ONTARIO

Court file number

Superior Court of Justice Family Court Branch
(Name of Court)
Form 35.1: Affidavit in Support of
at Claim for Custody or Access, dated
Court office address

Applicant(s)
Full legal name & address for service — street & number, municipality, Lawyer’s name & address — street & number, municipality, postal
postal code, telephone & fax numbers and e-mail address (if any). code, telephone & fax numbers and e-mail address (if any).

Respondent(s)
Full legal name & address for service — street & number, municipality, Lawyer’s name & address — street & number, municipality, postal
postal code, telephone & fax numbers and e-mail address (if any). code, telephone & fax numbers and e-mail address (if any).

Affidavit in Support of Claim for Custody or Access

(If you need more space, attach extra pages.)

My name is (full legal name)

My date of birth is (d, m, y)
I live in: (name of city, town or municipality and province, state or country if outside of Ontario)

I swear/affirm that the following is true:

PART A:
TO BE COMPLETED BY ALL PERSONS SEEKING CUSTODY OR ACCESS
(Write "N/A" if any of the paragraphs do not apply to you or the child(ren).)

1. During my life, I have also used or been known by the following names:

2. The child(ren) in this case is/are:

My relationship
Name(s) of all people
Birthdate Full legal name(s) of to the child
Child’s Full Legal Name Age the child lives with now
(specify if parent,
(d, m, y) parent(s) (include address if the child
grandparent, family
does not live with you)
friend, etc.)

FLR-35-1-E (2009/11) Continued on next sheet

Form 35.1: Affidavit in Support of Claim for (page 2) Court file number
Custody or Access

My relationship
Name(s) of all people the
Birthdate Full legal name(s) of to the child
Child’s Full Legal Name Age child lives with now
(specify if parent,
(d, m, y) parent(s) (include address if the child does
grandparent, family
not live with you)
friend, etc.)

MICHAEL DAVID 08 OCT 1 CORY ROSS CORY ROSS MCCOOEYE FATHER

MCCOOEYE 2022 MCCOOEYE

3. I am also the parent of or have acted as a parent (for example, as a step-parent, legal guardian etc.) to the following
child(ren): (include the full legal names and birthdates of any child(ren) not already listed in paragraph 2)

My relationship to the child Name(s) of the person(s) with whom

Birthdate
Child’s Full Legal Name (specify if parent, step-parent, the child lives now (if the child is under
(d, m, y)
grandparent, etc.) 18 years old)

DEMIKA FALLON 05 FEB FATHER SUSAN MCCOOEYE

MCCOOEYE 2013

FLR-35-1-E (2009/11) Continued on next sheet

Form 35.1: Affidavit in Support of Claim for (page 3) Court file number
Custody or Access

4. I am or have been a party in the following court case(s) involving custody of or access to any child: (Including the
child(ren) in this case or any other child(ren). Do not include cases involving a children’s aid society in this section. Attach a copy of any
custody or access court order(s) or endorsement(s) you have.)

Court orders made

Court location Names of parties in the case Name(s) of child(ren)
(include dates of orders)

5. I have been a party or person responsible for the care of a child in the following child protection court case(s):
(attach a copy of any relevant court order(s) or endorsement(s) you have)

Names of people involved in Name of children's aid Court orders made

Court location
the case society (include dates of orders)

6. I have been found guilty of the following criminal offence(s) for which I have not received a pardon:
Approximate date of
Charge Sentence received
finding of guilt

FLR-35-1-E (2009/11) Continued on next sheet

Form 35.1: Affidavit in Support of Claim for (page 4) Court file number
Custody or Access

7. I am now charged with the following criminal offence(s):

Date of next court Terms of release while waiting for trial

Charge (attach copy of bail or other
appearance
release conditions, if any)

8. When the court is assessing a person’s ability to act as a parent, s. 24 (4) of the Children’s Law Reform Act requires
the court to consider whether the person has at any time committed violence or abuse against:
• his or her spouse;

• a parent of the child to whom the claim for custody or access relates;

• a member of the person’s household; or

• any child.

I am aware of the following violence or abuse the court should consider under s. 24 (4) of the Children’s Law
Reform Act: (describe incident(s) or episode(s) and provide information about the nature of the violence or abuse, who committed
the violence and who the victim(s) was/were)

9. To the best of my knowledge, since birth, the child(ren) in this case has/have lived with the following caregiver(s):
(including a parent, legal guardian, children’s aid society etc.)

