SAMPLE DECLARATION / AFFIDAVIT

Double-space everything from the first number, down to the end, and indent paragraphs by ten spaces.



Name:

Address:

Phone:

Email:

 

Declaration of Facts



          I, ______________________________, state:
                              (Your Name)

          1. I am the mother/father of three children: (Names of kids.)



          2. This declaration is being written (state reason for writing the declaration of facts - for example, "in support of a motion to return children to mother" or "in support of a national class action lawsuit" or "to let the public know about the injustice done to us in (name of county) Superior Court".



          3. This is in reference to (Case Name, Case Number, Date Filed and the name of the court.)


          4. (Just state facts one at a time... I'll give some examples.) On June 2, 2002 I let my children go to school as usual and while they were there a CPS employee interviewed them without letting me know first.


          5. My children were detained by the CPS employee and I was not notified by the school so by 4:30 when they didn't come home from school I was worried about them and called the school to find out if they knew anything.


          6. When I called the school nobody wanted to talk to me and they handed the phone to three different people and put me on hold for fifteen minutes.


          7. When the principal got on the line he told me that CPS took my three kids because my son, Johnny, had a bruise on his arm and said I did it.

          8. The bruise happened because he climbed the apple tree and then got scared and couldn't get down. I climbed up there and grabbed him and had to lower him down by his arm and that's how he got bruised.


          9. By the time I got off the phone with the principal of the school, it was only a few minutes before five PM so I called CPS but only got a recording and nobody would answer. It was Friday and I couldn't get through to them all weekend and even went to the office twice but it was closed. That was why I didn't check on them for two days - not because I didn't care which is what the worker, Judy Jones, made it sound like in court on Wednesday.


          10. I haven't seen my children in three weeks because they say I'm a danger to them. This is not true. In fact most of what they say about me is not true which is why I'm contesting the charges and asking for a full trial to make them try to prove their untrue statements.

          11. The CPS employees I talk to on the phone are extremely rude to me. They are Judy Jones and her supervisor, Mr. Smith. Judy Jones said very sarcastically: "You should never have had kids if you were going to hurt them. People like you make me sick." This woman, Judy Jones, won't believe this happened in the apple tree.

          12. I am requesting a court order for the return of my children immediately.

 

[NOTE: This last part should state the exact words used, just change the date and place to match your circumstance.]


          Executed January, 1, 2003 Town, State


          I declare under penalty of perjury that the foregoing is true and correct.



                              _________________________________
                                            (Your Name)