IN THE CIRCUIT COURT OF JACKSON COUNTY, MISSOURI
IN THE MATTER OF: )
, ) Estate No.
The following information is submitted pursuant to R.S. Mo. § 452.480, in support of the
Petition for Limited Guardianship of the above-named minor.
1. Said minor is presently living with Name and address.
2. Said minor has lived in Jackson County, Missouri for the six months preceding the filing
of the Petition for Limited Guardianship.
3. I have not participated in other litigation concerning the custody of this child in this or
any other state.
4. I have no information of any custody proceeding concerning this child pending in a court
of this or any other state.
5. I have no knowledge of any person, not a party to these proceedings, who has physical
custody of this child or claims to have custody or visitation rights with respect to this
The undersigned swears that the matters set forth in the foregoing Affidavit are true and
correct to the undersigned’s best knowledge and belief, subject to penalty for making a false
affidavit or declaration.
Date , Petitioner
STATE OF MISSOURI )
COUNTY OF )
Subscribed and sworn to before me, a Notary Public, this ____ day of
My Commission Expires:_____________ ____________________________________