On August 11, 2017 a
Miscellaneous
was filed
involving a dispute between
and
for MODIFICATION-CUSTODY
in the District Court of Tarrant County.
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INFORMATION ON SUIT AFFECTING THE FAMILY RELATIONSHIP
(EXCLUDING ADOPTIONS)
SECTION I GENERAL INFORMATION (REQUIREO) STATE FILE NUMBER
1a. couNTY TARRANT 'd-33
, b. couRT No. Judicial District
1c. CAUSE NO. 233- {il.3::'\'Q ! -\ 1 1d. CATE OF ORDER (mm/dd/yyyy) \a-.,\\ D \ .;)..D\'t:
}:!/®II 11 !!
2. TYPE OF ORDER (CHECK ALL THAT APPLY):
[ZJ DIVORCE/ANNULMENT 1'1'1I1::1 CHILDREN (Sec. 1, 2 ANO 3) 0DIVORCEIANNULMENTWITHOUT CHILDREN (Sec 1 AND2)
0ESTABLISHMENT OF COURT OF CONTINUING JURISDICTION (SEC 1 ANO 3)
(Court Order Establishing Pa™11ity, Conservaforship, Child Support or Termination of Parental Rights)
OcHANGE IN THE NAME OF THE CHILD (SEc 1 ANO 3)
(PROVIDE PRJOR AND NEW NAME OF CHILD IN SECnON 3)
O TRANSFER OF COURT OR CONTINUING JURISDICTION (SEC1, 3ANO INFORMATION BELOW)
TRANSFER TO· COUNTY COURT NO STATE COURT ID#
3a. NAME OF ATIORNEY FOR PETITJONER I3b. TELEPHONE NUMBER (indlid1ng Mea code)
Elizabeth Parmer 817.877.1224
3c. CURRENT MAI UNG ADDRESS {STREET AND NUMBER OR P. 0 BOX
OTY, STATE, ZIP)
309 W. 7th Street, Suite 900 Fort Worth Texas 76102
SECTION 2 (IF APPLICABLE) REPORT OF DIVORCE OR ANNULMENT OF MARRIAGE
4. tw.!E (FIRST Id/ODLE LAST SUFFIX) 5. MAIDEN LAST NAME {NAME BEFORE 1" MARRJAGE)
0: SONIA PALOMINOS
w
z
a
,=
6. PLACE OF BIRTH (CITY ANO STATE OR FOREIGN C01..1,jrRY) 17.RACE (mnv'da'.YYYY)
8. DATE OF BIRTH
,= fort worth texas hispanic 07/31/1987
w 9. USUAL RESIDENCE STREET NAME & NUMBER CITY STATE ZIP
a.
I O15 7 Buffalo Grove Rd Fort Worth Texas
.
z
i!j
10. NAME (FIRST MIDDLE LAST SUFFIX)
ISMAEL OROSCO PALOMINOS
11. MAJ DENI.AST NAME (NAME BEFORE 1" MARRIAGE}
z 12. PLACE OF BIRTH (CITY AND STATE OR FOREIGNCOr>ITRY} 113.RACE 1,4. DATE OF B I R T H ( ~ }
aQ. portland oregon hisoanic 03/17/1989
U)
w 15. USUAL RESIDENCE (STREET AND NUMBER CITY, STATE, ZIP)
0:
207 Bayne Road
;6.NUMBEROFMlNORCHILDREN ;~rs-TnooR\AGE(~J Haslet
118.
Texas 76052
Pt.ACE OF MARRIAGE (CITY AND STATE OR FOREIGN COUNTRY)
fort worth texas
1
SECTION 3 (IF APPLICABLE) CHILDREN AFFECTED BY THIS SUIT
19a. CHILD CURRENT NAME {RRSTMIDDLELAST SUFFIX)
-
9
ru
ALEXA NICOLE PALOMINOS
08/25/2015
I
19b. DATE OF BIRTH {mmldd'yyyyJ19c. SEX
Female
I
fort worth
{CITY, COUNTY ANO STATE)
19d. BIRTHPLACE
tarrant Texas
19e. PRIOR NAME Of CHILO (FIRST MIDDLE LAST SUFFIX) - IF APPLICABLE
20a. CHILD CURRENT NAME {FIRST MIDDLE LAST SUFFIX)
"' I
20b. DATE OF BIRTH (mm/dTIONAL CHILDREN LISTED ON BACK Cl' THS FORM. ,,;_'i).'!;\
.)·'" t,
{.::i '"''l't
"j.~
•0
I CERTIFY THAT THE ABCNE ORDER WAS GRANTED ON THE DATE ANO PLACE A\~. ~~.{!.W.toi ff1Vl!W1. '2nr4. ,hO
·.•• .1~~:"i" 1:_v i ......
