Free Affidavit of Separation for Child Custody Template

Affidavit of Separation for Child Custody

Prepared by: [YOUR NAME]
Email: [YOUR EMAIL]


This affidavit is made to formally document the separation of the parties and the resulting custody arrangements for the child/children involved, ensuring clarity and addressing the best interests of the child.


II. Date of Separation and Living Arrangements

I, [YOUR NAME], residing at Chandler, AZ 85224, hereby declare that the date of separation between myself and Alanis Durgan was January 15, 2051.

Following the separation:

  • I have been residing at Chandler, AZ 85224.

  • Alanis Durgan has been residing at Glendale, AZ 85301.

The child, Emily Taylor, born on March 10, 2045, has primarily resided with me since the separation.


III. Care and Custody of the Child

Since the date of separation, I have been responsible for the following:

  • Educational needs: I have ensured enrollment and regular attendance at Springfield Elementary School.

  • Health and medical care: Emily’s medical appointments and expenses have been fully managed and covered by me.

  • Daily care: I have provided for her meals, clothing, and other necessities.

Alanis Durgan has visitation rights and has visited Emily every weekend, as mutually agreed.


IV. Statement of Child’s Best Interests

In my opinion, the current arrangement serves the best interests of Emily because:

  1. She has a stable home environment with access to her school and community.

  2. Her physical, emotional, and educational needs are being met under my care.

I respectfully request that this arrangement be recognized and formalized by the court.


I solemnly affirm that the statements made above are true to the best of my knowledge and belief.


Date: February 5, 2052

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