Fillable ATTACHMENT CV-5058 SUPERIOR COURT OF CALIFORNIA, COUNTY OF (The Superior Court of California, County of Santa Clara)

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ATTACHMENT CV-5058 SUPERIOR COURT OF CALIFORNIA, COUNTY OF (The Superior Court of California, County of Santa Clara)

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ATTACHMENT CV-5058
CV-5058 REV 02/10/12
STIPULATION AND ORDER
Page 1 of 2
ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME AND ADDRESS) TELEPHONE NUMBER:
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA
STREET ADDRESS:
MAILING ADDRESS: 191 North First Street
CITY AND ZIP CODE: San José, California 95113
BRANCH NAME:
PETITIONER:
RESPONDENT:
OTHER PARTY:
FOR COURT USE ONLY
STIPULATION AND ORDER
Modification
CASE NUMBER:
DEPARTMENT:
1. Not based on a hearing
Today’s Hearing (date)
2. Judge:
3. Parties/Attorneys:
Petitioner present in court Petitioner’s attorney present:
Respondent present in court Respondent’s attorney present:
Other party present in court Other party’s attorney present:
Do not use this form for Civil Harassment Restraining Order after Hearing.
Those orders must be made on form CH-130.
In addition, do not use this form for Continuance and Reissuance.
Those orders must be made on form CH-116.
4. The parties agree that the Court will make orders about the following items:
Other orders:
See Attachment Not Applicable
Attorney’s fees and costs:
See Attachment Not Applicable
Petitioner
Respondent
ATTACHMENT CV-5058
PETITIONER:
RESPONDENT:
CASE NUMBER:
CV-5058 REV 02/10/12
STIPULATION AND ORDER
Page 2 of 2
We have read this entire Stipulation and Order, including all Attachments. We understand it fully and ask that
the Court make our stipulation the Court’s orders. We give up the right to all further notice of this order.
Date:
Petitioner
Date:
Attorney for Petitioner
Date:
Respondent
Date:
Attorney for Respondent
Date:
Other party:
Date:
Attorney for Other party:
Interpreter Witness Declaration
Interpreter: The Petitioner Respondent Other party is unable to read or understand this
Stipulation and Order and its attachments because:
a.
his/her primary language is (specify):
b.
other (specify):
I certify under penalty of perjury under the laws of the State of California that I have, to the best of my ability, read or
translated for the
Petitioner Respondent Other party this Stipulation and Order including all
attachments. He or she said they understood this Stipulation and Order and its attachments before signing them.
Date Interpreter’s printed name Interpreter’s signature
ORDER
The Court approves the terms stipulated and agreed to by the parties in this document and makes them court
orders.
Date:
Judicial Officer of the Superior Court
Petitioner
Respondent
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ATTACHMENT CV-5058 SUPERIOR COURT OF CALIFORNIA, COUNTY OF (The Superior Court of California, County of Santa Clara)

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Completed 29 June 2021

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