IN THE 17 th JUDICIAL CIRCUIT COURT OF CASS COUNTY HARRISONVILLE, MISSOURI

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Clementine Horn
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1 IN THE 17 th JUDICIAL CIRCUIT COURT OF CASS COUNTY HARRISONVILLE, MISSOURI, a minor, SSN: XXX-XX- by next friend,, and, SSN: XXX-XX- Individually, Plaintiffs, vs. Case No., SSN: XXX-XX- Defendant. AFFIDAVIT F JUDGMENT ESTABLISHING PATERNITY, CUSTODY AND SUPPT (Check appropriate boxes 1. My name is and I am the Petitioner in this paternity case. 2. My name is and I am the Respondent in this paternity case. 3. A Petition to Establish Paternity was filed on. 4. Each has subjected themselves to the jurisdiction of this court by the following acts: ÿ Served by the sheriff on (date. ÿ Entry of Appearance and Waiver of Service filed on (date. ÿ Answer filed on (date. 1

2 ÿ Filed the Petition for Dissolution of Marriage herein on (date. 5. I am a resident of the County of, State of Missouri. 6. The Other Party is a resident of the County of, State of Missouri. 7. My social security number and that of the Other Party is set forth in the Case Information Sheet and the last four digits are set forth in the caption above. 8. ÿ Neither the Other Party nor I are on active duty in the armed services at the present time or any time since the filing of the petition. ÿ is on Active Duty in the Armed Forces at this present time, or has been at some point, since the filing of the Motion, but he/she waives his/her rights under the Servicemembers Civil Relief Act of 2003, and agrees to proceed in this action without postponement. 9. The Court has jurisdiction over the parties and the subject matter. 10. (minor child, age, SSN XXX-XX-, was born of the mother. 11. In compliance with RSMo, we state that: a. We have not participated as a party, witness, or in any other capacity in any other proceeding concerning the custody of or visitation with the child. b. We do not know of any proceeding that could affect the current proceeding including proceedings for enforcement and proceedings relating to domestic violence, protective orders, termination of parental rights and adoption. c. We do not know the names or address of any person not a party to the proceeding who has physical custody of the child or claims rights of legal custody or physical custody of or visitation with, the child. 12. The minor child resides in the County of, State of Missouri. The Other Party and I had sexual intercourse during the period of time when the above child was conceived. 13. The father admits that he is the biological father of (minor child, age, SSN XXX-XX-, born of the mother. ÿ The father s name is on the Birth Certificate of the minor child. 14. The Other Party and I are over the age of 18 years. 2

3 15. The Parenting Plan is attached hereto as Exhibit. 16.ÿ It is in the best interest of the minor child that the Other Party and I be awarded Joint Legal Custody and Joint Physical Custody of the unemancipated child pursuant to a Parenting Plan filed with the Court. ÿ It is in the best interest of the minor child that ÿ Plaintiff Parent ÿ Defendant Parent be awarded Sole Legal Custody and Sole Physical Custody of the unemancipated child pursuant to a Parenting Plan filed with the Court. ÿ Income and Expense Statement for each party has been filed and a Form 14 is attached 17. to the proposed judgment. The parties agree that the presumed amount of child support is just and appropriate under the circumstances of this case. ÿ An Income and Expense Statement for each party has been filed and a Form 14 is attached to the proposed judgment. The parties ask the Court to deviate from the Form 14 presumed child support amount and/or the Form 14 guidelines in the establishments of child support for the following reasons:. 18.ÿ Plaintiff Parent ÿ Defendant Parent has work-related child-care costs in the amount of $ per month. The work-related childcare cost shall be split: % to Father % to Mother 19. Neither parent has health insurance available for the minor child nor is it economically possible for either parent to provide medical insurance coverage at this time. ÿ Mother ÿ Father has medical insurance for the minor child through place of employment at a cost of $ per month. The Court has reviewed all of the factors set forth in RSMo and finds that the medical insurance available for the minor child through ÿ Mother ÿ Father place of employment, or the private policy currently in effect, is the best insurance available at this time. 20. Plaintiff Ordered to pay Court costs and therefore I request that no attorney s fees be ordered to be paid by either party. 3

4 21. The parents request that the Court change the name of the minor child to:. 22. I hereby request the pleadings, documents and filings in the court file be admitted as evidence in this cause. 23. I hereby acknowledge that I have read the proposed judgment and consent to entry of same. Plaintiff Parent STATE OF MISSOURI SS COUNTY OF I, of lawful age, being duly sworn upon his/her oath, states that he/she is the Plaintiff named above; and that the facts stated herein are true according to his/her best knowledge and belief. Subscribed and sworn to before me on. Notary Public 4

5 Defendant Parent STATE OF MISSOURI SS COUNTY OF I, of lawful age, being duly sworn upon his/her oath, states that he/she is the Defendant named above; and that the facts stated herein are true according to his/her best knowledge and belief. Subscribed and sworn to before me on. Notary Public 5

JOINT SIMPLIFIED DISSOLUTION OF MARRIAGE

JOINT SIMPLIFIED DISSOLUTION OF MARRIAGE INFORMATION AND INSTRUCTIONS BOTH PARTIES NEED TO BE PRESENT This brochure is being provided to you along with the necessary forms for filing a joint simplified