IN THE CIRCUIT COURT OF THE FIRST JUDICIAL CIRCUIT
IN AND FOR ESCAMBIA COUNTY, FLORIDA
Case No.: [Insert Case Number]
Division: Family Law
IN RE:
The matter of custody of minor:
CAMERON JAY SMITH, Minor
PETITIONER:
ROBERT B. SMITH, Father
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UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT AFFIDAVIT
I, Robert B. Smith, the undersigned, being duly sworn, depose and state as
follows:
1. Minor Child Information
Name of Minor Child: Cameron Jay Smith
Date of Birth: 12/18/2024
Place of Birth: Pensacola, FL Escambia County
Gender: maile
2. Child's Current Address
The child is currently residing at:
Unknown
3. Past Addresses of Child (for the last 5 years)
Provide information about the child's past addresses and those they have
lived with during the last 5 years. If the child has lived in multiple places, list
the most recent first. If the child has lived in only one place for 5 years, state
"same as current address."
From 12/24/2024
Address: Southpointe place
Pensacola, FL 32514
Person(s) Child Lived With: Taylor Pacyga mother, Gail Arel GMA, Robert
Smith father
4. Participation in Other Custody Proceedings
I have [check one]:
☐ NOT participated as a party, witness, or in any other capacity in any other
litigation concerning the custody of, or visitation with, the minor child(ren) in
this or any other state.
x Participated in the following custody or visitation litigation concerning the
minor child(ren):
Court Name: Escambia County
Case Number:
Date: 10/01/2024
Type of Case: [Insert Type of Case]
Disposition/Status: Recently Custody was ordered back to family
5. Information About Custody Proceedings in Other States
I have [check one]:
☐ NO information of any custody or visitation proceedings in this or any
other state that are pending concerning the minor child(ren).
X☐ Information about the following pending custody or visitation proceedings
in this or another state concerning the minor child(ren):
Court Name: Escambia county 1st judicial circuit
Case Number: [Insert Case Number]
State: Florida
Date: 10/01/2024
Parties Involved: Minor Cameron Smith, Father Robert Smith, Mother Taylor
Pacyga
6. Persons Not a Party to This Case Who Have Physical custody:
Gail Arel grandmother as of 10/01/2024
The petitiner never provided this court with any evidence showing the father
wasn’t able to care for minor child, was not afforded due process as statutws
and guidelines clearly states, and Ive files. A petition about this for more
detailed explanation.
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I declare under penalty of perjury under the laws of the State of Florida that
the foregoing is true and correct.
Executed this [Insert Day] day of [Insert Month], [Insert Year].
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Robert B. Smith
Petitioner
3908 Boyd’s Creek Highway
Seveirville , TN 37876
Rsmith10387@gmail.com
Sworn to and subscribed before me this __10_ day of _______01__, 2024, by
Robert B. Smith, who is personally known to me or produced [Insert ID] as
identification.
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Notary Public
My Commission Expires: ______________