Custody Statement

This Custody Statement is used to declare parental or legal custody arrangements for a minor child.

It includes:

• Parent/guardian and child information

• Statement of custody status or rights

• Supporting details for legal or school purposes

• Notary acknowledgment section

Format: Fillable PDF (print or complete digitally)

Use Cases: School enrollment, medical care, court filings, child travel documentation

Notarization: Required — notarization ensures acceptance and legal validity

⚠️ Disclaimer:

This is a general template and may not replace state-specific custody documents. Please confirm acceptance with the requesting party. Utsey Notary Services LLC does not provide legal advice.

Instructions:

Download instantly after purchase, complete the form, and have it notarized by Utsey Notary Services or any licensed notary of your choice before submitting it to your insurance company.