Introduction

I, [Your Name], currently residing at [Your Address], in the County of [County], State of [State], do solemnly affirm and declare under penalty of perjury:

Statement of Facts

1. I am the father of [Child's Name], born on [Child's Birthdate].

2. The other parent of the child is [Mother's Name].

3. Our child custody arrangements are as follows:

• Primary Custody: I, [Your Name], have been granted primary physical custody of the child, while [Mother's Name] has visitation rights. The child will reside with me for the majority of the time.

• Visitation Schedule: [Mother's Name] shall have visitation rights on alternating weekends, from Friday evening to Sunday evening. Additionally, visitation shall be granted on [Day] evenings, as well as during school breaks/holidays as outlined in the attached schedule.

• Holiday Schedule: Holidays and special occasions shall be alternated between the parents.

• Transportation: Both parents shall be responsible for transporting the child to and from visitation exchanges.

4. Both parents agree to adhere to the terms outlined in this affidavit and understand that failure to comply may result in legal consequences.

5. Any modifications to this custody and visitation agreement shall be made in writing and signed by both parties.

Oath and Affirmation

I affirm that the information provided in this affidavit is true and accurate to the best of my knowledge.

Signature

Signed and affirmed under oath this [Date] day of [Month], [Year] in [County], [State].

[Your Name]

Sworn to and subscribed before me this [Date] day of [Month], [Year].

[Notary Public Name]

My Commission Expires: [Notary Expiration Date]

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