Party Statement: BR21W1063WD Lopes, Elvis P vs. Finegold, Kelly E

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                                AFFIDAVIT DISCLOSING CARE TRIAL COURT OF MASSACHUSETTS DOCKET NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OR CUSTODY PROCEEDINGS Name of
Pursuantto Trial Court Rule IV Case LoPES Vs Finleaaolip LB lw WO Sut
O Boston C1 District Court 1 Juvenile Court bate & Family SS ee
Municipal Rist ou 2 Ih A
Court Division Division Division Division cil
Uy
section] | EWS ?. Loe te J oyAllGa, G8 Weber 47
1 NAME OF PARTY (PRINT)
my knowledge, information and belief that all the information on this form is true and comglete: PROGATE COURT
_The name(s) ofthe child(ren) whose care or custody is at issue in this case are: ISTOL SS H

 

 

son A (ftS, L5066L 8. Los , SADIE c. Lopes Sele

dist FIRST) (LAST FIRST) (VAST FIRST)
Use only the letter appearing in front of the child's name above when referring to that child in completing the remaining sections.

 

The party filing this affidavit may request certain addresses to be kept confidential if the address is a shelter for battered persons and their

 

 

 

 

 

 

 

 

 

Section dependent child(ren), or the party filing this affidavit believes that he/she or the child(ren) are in danger of physical or emotional abuse, or
the party is filing an action under G.L.c.209A. If the party who completed this affidavit believed this provision applied to him/her,
then the box at the right has been checked and sections 4 and 5 have not be completed.
The address(es) of the above-named child(ren) whose care or custodyis at issue in this case are:
Address(es) Address(es) During the Last 2 Years, If Different
Section} CHILD A. 0 whe ag
4
CHILD B. Same 45 ABpvE
CHILD C. Sams 5 ABS
Section :
5 My address is: ZG WHitaA on! si Ker 2 New be DFoeD Mbhe on: TAS
Section

101 have Sanave not participated in and| QO) know wy do not know of other care or custody proceedings involving the above-named
child(ren) in Massachusetts or in any other state or country.

 

Certified copies of any pleadings or determination in a care or custody proceeding outside of Massachusetts listed in sections 7 and 8 must be filed with
this affidavit unless already filed with this court or an extension for filing these documents has been granted by this court.

 

The following is a list of ALL pending or concluded proceedings | have participated in or know of involving the care or custody of the

 

 

 

 

 

 

 

 

 

above-named child(ren): Status of Case . ray
, (Custody awarded to) [0] ther
Section Letter of Child Court Docket No. (Date of award) [N] one
7 | CHILD {_]
CHILD |
CHILD tod
‘The names and addresses of parties to care or custody proceedings involving any of the above-named child(ren) or those claiming a legal right to
these child(ren) during the last two years (including myself are:
Section | b&tter of Child Name of Party/Claimant Current (or last known) Address of Party/Claimant
* lows KM _$9ABEL LOPES 42 Glepiyl sr Nib MASS 02745)
cH SAdie_Lofes ZZ GlEnwoNST NB MAS 0274S
co WK _Spafon LpPes ZLQLENNON ST NB MASS 68745
Section | If the box at the right is checked, this affidavit discloses the adoption of one or more of the above- CL
9

named child(ren) and.! am requesting the court to impound this affidavit. See instructions.

 

This affidavit must be personally signed by the party listed in section 1 above, unless he/she is under 18 years of age or has been adjudged incompetent
in which case the 30 of record must sign. A revised affidavit must be filed with the court if new information is discovered subsequent to this filing.

Signedthis os FU ayo Aw uQusr 0 Di under the penalties of perjury.

cond OF PARTY OR Al re a RD FOR INCOMPETENT/JUVENILE tet 28 oF hh a as

 

 

ADDRESS OF ATTORNEY OF RECORD FOR INCOMPETENT/JUVENILE
THE PARTY FILING THIS AFFIDAVIT MUST FURNISH A COPY OF IT TO ALL OTHER PARTIES TO THIS ACTION

 

 

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1 TCRIV - AFFIDAVIT DISCLOSING CARE OR CUSTODY PROCEEDINGS C.G.E.

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