Name(s) of Caregiver(s) Period(s) of Time with

Child’s Name (if the child was in the care of a children’s aid society, Caregiver(s)
give the name of that children’s aid society) (d,m,y to d,m,y)

MICHAEL DAVID CORY ROSS MCCOOEYE 8 OCT 2022 TO

MCCOOOEYE PRESENT

FLR-35-1-E (2009/11) Continued on next sheet

Form 35.1: Affidavit in Support of Claim for (page 5) Court file number
Custody or Access

Name(s) of Caregiver(s) Period(s) of Time with

Child’s Name (if the child was in the care of a children’s aid society, Caregiver(s)
give the name of that children’s aid society) (d,m,y to d,m,y)

10. My plan for the care and upbringing of the child(ren) is as follows:

a) I plan to live at the following address: 3769 AUGHAN ST WINDSOR ON N9C 1Z6

b) The following people (other than the child(ren) involved in this case) will be living with me:
Has this person been found
Has a child of this
guilty of a criminal offence (for
Full legal name and person
Birthdate Relationship which he/she has not received a
other names this ever been in the care of a
(d, m, y) to you pardon) or is he/she currently
person has used children’s aid society?
facing criminal charges?
(if yes, give details)
(if yes, give details)

c) Decisions for the child(ren) (including education, medical care, religious upbringing, extra-curricular activities,
etc.) will be made as follows:
jointly by me and (name(s) of person(s))
✔ by me
by (name(s) of person(s))
(If necessary, provide additional details below.)

FLR-35-1-E (2009/11) Continued on next sheet

Form 35.1: Affidavit in Support of Claim for (page 6) Court file number
Custody or Access

d) ✔ I am a stay-at-home parent.
I work: full time. ✔ part time.
I attend school: full time. part time.

at: (name of your place of work or school)

I anticipate that my plans for work and/or school may change as follows: (complete if you know or expect that you
will be doing something different from what you are doing now))

e) The child(ren) will attend school, daycare or be cared for by others on a regular basis as follows:

MICHAEL WILL ATTEND DAYCARE AT TIMES WHEN MR. MCCOOEYE IS REQUIRED TO WORK
AS HE IS A BUSINESS OWNER.

f) My plan for the child(ren) to have regular contact with others, including the child(ren)’s parent(s) and family
members, is as follows:

MICHAEL WILL BE ABLE TO SPEND TIME WITH HIS MOTHER AND MATERNAL
GRANDPARENTS AT ANY TIME AS THERE IS NO TURMOIL IN THE RELATIONSHIP BUT HAVE
AGREED TO EVERY SECOND WEEKEND AS WELL AS EVERY SECOND HOLIDAY E.G.
CHRISTMAS, BIRTHDAYS ETC.

g) Check the appropriate box:

✔ The child(ren) does not/do not have any special medical, educational, mental health or developmental needs.
The child or one or more of the children has/have the following special needs and will receive support and
services for those needs as follows: (if a child does not have special needs, you do not have to include information about
that child below)
Support or service child will be
Description of child’s receiving (include the names of any
Name of child Special need(s) doctors, counsellors, treatment centres,
needs
etc. that are or will be providing support
or services to the child)

N/A medical
educational
mental health
developmental
other

N/A medical
educational
mental health
developmental
other

FLR-35-1-E (2009/11) Continued on next sheet

Form 35.1: Affidavit in Support of Claim for (page 7) Court file number
Custody or Access

Support or service child will be

Description of child’s receiving (include the names of any
Name of child Special need(s) doctors, counsellors, treatment centres,
needs
etc. that are or will be providing support
or services to the child)

N/A medical
educational
mental health
developmental
other

N/A medical
educational
mental health
developmental
other

h) I will have support from the following relatives, friends or community services in caring for the child(ren):
MOTHER OR PATERNAL GRANDMOTHER - SUSAN MCCOOEYE, DAUGHTER - DEMIKA
MCCOOEYE, BROTHER- JUSTIN MCCOOEYE

11. I acknowledge that the court needs up-to-date and accurate information about my plan in order to make a custody
or access order in the best interests of the child(ren) (subrule 35.1 (7)). If, at any time before a final order is made in
this case,
a) there are any changes in my life or circumstances that affect the information provided in this affidavit; or
b) I discover that the information in this affidavit is incorrect or incomplete,
I will immediately serve and file either:
a) an updated affidavit in support of claim for custody or access (Form 35.1); or,
b) if the correction or change is minor, an affidavit in Form 14A describing the correction or change and indicating any effect
it has on my plan for the care and upbringing of the child(ren).

