Form 1 "Custodial Statement and Agreement - Divorce, Separation, or Abandonment" - Indiana

What Is Form 1?

This is a legal form that was released by the Indiana Department of Education - a government authority operating within Indiana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2017;
  • The latest edition provided by the Indiana Department of Education;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 1 by clicking the link below or browse more documents and templates provided by the Indiana Department of Education.

ADVERTISEMENT
ADVERTISEMENT

Download Form 1 "Custodial Statement and Agreement - Divorce, Separation, or Abandonment" - Indiana

Download PDF

Fill PDF online

Rate (4.6 / 5) 48 votes
Page background image
FORM I
DOE 11/17
CUSTODIAL STATEMENT AND AGREEMENT
DIVORCE, SEPARATION, OR ABANDONMENT
This agreement is prepared by the State Superintendent of Public Instruction as required by Indiana Code 20-26-11-3.
Student Information
Name: (last)
(first)
(mi)
(street)
(city)
(state)
(zip code)
Last school corporation attended:
Current school corporation:
Indicate the reason for utilization of this form:
No court order has been made establishing custody of the student. (Signature from one (1) Parent enrolling Student)
The parents have agreed on the parent with whom the student will live. (Requires Signature of BOTH Parents)
The parent granted custody of the student has abandoned the student. (Signature from one (1) Parent enrolling Student)
Parent Information
Parent/Guardian:
Name: (last)
(first)
(mi)
(street)
(city)
(state)
(zip code)
Parent/Guardian:
Name: (last)
(first)
(mi)
(street)
(city)
(state)
(zip code)
Parent with whom the student will live :
agrees to assume all the duties and be subject to all the liabilities of the
(parent/guardian with whom student will live)
parent of
with respect to dealing with the school corporation and for all other purpose
(student)
under Indiana Code 20-26. This agreement is binding from the date signed until terminated by either parent in writing.
I affirm, under the penalties for perjury, that the foregoing representations are true.
Name (printed)
Name (printed)
Signature
Signature
Date
Date
Acknowledged by
on behalf of
(name and title)
(school corporation)
Date
Page 1 of 1
FORM I
DOE 11/17
CUSTODIAL STATEMENT AND AGREEMENT
DIVORCE, SEPARATION, OR ABANDONMENT
This agreement is prepared by the State Superintendent of Public Instruction as required by Indiana Code 20-26-11-3.
Student Information
Name: (last)
(first)
(mi)
(street)
(city)
(state)
(zip code)
Last school corporation attended:
Current school corporation:
Indicate the reason for utilization of this form:
No court order has been made establishing custody of the student. (Signature from one (1) Parent enrolling Student)
The parents have agreed on the parent with whom the student will live. (Requires Signature of BOTH Parents)
The parent granted custody of the student has abandoned the student. (Signature from one (1) Parent enrolling Student)
Parent Information
Parent/Guardian:
Name: (last)
(first)
(mi)
(street)
(city)
(state)
(zip code)
Parent/Guardian:
Name: (last)
(first)
(mi)
(street)
(city)
(state)
(zip code)
Parent with whom the student will live :
agrees to assume all the duties and be subject to all the liabilities of the
(parent/guardian with whom student will live)
parent of
with respect to dealing with the school corporation and for all other purpose
(student)
under Indiana Code 20-26. This agreement is binding from the date signed until terminated by either parent in writing.
I affirm, under the penalties for perjury, that the foregoing representations are true.
Name (printed)
Name (printed)
Signature
Signature
Date
Date
Acknowledged by
on behalf of
(name and title)
(school corporation)
Date
Page 1 of 1