~e ciERK OF THE cou1
··..~~<'~~,..~:,,·SIGNATl.JRE OF
rr{.;
••• 10 ••••
WARNING: This is a governmental document.
····· ·······
Texas Penal Code, Section 37.10, specifies penaltes for making false
.....
entnes or providing false information in this document.
VS-165 REV 07/2017
Texas Department of State Health Services-Vital Statistics VS,165 REV 0712017
1
ADDITIONAL CHILDREN AFFECTED BY THIS SUIT FROM SECTION 3 (IF APPLICABLE)
23a. CHLO CURRENT NAME {FIRST MIDDLE LAST SUFF/x)
.. l
23b. DATE OF BIRTH (mm/ddlyyyy)
23c.SEX I23d. BIRTHPLACE (CITY, CO~TY AND STATE)
g
23&. PRIOR NAME OF CHILD{flRST MIDDLE LAST SUFFIX}-JFAPPLJCABLE
24a. CHILD CURRENT NAME (FIRST MIDDLE LAST SUfflx}
.,
9
I
24b, DATE OF BIRTH (mm/ddlyyyy)24c.SEX I24d. BIRTHPLACE (CITY, COUNTY AND STA TE)
"
Q
24e. PRIOR NAME Of CHILO {FIRST MIDDLE LAST SUFFIX}-IFAPPLJCABLE
25a. CHILO CURRENT NAME (FIRST MIDDLE LAST SUfflX)
.9 I
25b. DATE OF BIRTH (mm/dd/yyyy)25c. SEX I25d. BIRTHPLACE {CITY, C(){l,JTY AND STATE}
0
25e. PRIOR NAME OF CHILO (FIRST MIDDLE UIST SUFFIX}- IF APPLICABLE
Instructions for Completing the Suit Affecting Parent Child Relationship Form
GENERAL REQUIREMENT:
All divorces/annulments {with or without children) and all suits affecting the parent
Document Filed Date
December 10, 2018
Case Filing Date
August 11, 2017
Category
MODIFICATION-CUSTODY
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INFORMATION ON SUIT AFFECTING THE FAMILY RELATIONSHIP (EXCLUDING ADOPTIONS) SECTION I GENERAL INFORMATION (REQUIREO) STATE FILE NUMBER 1a. couNTY TARRANT 'd-33 , b. couRT No. Judicial District 1c. CAUSE NO. 233- {il.3::'\'Q ! -\ 1 1d. CATE OF ORDER (mm/dd/yyyy) \a-.,\\ D \ .;)..D\'t: }:!/®II 11 !! 2. TYPE OF ORDER (CHECK ALL THAT APPLY): [ZJ DIVORCE/ANNULMENT 1'1'1I1::1 CHILDREN (Sec. 1, 2 ANO 3) 0DIVORCEIANNULMENTWITHOUT CHILDREN (Sec 1 AND2) 0ESTABLISHMENT OF COURT OF CONTINUING JURISDICTION (SEC 1 ANO 3) (Court Order Establishing Pa™11ity, Conservaforship, Child Support or Termination of Parental Rights) OcHANGE IN THE NAME OF THE CHILD (SEc 1 ANO 3) (PROVIDE PRJOR AND NEW NAME OF CHILD IN SECnON 3) O TRANSFER OF COURT OR CONTINUING JURISDICTION (SEC1, 3ANO INFORMATION BELOW) TRANSFER TO· COUNTY COURT NO STATE COURT ID# 3a. NAME OF ATIORNEY FOR PETITJONER I3b. TELEPHONE NUMBER (indlid1ng Mea code) Elizabeth Parmer 817.877.1224 3c. CURRENT MAI UNG ADDRESS {STREET AND NUMBER OR P. 0 BOX OTY, STATE, ZIP) 309 W. 7th Street, Suite 900 Fort Worth Texas 76102 SECTION 2 (IF APPLICABLE) REPORT OF DIVORCE OR ANNULMENT OF MARRIAGE 4. tw.!E (FIRST Id/ODLE LAST SUFFIX) 5. MAIDEN LAST NAME {NAME BEFORE 1" MARRJAGE) 