Child Care or Custody Disclosure Supplemental Affidavit (Trial Court Rule IV)

Jurisdiction: United States — Massachusetts

What is a Child Care or Custody Disclosure Supplemental Affidavit (Trial Court Rule IV)?

A Child Care or Custody Disclosure Supplemental Affidavit tells the court about any new or changed information related to a child’s residence, care, custody, or related court cases. It supplements your original Affidavit Disclosing Care or Custody Proceedings. You use it to update the court when something meaningful changes after you file the first affidavit. The court uses this information to confirm its authority to make orders and to avoid conflicting orders from other courts.

This form is a sworn statement. You sign under the penalties of perjury. You report where the child has lived, who the child lived with, and any other cases involving the child. If new cases arise or address change, you file the supplemental affidavit to keep the record accurate.

Who Typically Uses This Form?

You use this form if you are involved in a Massachusetts case that affects a child’s custody, parenting time, guardianship, or placement. Common filers include:

• A parent in a divorce, separation, paternity, or modification case.
• A guardian or proposed guardian.
• A party in a care and protection, adoption, or termination case.
• A party seeking or responding to a restraining order that involves child custody.
• Anyone asking the court for an order that will affect a child’s living arrangements or custody.

Both self-represented parties and attorneys use the form. Each party files their own affidavit, because each has a duty to disclose what they know.

Why Would You Need This Form?

You need the supplemental affidavit when new facts arise after your first affidavit, including:

• The child moves to a new address.
• A new case is filed in any court that involves the same child.
• An existing case changes status or outcome, such as a new order or dismissal.
• A person not previously identified now claims custody or visitation rights.
• You learn information you did not know when you filed the original affidavit.

Filing this update helps the court confirm it has jurisdiction and prevents contradictory orders. It also ensures the court can coordinate with other courts if needed.

Typical Usage Scenarios

Imagine you filed for divorce with a minor child and provided five years of address history in your original affidavit. Three months later, the other parent files a custody case about the same child in another state. You would file a supplemental affidavit to report that new case.

Or, your child moves to a different school district with your consent. You would update the court with the new address and the date of the move.

In a guardianship, the proposed guardian learns of a prior juvenile case involving the child. The guardian files the supplemental affidavit to disclose that older case, even if it is closed.

If you have a 209A restraining order that includes custody terms, and the court modifies those terms, you update your family case with a supplemental affidavit so the judge sees the change.

The supplemental affidavit is not about arguing your position. It is about reporting facts that help the court make legally valid orders.

When Would You Use a Child Care or Custody Disclosure Supplemental Affidavit (Trial Court Rule IV)?

You use a supplemental affidavit any time new, relevant information arises after your initial disclosure. For example, the child’s residence changes, or you learn of a related case in another court. If the child starts living with a different adult, you update the court. If a juvenile court issues a care and protection order, you disclose it. If a parent files a custody case in another state or another Massachusetts county, you report that promptly.

As a parent in a divorce, you file this when your child relocates, even across town. As a guardian, you file if an adoption petition begins. As a party in a modification or contempt case, you file if any new restraining orders affect parenting time. If you are a self-represented litigant, you file it as soon as you learn something that changes the status described in your first affidavit. Attorneys should file it immediately upon discovery of new facts that the court needs to know.

Use this form in Probate and Family Court cases like divorce, paternity, custody, adoption, and guardianship. You also use it in related matters in other departments when custody or placement could be affected. If the juvenile court issues an order that changes custody, you disclose it here. If the district or Boston Municipal Court enters a protective order involving custody, you update your family case. The key is this: if the new information could affect the court’s custody decisions, you should file the supplemental affidavit.

There is no need to file a supplemental affidavit for minor, irrelevant changes. Focus on updates about:

• The child’s residences and caretakers.
• Existing or new cases in any court involving the child.
• Anyone asserting custody or visitation rights.
• Any new orders that affect custody or parenting time.

Timely updates reduce delays and prevent duplicate or conflicting orders. When in doubt, file the supplemental affidavit. It is short, factual, and protects your case from jurisdictional problems.

