Affidavit Disclosing Care and Custody

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                          AFFIDAVIT DISCLOSING CARE Name ot TRIAL COURT OF MASSACHUSETTS DOCKET NUMBER
OR CUSTODY PROCEEDINGS lame o}
Pursuant to Trial Court Rule IV Case KAVBew we, Voor BRAPI2OED
O Boston CO District Court C1 Juvenite Court Q% Probate & Family Court 1 Superior Court
Municipal BAwToOe
Court Division Division Division T ovsgis |; |
—
secton| & BARBARA Ex QuitrA by declare, to the best o}
1 NAME OF PARTY (PRINT) AUG -7 202 |e
my knowledge, information and belief that all the information on this form is true and complete:
The name(s) of the child(ren) whose care or custody is at issue in this case are: |
PROBATE | COURT 1
Section] A YOR ooo = B KAMEN c. Liys—_
2 (LAST FIRST) (LAST FIRST) (LAST FIRST)

 

 

 

 

Use only the letter appearing in front of the child's name above when referring to that child in completing the remaining sections.

 

Section

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