NO:
DIV.
---------
---
(PETITIONER)
VERSUS
22ND
JUDICIAL
DISTRICT
COURT
PARISH
OF
--------------
(DEFENDANT)
Filed:
--------------
STATE
OF
LOUISIANA
Deputy
Clerk
RULE
TO
ESTABLISH
CUSTODY
WITH
REQUEST
FOR
EMERGENCY
CUSTODY
BY
PARENT
[Initial and complete
th
e following information.
If
there are no initials or information
is
not provided, the court
may not grant
you
relief]
NOW
INTO
COURT
comes , a person
of
----------
--
---
---
the full age
of
majority and domiciled in the Parish/County
of
, State
of
___
_ _
___
who respectfully represents:
1.
Made Defendant-in-rule herein
is
, a person
of
the full age
of
------
-----
Majority and domiciled
in
the Parish/County
of
, State
of
2.
Custody
of
the following minor child(ren) is at issue:
(CHILD ' S
NA
ME)
(DATE
OF
B
IR
TH)
(CH
ILD"
S NAME)
(DA
TE
OF
BIRTH)
(CHILD' S N
AME)
(DATE
OF
BIRTH)
(CHILD'S
NA
ME)
(DA
TE
OF
BIRTH)
(CHILD'S
NA
ME)
(DATE
OF
BIRTH) (CHILD' S N
AM
E)
(DA
TE
OF
BIRTH)
3.
Mover
is
related to the minor children as follows: (describe relationship)
4.
Defendant
is
related to the minor children as follows: (describe relationship)
5.
This court has jurisdiction over this petition because the minor child(ren) is either:
Domiciled in the State
of
Louisiana;
OR
Physically located in the State
of
Louisiana.
6.
This court
is
a court
of
proper venue for this Rule because either:
One
of
the parties is domiciled in this Parish;
OR
This is the parish
of
the last matrimonial domicile.
Revised 81
12
/
]0/
6
7.
The minor child(ren) listed in Paragraph 2 above was: {Initial
ONE
of
the below paragraphs}
Born of/adopted [ circle as appropriate] during the marriage between the Mover
and Defendant;
OR
The parties were never married but [Also initial ONE
of
the below subparagraph.1}:
Mover and Defendant are listed as the parents on the minor child(ren)'s
birth Certificates
{attach a copy],
The Defendant has acknowledged his paternity
of
the child(ren)
[a11ach
a
copy
of
the document};
A Judgment establishing Defendant's paternity was signed by a court
[ attached a copy
of
the Judgment}.
8.
Mover believes it
is
in the best interest
of
the child(ren) that Mover be awarded sole
custody subject to one
of
the following visitation plans for the Defendant:
[Initial only
ONE
of
the.following
and
provide a description
as
requested]
Mover requests that the Defendant be awarded reasonable visitation as
follows:
Mover requests that the Defendant be awarded supervised visitation as
follows:
__
Mover requests that the Defendant not be awarded any visitation, for the
following reason(s):
9.
Mover asks this court grant emergency and immediate custody
of
the minor child(ren)
before a hearing can be held in accordance with Louisiana Code
of
Civil Procedure Article 3945
for the following reasons and by signing this Rule certifies that Mover has
proof
that immediate
and irreparable injury will result to the minor child(ren) before a hearing can be held.
By signing
this pleading, the Mover acknowledges that
if
at a hearing it
is
proven that the minor child(ren) was/were not
in
danger
of
immediate
and
irreparable injury, that Mover may be sanctioned by the court:
10.
Mover certifies that defendant was given notice
of
this request for emergency and
immediately custody
of
the mmor child(ren) on the day
of
, 20 at
o'clock
.m.
of
Mover's
intention
to
-----------
----
present this request.
Mover notified defendant in the following manner: (whether via personal contact, email,
voice mail, etc.) and the contact information used (i.e. telephone number, email address,
etc.):
[Note that
if
this paragraph
is
not completed, the court will
NOT
consider
your
request.for emergency
and
immediate custody
of
the minor child(ren).}
Mover has completed the attached Affidavit which
is
properly notarized.
Revised 81 ! ] ,'2
()
16
11.
[Initial only
ONE
of
the paragraphs below}
OR
OR
Mover
acknowledges the right to seek child support by contacting the Louisiana Child
Support Enforcement Agency and intends to do so.
Mover
requests that Defendant be ordered to pay child support because Defendant has
income or is capable
of
earning sufficient money to contribute to the support
of
the minor
children and asks the Court to order the Defendant to pay child support.
__
No
child support
is
requested.
12.
Other
reliefrequested
by
Mover
[include a
brief
factual statement]:
Mover requests:
[Initial
ONE
of
the.following paragraphs}
___
Each party pay their own costs.
13.
___
Defendant be cast with all costs for the following reason(s):
WHEREFORE
, Mover prays that:
1.
Defendant(s) be served with a certified copy
of
this Rule.
2.
Mover
be granted temporary sole custody
of
the minor child(ren) pending a
hearing.
3.
A Rule to
Show
Cause issue herein ordering the Defendant(s) to appear and show
cause on a date and time to be fixed by this Court why a
judgment
of
custody and child support
(if
requested) should not be awarded as requested herein and any other relief requested by Mover
herein.
By signing below, I do hereby cert(fy that all r~ftheforegoing is true
and
correct to the best
r~f
my
knowledge
and
understand that any
false
statements
may
constitute
perju,y
and
may
subject
me
to being
held
in contempt
<~f
court.