Legal Characteristics of the Child Care or Custody Disclosure Supplemental Affidavit (Trial Court Rule IV)

This form is a sworn affidavit. You sign it under the penalties of perjury. That signature makes it legally binding as to the truthfulness of what you state. The court relies on it to assess jurisdiction and to identify related cases and orders. False statements can result in sanctions, adverse credibility findings, or referral for prosecution.

The form does not grant custody by itself. It does not create rights. It is an evidentiary document that informs the court about the child’s residence history and related proceedings. The court then uses that information to determine whether it can issue or modify custody orders. The affidavit supports compliance with governing jurisdictional rules for child custody cases. It helps prevent courts in different places from issuing conflicting orders about the same child.

Enforceability comes from three features. First, your signature under the penalties of perjury. Second, the court’s authority to require complete and truthful disclosures in cases that affect children. Third, the court’s power to sanction noncompliance. If you omit a known case, or conceal a child’s location without a safety basis, the court can strike filings, delay hearings, impose fines, or issue other appropriate orders. In serious cases, the court can refer the matter for investigation.

The court also treats safety with care. If revealing an address poses a risk to a child or a party, you can ask the court to limit public access to the sensitive detail. The court can order that specific information be kept from the public case file, while still allowing the judge to see it. If you need protection, you should request it at the same time you file the supplemental affidavit.

You must serve other parties with the supplemental affidavit unless the court orders otherwise for safety reasons. Proper service ensures all parties share a common set of facts about the child’s residence, related cases, and potential claims to custody. That transparency allows the court to issue orders that are both lawful and practical.

Finally, the affidavit requires precision. The court expects exact addresses, dates, case numbers, court locations, and names of caretakers. Guessing or rounding dates can lead to confusion. If you do not know something, you should say so clearly, explain the gap, and update the court when you learn more.

How to Fill Out a Child Care or Custody Disclosure Supplemental Affidavit (Trial Court Rule IV)

Follow these steps. Keep your statements factual and complete. Print clearly if you use a paper form. If you need more space, attach a sheet and label it.

1) Gather the information you will need

• Full legal names of each child covered by your case.
• Dates of birth for each child.
• Current and past addresses for the last five years, with exact move-in and move-out dates.
• Names and relationships of each adult the child lived with at each address.
• Names and addresses of any person who claims custody or visitation rights.
• Details for any related case: court name, location, docket number, parties, type of case, and status.
• Copies of any orders from other courts that affect custody or parenting time.
• Your Massachusetts case docket number, if already assigned.

2) Complete the case caption

• Court name: Identify the correct division of the Probate and Family Court hearing your case. If your case is in another department, list that court.
• Case name: Use the names of the parties as they appear on your main case.
• Docket number: If you do not have a docket number yet, leave it blank and fill it in later.

3) Identify the filer

• Check whether you are the plaintiff/petitioner, defendant/respondent, guardian, or other party.
• Provide your full name, mailing address, and contact information. If disclosure of your address poses a safety risk, ask the court for permission to keep it confidential and provide an alternative mailing address if allowed.

4) List each child covered by your case

• Provide the full legal name and date of birth for each child.
• Use one line per child. If you have more children than the form allows, attach a page labeled “Attachment A — Children.”

5) Provide five-year address history for each child

• For each child, list every address where the child has lived during the last five years, including the current address.
• For each address, include:
• Street address, city or town, state, and zip code.
• Start and end dates the child lived there. Use month/day/year if you can.
• The names of the adults who lived with the child at that address.
• The relationship of each adult to the child (for example, mother, father, grandparent, guardian).
• If the child is under five years old, provide address history since birth.
• If you cannot recall exact dates, provide the best specific dates you can, and note that they are approximate. Then update the court when you verify them.

