE (Street) AoOliw, “yno b4S5O| (City) (State) (Zip) Respondent cannot rved in Missouri. Therefore, service by registered mail is requested. A copy of the Affidavit for Serv by Mail is attached to this form. See Missouri Supreme Court Rule 54.12(b). Service on Fam ly Support Division (if necessary) If any child. ted in this Petition receives Temporary Assistance for Needy Families (TANF) benefits, you must se the Family Support Division with a copy of your Petition and Parenting Plan. (1 Fhe'child(ren) receive TANF benefits through the Family Support Division. The Family Support saS Division shall be served at the following address: AGS Director, Family Support Division, 615 Howerton Court, Jefferson City, Missouri 65102 If you request a summons to be served outside of the county where you filed this Petition, the court may require you to deliver the summons to the sheriff of the county where the summons will be served. You must also pay the appropriate service fee to that sheriff. For further instructions, please contact the circuit clerk in the county where your petition is filed. Petition for Child Custody and Support Page 7 of 8 Form CAFC201 01/01/2019 This form is available for free at www.selfrepresent.mo.gov Sign Below in the Presence of a Notary Public Petitioner, of lawful age, being duly sworn on his or her oath, states that he or she is the Petitioner named above and that the facts stated in the Petition for Child Custody and Support are true accol rding to his or her best knowledge, information and belief. Crops (Sign above in the-pgesénce of a Notary Public) AsSuven (Print your name aboye) HIEss ot The following information must be completed by a notary public. STATEOF MUSSOUG < “_)SS COUNTY OF 5Des Ver ) On this day of , 20. , before me:personally appeared ‘son described in and who , to me known to be the:6 executed the foregoing instrument and acknowledged that he/she executed dthe same as his/her free act and deed. “ee to IN WITNESS WHEREOF, | have hereunto set my hand and afi dey Official seal in the County and State aforesaid, the day and yearfirst above written. Se Be .* Notary Public ? County, State of Missouri Ne My commission expires: iz ' Attorney Information saan Do this have assiste itioner in the preparation of these pleadings, but | am not entering my appearance on behalf of Petitioner. Be 8% (Attorney - Sigh above) (Missouri Bar Number) (Attorney’- int your name above) tory (Sitreet) a. (City) (State) (Zip) (Telephone Number with Area Code) (Fax Number with Area Code) (E-mail Address - Optional) Petition for Child Custody and Support Page 8 of 8 Form CAFC201 01/01/2019 This form is available for free at www.selfrepresent.mo.gov