16.State all addresses at which the children have resided during the past six months and the name of the person with whom said children resided.
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17.Do you know of anyone other than you or the other parent that has physical custody of any of the children or claims to have custody or visitation rights with respect to any of the children?
Yes - State the name(s) and address(es) of these people in Paragraph 19. 
No
18.Do you have any information of any other custody proceeding concerning any of the children pending in a court of this or any other state?
Yes – Attach a copy of the petition or judgment from all other cases. 
No
19.Have you participated in any other litigation concerning the custody of any of the children in this or any other state?
Yes – Attach a copy of the petition or judgment from all other cases. 
No
20.Have any of the child(ren) been a victim of abuse or neglect?
Yes
No
21.If you answered “Yes” to questions 17, 18, 19 or 20 please explain.
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22.The custody arrangement that is in the best interests of the minor children is set forth in Part A of the attached parenting plan marked Exhibit 1. (You must attach a completed copy of Parenting Plan Form CAFC501 to this petition.)
THEREFORE, I want the court to enter a judgment concerning custody as per Part A of the attached parenting plan marked Exhibit 1.
I also request the following relief:

Child support should be set as set forth in Part B of the attached parenting plan marked Exhibit 1.

I am without sufficient funds to pay for my attorney and I request that the other party pay my attorney’s fees for this case.

Other (Please state the other requests)
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Petition for Child Custody – Page 4 of 5
This form is available for free at www.selfrepresent.mo.gov