6) Disclose other cases involving the child

• State whether there are any other cases in any court that involve custody, parenting time, guardianship, placement, adoption, juvenile proceedings, protective orders, or similar matters for the child.
• For each case, list:
• The court name and location.
• The docket or case number.
• The parties involved.
• The type of case (for example, custody, guardianship, restraining order, juvenile case).
• The current status (for example, pending, dismissed, final judgment entered).
• Any orders that affect custody or parenting time, with the dates of those orders.
• If you learn of a new case after filing this supplemental affidavit, you must file another supplemental affidavit to disclose it.

7) Identify anyone claiming custody or visitation

• State whether you know of any person, not already listed as a party, who claims custody or visitation rights to the child.
• Provide full names, addresses, and the basis of each person’s claim, if known.
• If a relative or prior caretaker is asserting rights, disclose what you know, even if you disagree.

8) Report any agencies involved

• If a child welfare agency has taken action that affects custody or placement, disclose that involvement.
• Provide the agency name, office location, and the nature of the involvement, such as a care and protection petition or placement.
• If there are confidentiality concerns, ask the court for guidance on how to disclose safely.

9) Explain recent changes since your original affidavit

• Use the space provided to explain what has changed since you filed your original affidavit.
• Focus on new addresses, new cases, changed orders, or new claims to custody or visitation.
• Include dates and attach copies of any new orders if you have them.

10) Attach supporting documents

• Attach copies of relevant orders from other courts, if available.
• If you need more space for address history or case listings, attach labeled sheets:
• “Attachment B — Child Residence History”
• “Attachment C — Related Cases and Orders”
• Put the case caption and docket number at the top of each attachment.

11) Request confidentiality if needed

• If disclosing a child’s or your address would create a safety risk, ask the court to keep that information from the public file.
• File a separate request to limit access to sensitive information, and provide the court with the full details under seal if required.
• Do not omit required information without making a formal request for protection.

12) Review for accuracy

• Check names, dates of birth, and addresses for every child.
• Confirm court names, locations, and docket numbers for related cases.
• Make sure your explanation of changes is clear and specific.
• Correct any mistakes before signing.

13) Sign under the penalties of perjury

• Read the declaration carefully. You are swearing that the information is true and complete to the best of your knowledge.
• Sign and date the form. Print your name clearly below your signature.
• No notary is required for this affidavit unless the specific form you use states otherwise.

14) Make copies

• Make at least two copies: one for you, one for each other party, and one for the court if the court requires paper filing.
• Keep a copy with your records and bring a copy to any hearing.

15) File with the court

• File the original supplemental affidavit with the same court and case where your child-related matter is pending.
• If you are e-filing and your case type allows it, file electronically and follow the system prompts.

16) Serve other parties

• Serve each other party with a copy of the supplemental affidavit.
• Use a permitted method for service in your case. Common options include first-class mail to the address on file or electronic service if allowed.
• Keep proof of service. File a certificate of service with the court if required.

17) Update promptly as new information arises

• If anything changes again, file another supplemental affidavit right away.
• Do not wait for a hearing or an order to update. The court needs timely, accurate information to make valid decisions.

Practical tips as you complete the form:

• Be complete, not selective. You must include all related cases you know about, even if you think they are minor or closed.
• Use exact dates and addresses where possible. If you are not certain, say so, and explain how you will confirm and update.
• If you share custody, coordinate with the other parent if doing so is safe. Conflicting disclosures can cause delays.
• If the child has lived in more than one state in the last five years, make sure you include those addresses and dates.
• If a case exists in another state or county, attach copies of orders if you have them and identify the court precisely.

By keeping your disclosure current, you help the court confirm jurisdiction and issue orders that will be recognized and enforced. You also reduce the risk of conflicting orders, which can create confusion for schools, doctors, and law enforcement. Most problems arise from missing or outdated information. The supplemental affidavit solves that problem and moves your case forward on solid ground.

Legal Terms You Might Encounter

Affidavit means a written statement you sign under oath. By signing this form, you swear the information is true. False statements can bring penalties.

Party means anyone involved in the case, like you or the other parent. The form asks for details about all parties with custody or caretaking roles.

Person acting as a parent means someone who is not a parent but has cared for the child or claims custody rights. This can include relatives or other caregivers. You must disclose these people if they have cared for the child or claim rights.

