The Child Care or Custody Disclosure Affidavit

You do NOT need to file the Affidavit if the case is:

• a delinquency case, like a complaint that claims the child has broken the law.

You DO have to file the Affidavit in these cases if a child is involved:

• Complaint for Divorce,
• Joint Petition for Divorce
• Complaint for Separate Support,
• Complaint for Support-Custody-Parenting Time,
• Complaint to Establish Paternity
• Guardianship of Minor,
• Abuse Prevention,
• Care and Protection,
• Grandparent Visitation,
• Child Requiring Assistance,
• Adoption,
• Change of Name of Minor Child, and
• Any other case that is about the care or custody of your child.

You must file this Affidavit at the same time you file the other forms in the case. For example, when you file

• a complaint,
• a petition,
• an application for a Child Requiring Assistance,
• an answer, 
• a counterclaim, or
• an objection.

If any information has changed since the last Affidavit was filed, you must file a new, updated Affidavit.

File it with the Clerk-Magistrate or Register of Probate at the court that is handling this case. You can file it in person, by mail, or by e-filing if allowed for your case type.

You do not have to put the children’s address on the Affidavit if:

• The address is a shelter for victims of abuse and their children,
• You believe that you or the children are in danger of physical or emotional abuse, or
• You are filing a complaint for a 209A Abuse Prevention Order.

If it is not safe to put these addresses on the Affidavit for any of these reasons, you can ask the court to keep the addresses confidential.

To ask the court to keep your addresses confidential:

1. Check the 1st or 2nd box at the top of Page 2 of the Affidavit.
2. Leave empty the boxes for addresses in sections below on Page 2, and
3. Prepare and file a Motion to Impound and ask for the court’s permission not to list your address.

You have to give a copy only of the 1st page of the Affidavit to all other parties in the case.

Under:

• Court Department: Check the box for the type of court you are in.
• Court Division or County: Put the county you are in or if it is District Court in Boston, put where the Court is.
• Docket Number: If you have a docket number, you can put it here. If this is the 1st complaint you might not have one.
• Case Name: If your case has a name you can put it in, otherwise you can leave it blank.

Next, read "Important Instructions to Read Before Completing this Affidavit Form".

• If you have a lawyer, the lawyer will fill in their name. 
• Otherwise, check “I am a party in this case” and write your name.

Put the name of every child involved in the case next to a letter. If there are more than 4 children involved in this case, check the box at the bottom of Page 1 and fill in the supplemental Affidavit form to add more children. 

You can ask permission to not include certain addresses on the form if you plan to file a Motion to Impound and one of the following applies: 

• You are staying at a shelter for victims of abuse and their children. (Check box 1)
• You believe you or the children are in danger of physical or emotional abuse. (Check box 1)
• You are filing a complaint for a 209A Restraining Order (Check box 1) Or 
• If the affidavit says that 1 or more children were adopted, and you would like to ask that certain addresses be kept confidential. (Check box 2)

If you checked box 1 or 2, you can skip writing the addresses for the child/children below while you wait to hear whether your Motion to Impound was allowed.

If you checked the box “The above DOES NOT apply to me. I will fill in the required section below” go to the next section.

If you did not check boxes 1 or 2 in the section above, do this step.

Look at the letter next to each child’s name on Page 1. 

Put each child’s address next to the same letter as on Page 1 that is next to their name.

If you have more than 4 children, you do this on the supplemental form too. 

Remember

If you check the box to ask that addresses be kept confidential, do not fill out the address information below. 

At the top of Page 3, it asks: Has there ever been a care or custody case that involves a child you named on this form?

If no, check the 1st box.

If yes:

• If you have not taken part in a care or custody case involving the children, but know of one: Check the 2nd box. 
• If you were the plaintiff or defendant, witness, or another role: Check the 3rd box.

If you checked the 3rd box, write in the section below:

• The name of the court (Boston Municipal Court, Juvenile Court, District Court, Probate & Family Court, or Superior Court).
• The docket number of the case that involved the child. If you don't have the docket number, put the type of case.
• In the Open/Closed column, check over whether the case is still active or not.
  • If the case is still active, write "Open."
  • If the case has gone to judgment, write "Closed."
• In the last column, put in the letter that shows your role in the case:
  • “P” for party, if you were the plaintiff or defendant, 
  • “W” for witness, or
  • “O” for other.

Write in the lines below whether any attorneys, guardians ad litums, probation officers, court investigators or court evaluators were appointed in any of the cases involving any of the children listed on your form. 

Look to the letter that corresponds to each child on Page 1 and write whether there was any such involvement for each child and the name of the person appointed (if you know it). 

Below, list any other parties who were involved in the care or custody of any of the children. Write their addresses if you know them. 

At the bottom of Page 3, write your full name, phone number, email address, and home address.

Sign your name where it says “Signature” and write the date.

If you have a lawyer, they must fill out the part below the Signature line.