(Initial here to show you have read this paragraph and you understand it.)
NOTE: If you are not the parent of the child for whom you are seeking an order of custody, you must complete Part B of
this affidavit.
You are a parent of a child if:
a) you are the biological parent of the child;
b) you are the adoptive parent of the child;
c) a court has declared that you are the child’s parent under the Children’s Law Reform Act; or
d) you are presumed to be a father under section 8 of the Children’s Law Reform Act.
If you are completing Part B, you do not have to swear/affirm the affidavit at this point. You will swear/affirm at the end
of Part B.
Sworn/affirmed before me at WINDSOR
municipality

in ONTARIO
province, state, or country
Signature
on (This form is to be signed in front of a
Date Commissioner for taking affidavits lawyer, justice of the peace, notary public
(Type or print name below if signature is illegible.) or commissioner for taking affidavits.)
FLR-35-1-E (2009/11) Continued on next sheet
Form 35.1: Affidavit in Support of Claim for (page 8) Court file number
Custody or Access

PART B
TO BE COMPLETED ONLY BY A NON-PARENT SEEKING A CUSTODY ORDER
You are not a parent of a child unless:
a) you are the biological parent of the child;
b) you are the adoptive parent of the child;
c) a court has declared that you are the child’s parent under the Children’s Law Reform Act; or
d) you are presumed to be a father under section 8 of the Children’s Law Reform Act.
NOTICE: If you are a non-parent claiming custody of a child, court staff will conduct a search of the databases maintained by the
Ontario courts to identify previous or current family court cases in which you or the child(ren) may have been or may be involved
and provide you with a list of those cases. This information will be shared with the court and you must provide a copy to any
other party.
If the list contains information about someone other than you, you may swear or affirm an affidavit indicating that you are not the
same person as the person named in the list.

In addition to the information in Part A, I swear/affirm that the following is true:

12. To the best of my knowledge, the child(ren) in this case has/have been involved in the following custody/ access or
child protection court cases: (do NOT include cases in which the child was charged under the Youth Criminal Justice Act (Canada))
Child(ren)’s name(s) Type of Case Details of Case

FLR-35-1-E (2009/11) Continued on next sheet

Form 35.1: Affidavit in Support of Claim for (page 9) Court file number
Custody or Access

13. You must file a police records check with the court. Choose the option below that applies to you:
I have attached to this affidavit a copy of my police records check, dated (date of report from local police force)

. Since the date that the attached police records check was completed,
I have been found guilty of or charged with the following offence(s):

On (date) , I sent a request to (name of local police force)

for a police records check.

I agree to serve and file the police records check with the court within 10 days after the day I receive it. I
understand that the court may not make an order for custody of the child(ren) until I have filed the police
records check.
14. Since I turned 18 years old or became a parent, whichever was earlier, I have lived in the following places:
City, town or municipality where you lived
Approximate dates (month/year to month/year)
(if outside of Ontario, give name of province, state or country)

15. I have provided a signed consent form to the court, which authorizes each of the children’s aid societies listed
below to send a report to me and to the court indicating:
• whether the society has any records within the meaning of the Children’s Law Reform Act regulations relating
to me; and
• the date(s) on which any files were opened and/or closed (if applicable).

i) Name of children’s aid society:

ii) Name of children’s aid society:

iii) Name of children’s aid society:

iv) Name of children’s aid society:

v) Name of children’s aid society:

vi) Name of children’s aid society:

FLR-35-1-E (2009/11) Continued on next sheet

Form 35.1: Affidavit in Support of Claim for (page 10) Court file number
Custody or Access

16. I understand that if any report from a children’s aid society indicates that the children’s aid society has records related to me,
then, unless the court orders otherwise, that report will be shared with:
a) the court;
b) any other parties in this case; and
a) the child(ren)'s lawyer, if there is one in this case.
If I wish to bring a motion asking the court not to release all or part of this report, I understand that I must file my motion with
the court no later than 20 days from the day that the last report is received by the court.
I also understand that any report indicating that a children’s aid society has no records relating to me will not be shared with
the court, any other party or the child(ren)’s lawyer.

(Initial here to show you have read this paragraph and you understand it.)

Sworn/affirmed before me at
municipality

in
province, state, or country

Signature
on (This form is to be signed in front of a
Date Commissioner for taking affidavits lawyer, justice of the peace, notary public
(Type or print name below if signature is illegible.) or commissioner for taking affidavits.)

Save Form Print Form Clear Form

FLR-35-1-E (2009/11)