Legal custody means who has the right to make major decisions for the child. Physical custody means where the child lives day to day. The form helps the court see who has done what and where the child has lived.

Child’s home state usually means where the child lived for the six months before the case started. This matters because it helps the court decide if it has the power to make custody orders. Your residence history in the form supports this decision.

Jurisdiction means the court’s power to hear and decide your case. The court uses your disclosures to determine if it can issue custody orders. Clear, complete information helps avoid delays.

Pending proceeding means any open case involving the child, such as custody, guardianship, or protection matters. You must list all of them, even in other states. This prevents conflicting orders and guides the judge on next steps.

Protective order means a court order to protect a person from abuse, harassment, or threats. If a protective order exists, you should say so in the form. You can also ask the court to keep sensitive contact information confidential.

Impoundment or confidentiality means keeping parts of your filing out of the public file. If sharing an address risks harm, you can ask to impound that information. The form allows you to note confidentiality concerns and follow up with a separate request.

Penalty of perjury means you can face serious consequences for false statements. When you sign this affidavit, you declare the facts are true to the best of your knowledge. Take time to verify every detail before you sign.

FAQs

Do you need to file this if nothing has changed?

If the court asks for a supplemental affidavit, you file it even if nothing changed. If nothing changed since your last filing, say so clearly. If the court does not require it and nothing changed, you may not need to file. If you are unsure, ask the clerk for guidance on the local practice.

Do you include addresses if you fear harm?

You can ask the court to keep addresses confidential. Write “confidential” where the form asks for an address and file a request to impound that information. Provide a safe method for court contact. If you already have a confidentiality order, note that on the form.

Do you list cases from other states or different courts?

Yes. Include any case involving the child, even if it is in another state or a different division. Add case numbers and locations if you know them. If you do not know a detail, write what you do know and explain your effort to find the missing information.

Do you need to notarize your signature?

Most versions of this affidavit are signed under the penalties of perjury without notarization. If your form includes a notary section, you must sign in front of a notary. Read the signature block before you sign. Follow the instructions on your specific form.

Do you have to serve the other parent or parties?

Usually yes. After filing, you provide a copy to all parties unless the court orders confidentiality for some details. Use an approved method of service. Keep proof that you sent or delivered the form.

How many years of residence history do you provide?

Provide the full residence history requested by the form. Most custody disclosure forms ask for the past five years. If the child is younger than five, list the entire life of the child. Use additional pages if needed.

Do you include caregivers who only helped temporarily?

Yes, if they had significant caretaking or claim custody rights. Include anyone who lived with the child and acted like a parent, even if they are not a parent. Give names, addresses, and dates as best you can.

How do you fix a mistake after filing?

File an amended supplemental affidavit. Label it “Amended,” correct the errors, and re-date your signature. Provide copies to the other parties. Keep a copy of both the original and amended versions for your records.

Checklist: Before, During, and After the Child Care or Custody Disclosure Supplemental Affidavit (Trial Court Rule IV)

Before signing

• Case caption information: court, division, names of parties, and docket number.
• Full names and dates of birth for each child involved in the case.
• Current addresses for the child and all parties, unless confidential.
• Five-year residence history for each child, with month and year for each move.
• Names of adults the child lived with at each address, and relationship to the child.
• Details for any pending or past custody, guardianship, protection, or adoption cases.
• Names of anyone who claims custody or visitation rights, and their contact details.
• Protective order information, including case numbers if available.
• Any existing confidentiality or impoundment orders that affect addresses.
• A safe contact method for you if you request address confidentiality.
• Extra paper for attachments if the form fields are too small.

During signing

• Check the spelling of all names, including middle names and suffixes.
• Confirm each child’s date of birth and every address date range.
• Make sure every “yes/no” question is marked clearly with only one choice.
• Use “unknown” only when necessary and explain what you did to find the answer.
• Attach additional pages when needed and label each with the case caption.
• Number the pages of your attachments and reference them in the form.
• Review for conflicting dates, gaps in the timeline, or duplicate entries.
• Do not leave required fields blank. Write “none” or “N/A” when appropriate.
• Sign and date under the penalties of perjury. Print your name under your signature.
• If a notary is required, sign only in front of the notary and bring ID.

