UCCJEA Jurisdictional Affidavit

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00 CASE CAPTION

Filing County *

File No. (if assigned)

Plaintiff / Petitioner Name *

Defendant / Respondent Name *

01 AFFIANT INFORMATION

Affiant Full Legal Name *

Relationship to Child(ren) *

Affiant Current Address *

02 CHILD INFORMATION & RESIDENTIAL HISTORY

For each child, provide current information and ALL addresses where the child has lived during the past 5 years (G.S. 50A-209). Add at least one residence entry per child.

03 OTHER CUSTODY PROCEEDINGS

Are there any other custody, visitation, or adoption proceedings currently pending in any court anywhere? *

04 OTHER PERSONS WITH CUSTODY CLAIMS

Does any person (other than the parties) claim custody of or visitation rights with the child(ren)?

05 NC JURISDICTION BASIS (G.S. 50A-201)

Check ALL that apply. At least one must apply for NC courts to have jurisdiction.

NC is the child's "home state" — the child has lived in NC for at least 6 consecutive months immediately before this custody proceeding began (or since birth if less than 6 months old) NC was the child's home state within the last 6 months, the child is now absent from NC, and a parent or person acting as parent still lives in NC No other state has home-state jurisdiction AND the child has significant connections to NC AND substantial evidence concerning the child's care, protection, training, and relationships is available in NC The child is present in NC AND has been abandoned OR it is necessary in an emergency to protect the child because the child (or a sibling or parent) is subjected to or threatened with mistreatment or abuse

06 CERTIFICATION UNDER PENALTY OF PERJURY

I, the Affiant, declare under penalty of perjury that the foregoing information is true and correct to the best of my knowledge. I understand that making false statements in this affidavit may subject me to criminal penalties under G.S. 14-209.

Date Signed

City / County Where Signed

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STATUTORY REFERENCE

G.S. 50A-209UCCJEA — Affidavit required

G.S. 50A-201NC home-state jurisdiction

G.S. 50A-204Temporary emergency jurisdiction

28 U.S.C. 1738APKPA — Federal full faith and credit

WHAT IS THE UCCJEA?

The Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) is adopted in all 50 states and DC — it prevents competing custody orders from different states
This affidavit must be filed with EVERY custody complaint, petition, or motion — no exceptions
The 5-year residence history helps the court identify whether another state might have concurrent jurisdiction
If a child has lived in multiple states in the past 5 years, the affiant must list EACH state and address

HOME STATE RULE

"Home state" = the state where the child lived for 6 consecutive months immediately before custody proceedings began
For children under 6 months old: home state = state where child has lived since birth
If two states could both qualify, priority goes to the state where the child most recently lived for 6 months
If no state qualifies, significant connections jurisdiction applies