Initials
r~f
Mover
Respectfully submitted,
(SIG
NATU
RE)
(PRINTED
FULL
NAME)
(STR
EET
ADDRESS)
(CITY/
ST
ATE
/
ZIP
CODE)
(TELEPHONE NUMBER)
(FACSIMILE NUMBER)
(EMAIL ADDRESS)
Revised
81 I 21]
()
I 6
(PETITIONER)
VERSUS
NO:
DIV.
--------
zzNo
JUDICIAL
DISTRICT
COURT
PARISH
OF
---
-------------
ST A
TE
OF
LOUISIANA
(DEFENDANT)
Filed:
-------------
Deputy Clerk
VERIFICATION
ST A
TE
OF
[State where signed
and
notarized]
------
-----
PARISH/COUNTY
OF
[Parish/County
wh
ere signed
and
no
tari
z
ed]
BEFORE
ME, the undersigned
Notary
Public, duly commissioned and qualified in this
State and Parish, personally appeared:
PRINTED
NAME
who after being duly sworn, did depose and state that he/she is the
Mover
in the above and
foregoing numbered and entitled cause, has read the same, and that all
of
the allegations
contained therein are true and correct to the best
of
Mover's
knowledge, information, and belief.
SIGN.'\T L
1
RE
SWORN
TO
AND
SUBSCRIBED
before me,
on
this
__
day
of
_____
, 20
NOTARY
PUBLIC,
No.:
Printed Name:
------------
My
Commission
Expires:
___
____
_
Revised
8/ / ]/
]{)
16
APPENDIX 29.0A: APPLICATION FOR
EX
PARTE TEMPORARY CUSTODY ORDER
AFFIDAVIT OF MOVER IN COMPLIANCE WITH LA-C.C.P. ART. 3945{B}
APPLICATION FOR EX PARTE TEMPORARY CUSTODY ORDER
Affidavit
of
Mover In Compliance With La. C.C.P. Art. 3945B
DOCKET NUMBER:
Petitioner
Versus
PARISH OF
Respondent
PARISH OF
STATE OF LOUISIANA
BEFORE
ME,
thi
s
da
y
of
'
---
20
'
personally came a
nd
a
pp
ea
red
who, after being duly sworn, did depose as
foll
ows:
I have read the allegation
of
the petition/motion and they are true and accurate
to
th
e
be
st of my knowledge,
in
form
ation a
nd
belief.
Imm
ediate a
nd
irreparable injury w
ill
result
to
the child or children named
in
the attached petition/moti on before the
defendant/
re
spondent herein or his/her attorney can
be
heard
in
opposition because
of
the follo w
in
g SPECIFIC
FA
C
TS:
(Attach supplemental pages,
if
necessary)
Signed by
(Petitione
r)
SWORN TO AND SUBSCRIBED before
me
, Notary Public,
on
this
__
day
of
, 20
, at
, Louisiana.
Signed by Notary Public
Printed Name:
Bar/ID No.:
Revised 81
12
/2016
(PETITIONER)
VERSUS
(DEFENDA1'T)
Filed:
NO: DIV.
---------
22ND
JUDICIAL DISTRICT COURT
PARISH OF
---
--------------
STATE OF LOUISIANA
Deputy
Clerk
ORDER AND RULE TO SHOW CAUSE
Considering the above and foregoing Rule to Establish Custody and Request for Emergency Custody by
Parent:
IT IS HEREBY ORDERED that Mover,
____________
is
granted
emergency
ex
parte
custody
of
the following minor child(ren) pending further order
of
this Court:
(C
HI
L s
NAME)
(D
A
TE
OF
BIRTH)
(C
HILD
' S
NAME)
(DATE
OF
BIRTH)
(C
HILD·
s
NAME)
(D
ATE
OF
BIRTH)
(C
HILD
'S
NAME)
(DATE
OF
BI
RTH)
(C
HIL
D' S
NAME)
( DATE
OF
BIRTH)
(C
HIL
D· s N
AME)
(DATE
OF
BIRTH)
IT IS HEREBY FURTHER ORDERED that the
--
-----
---
----
Sheriffs
Office/Police Department
is
authorized and directed to immediately transfer physical
custody
of
the above identified minor child(ren) to Mover,
__
_
_______
__
_
IT
IS
HEREBY FURTHER ORDERED that Defendant-in-Rule,
------
- -
--
1 S granted visitation with the minor child(ren) pending further order
of
this Court
as
follow:
IT
IS
HEREBY FURTHER ORDERED that a rule nisi issue herein ordering the Defendant to
show cause
on
the
___
day
of
___________
,
20
at
___
_ o'clock .m.
why Defendant should not
be
awarded the custody or visitation
of
the child which hearing shall
be
held
not more than
th
i1iy
(3
0)
days after the signing
of
this ex parte order
of
temporary custody.
IT
IS
HEREBY FURTHER ORDERED that the Defendant,
------
--
- -
[Print De
fend
a
nt"
s N
a111
eJ
show cause on the _ _ day
of
__
__
_
____
, 20 , at
___
o' clock .m. before
the Hearing Officer and on the
__
day
of
_________
, 20 , at _ _ _
o'clock
_ .m. before the Judge why the following
relief
sought in the Rule should not be granted as
prayed
for.
Signed in Covington/Franklinton, Louisiana, this _ day
of
________
, 20
JUDGE
PLEASE SERVE:
(D
EFE
ND
AN
T'
S FU
LL
NA
ME)
(
ST
RE
ET
ADD
R
ES
S)
(C
IT
Y/
ST
ATE/Z
IP
CO
DE
)
(D
EFEN
DANT'S
PH
ONE
NUM
BE
R)
Revised 811 Jl]D 16
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