After signing

• Make at least two copies: one for the court and one for your records.
• File the original with the court clerk for your case.
• Serve copies on the other parties as the court requires.
• If you requested confidentiality, confirm the court addressed it before service.
• Keep proof of filing and proof of service for your records.
• Store a clean copy with your case documents and hearing notices.
• Calendar any follow-up hearing dates or deadlines set by the court.
• Update the affidavit if any information changes before the next hearing.
• Bring a copy to every court appearance for quick reference.

8. Common Mistakes to Avoid

Leaving gaps in the five-year residence history

• Consequence: The court may delay orders or question jurisdiction.
• Don’t forget: List every address with start and end months and years.

Omitting out-of-state or prior court cases

• Consequence: The court may doubt your disclosures or impose sanctions.
• Don’t forget: Include all custody, guardianship, and protection matters anywhere.

Listing “unknown” without explanation

• Consequence: The judge may question your effort and credibility.
• Don’t forget: Write what you do know and explain how you tried to find missing details.

Exposing a confidential address

• Consequence: Safety risks and possible violation of court protections.
• Don’t forget: Ask to impound sensitive information and provide a safe contact method.

Failing to update when facts change

• Consequence: Noncompliance, delays, or adverse inferences.
• Don’t forget: File an amended supplemental affidavit as soon as you learn of changes.

What to Do After Filling Out the Form

Review your entries one last time. Confirm the child’s address history covers the required period. Check that every relevant case is listed. Make sure your signature and date are in place, and that a notary signed if your form demands it.

File the original with the court. You can file it with your complaint or motion, or as the court directs. If you complete the form after your first filing, submit it as soon as possible. Ask the clerk how to ensure it is placed in the correct file.

Serve other parties. Unless the court orders confidentiality, provide a copy to the other parent and any other party. Follow accepted service methods. Keep proof of service with your file. If parts are impounded, serve only the allowed version.

Confirm any confidentiality or impoundment orders. If you requested confidentiality for addresses or contact information, ask the clerk to confirm the judge’s action. Do not serve or share a confidential address unless the court allows it.

Bring the affidavit to hearings. The judge may ask about addresses, prior cases, or caretaking history. Use your affidavit to answer questions clearly. If a detail is disputed, explain your records or attachments.

Monitor for changes. Update your affidavit if anything changes. New addresses, new cases, or new caretakers require a fresh supplemental filing. Label the new document “Amended” or “Supplemental,” and include the filing date.

Keep your records organized. Store a copy of your filed affidavit, attachments, proof of service, and any orders in one place. Note the dates for every filing. This helps you answer future questions quickly.

Prepare for jurisdiction questions. The court may review where the child lived and whether another court is already handling custody. Be ready to discuss your timeline and any overlapping cases. Stick to facts, not arguments.

Use addenda when you need more space. Residence histories and case lists often exceed the form space. Attach labeled pages with the case caption. Cross-reference them in the form fields.

If you find an error, correct it promptly. File an amended supplemental affidavit as soon as you spot the issue. Serve it on the other parties. Bring a copy to the next hearing. Document what changed and why.

If service is difficult, document your efforts. If you cannot find a party, keep notes of each attempt. Ask the clerk about options the court may allow in such situations. Follow any instructions you receive in writing.

Stay consistent with other filings. Make sure the names, dates, and addresses match your complaint or motion. Correct any mismatch with an amended filing. Consistency builds credibility.

Ask the clerk about next steps. After you file, confirm whether the court needs anything else. Ask about hearing dates, deadlines, and whether you must bring original attachments. Keep any scheduling notice with your copy of the affidavit.

Revisit the affidavit before each hearing. Update your notes. Mark any change since your last filing. If there are changes, bring an amended supplemental affidavit. That keeps your record current and complete.