0: SONIA PALOMINOS w z a ,= 6. PLACE OF BIRTH (CITY ANO STATE OR FOREIGN C01..1,jrRY) 17.RACE (mnv'da'.YYYY) 8. DATE OF BIRTH ,= fort worth texas hispanic 07/31/1987 w 9. USUAL RESIDENCE STREET NAME & NUMBER CITY STATE ZIP a. I O15 7 Buffalo Grove Rd Fort Worth Texas . z i!j 10. NAME (FIRST MIDDLE LAST SUFFIX) ISMAEL OROSCO PALOMINOS 11. MAJ DENI.AST NAME (NAME BEFORE 1" MARRIAGE} z 12. PLACE OF BIRTH (CITY AND STATE OR FOREIGNCOr>ITRY} 113.RACE 1,4. DATE OF B I R T H ( ~ } aQ. portland oregon hisoanic 03/17/1989 U) w 15. USUAL RESIDENCE (STREET AND NUMBER CITY, STATE, ZIP) 0: 207 Bayne Road ;6.NUMBEROFMlNORCHILDREN ;~rs-TnooR\AGE(~J Haslet 118. Texas 76052 Pt.ACE OF MARRIAGE (CITY AND STATE OR FOREIGN COUNTRY) fort worth texas 1 SECTION 3 (IF APPLICABLE) CHILDREN AFFECTED BY THIS SUIT 19a. CHILD CURRENT NAME {RRSTMIDDLELAST SUFFIX) - 9 ru ALEXA NICOLE PALOMINOS 08/25/2015 I 19b. DATE OF BIRTH {mmldd'yyyyJ19c. SEX Female I fort worth {CITY, COUNTY ANO STATE) 19d. BIRTHPLACE tarrant Texas 19e. PRIOR NAME Of CHILO (FIRST MIDDLE LAST SUFFIX) - IF APPLICABLE 20a. CHILD CURRENT NAME {FIRST MIDDLE LAST SUFFIX) "' I 20b. DATE OF BIRTH (mm/dTIONAL CHILDREN LISTED ON BACK Cl' THS FORM. ,,;_'i).'!;\ .)·'" t, {.::i '"''l't "j.~ •0 I CERTIFY THAT THE ABCNE ORDER WAS GRANTED ON THE DATE ANO PLACE A\~. ~~.{!.W.toi ff1Vl!W1. '2nr4. ,hO ·.•• .1~~:"i" 1:_v i ...... ~e ciERK OF THE cou1 ··..~~<'~~,..~:,,·SIGNATl.JRE OF rr{.; ••• 10 •••• WARNING: This is a governmental document. ····· ······· Texas Penal Code, Section 37.10, specifies penaltes for making false ..... entnes or providing false information in this document. VS-165 REV 07/2017 Texas Department of State Health Services-Vital Statistics VS,165 REV 0712017 1 ADDITIONAL CHILDREN AFFECTED BY THIS SUIT FROM SECTION 3 (IF APPLICABLE) 23a. CHLO CURRENT NAME {FIRST MIDDLE LAST SUFF/x) .. l 23b. DATE OF BIRTH (mm/ddlyyyy) 23c.SEX I23d. BIRTHPLACE (CITY, CO~TY AND STATE) g 23&. PRIOR NAME OF CHILD{flRST MIDDLE LAST SUFFIX}-JFAPPLJCABLE 24a. CHILD CURRENT NAME (FIRST MIDDLE LAST SUfflx} ., 9 I 24b, DATE OF BIRTH (mm/ddlyyyy)24c.SEX I24d. BIRTHPLACE (CITY, COUNTY AND STA TE) " Q 24e. PRIOR NAME Of CHILO {FIRST MIDDLE LAST SUFFIX}-IFAPPLJCABLE 25a. CHILO CURRENT NAME (FIRST MIDDLE LAST SUfflX) .9 I 25b. DATE OF BIRTH (mm/dd/yyyy)25c. SEX I25d. BIRTHPLACE {CITY, C(){l,JTY AND STATE} 0 25e. PRIOR NAME OF CHILO (FIRST MIDDLE UIST SUFFIX}- IF APPLICABLE Instructions for Completing the Suit Affecting Parent Child Relationship Form GENERAL REQUIREMENT: All divorces/annulments {with or without children) and all suits affecting the parent