1Each petition for temporary or concurrent custody of a minor child must be verified by the petitioner, who must be an extended family member, and must contain statements, to the best of the petitioner’s knowledge and belief, providing:39(1) 40The name, date of birth, and current address of the child.
51(2) 52The names and current addresses of the child’s parents.
61(3) 62The names and current addresses of the persons with whom the child has lived during the past 5 years.
81(4) 82The places where the child has lived during the past 5 years.
94(5) 95Information concerning any custody proceeding in this or any other state with respect to the child.
111(6) 112The residence and post office address of the petitioner.
121(7) 122The petitioner’s relationship to the child.
128(8) 129If concurrent custody is being requested:135(a) 136The time periods during the last 12 months that the child resided with the petitioner;
151(b) 152The type of document, if any, provided by the parent or parents to enable the petitioner to act on behalf of the child;
175(c) 176The services or actions that the petitioner is unable to obtain or undertake without an order of custody; and
195(d) 196Whether each parent has consented in writing to the entry of an order of concurrent custody.
212A copy of the written consent and any documents provided by the parent to assist the petitioner in obtaining services must be attached to the petition.
238(9) 239If temporary custody is being requested, the consent of the child’s parents, or the specific acts or omissions of the parents which demonstrate that the parents have abused, abandoned, or neglected the child as defined in chapter 39.
277(10) 278Any temporary or permanent orders for child support, the court entering the order, and the case number.
295(11) 296Any temporary or permanent order for protection entered on behalf of or against either parent, the petitioner, or the child; the court entering the order; and the case number.
325(12) 326That it is in the best interest of the child for the petitioner to have custody of the child.
345(13) 346The period of time for which the petitioner is requesting temporary custody, including a statement of the reasons supporting that request.
367(14) 368Any other provisions that are related to the best interest of the child, including, but not limited to, a reasonable plan for transitioning custody.
