STATE OF LOUISIANA

PARISH OF __________

AFFIDAVIT OF CUSTODIAL PARENT SEEKING RETURN OF

CHILD KEPT IN VIOLATION OF COURT ORDER

BEFORE ME, the undersigned notary public, personally came and appeared _____________________________herein called affiant, who after being duly sworn did depose and say that affiant is the custodial parent of _____________________by virtue of the judgment of the ______Court, Parish of _____________, State of Louisiana, bearing Docket Number _____________, in the matter entitled _____________________________________________________a certified copy of which is attached to this affidavit.

Affiant declares that the attached custody and visitation order is true and correct.

Affiant summarizes the status of any pending custody proceedings as follows:

The child is being held in this parish by _________________________ who has refused to return the child/removed the child from the custodial parent in violation of the attached custody order.

Affiant further declares that the following facts concerning the removal of/failure to return the child are true to the best of affiant’s knowledge, information, and belief:

Affiant desires the return of the child and desires the issuance of a civil warrant directed to law enforcement authorities to return the child to the custodial parent pending further order of the court having jurisdiction over the matter, as authorized by LSA—R.S. 9:343.10.

The child is currently being held at ______________________________________.

A picture of the child is attached.

____________________________________

AFFIANT

SWORN TO AND SUBSCRIBED, before me, this ________day of ___________199___, in my office in _________________________, Louisiana.

_______________________________

NOTARY PUBLIC