Family Code, § 3400 et seq.; Form Adopted for Mandatory Use
Judicial Council of California
FL-105(A)/GC-120(A)
[New January 1, 2009]
ATTACHMENT TO
DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION
AND ENFORCEMENT ACT (UCCJEA)
Probate Code, §§ 1510(f), 1512
www.courtinfo.ca.gov
FL-105(A)/GC-120(A)
CASE NAME:
ATTACHMENT TO
DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA)
Page____ of ____
CASE NUMBER:
Child’s name
Place of birth Date of birth
Sex
Residence information is the same as given on form
FL-105/GC-120 for child a. (If NOT the same, provide the
information below.)
Child’s name
Place of birth Date of birth Sex
Child’s name
Place of birth Date of birth Sex
Residence information is the same as given on form
FL-105/GC-120 for child a. (If NOT the same, provide the
information below.)
Residence information is the same as given on form
FL-105/GC-120 for child a. (If NOT the same, provide the
information below.)
Period of residence
Present address
Relationship
to present
to
to
to
Child's residence (City, State)
Child's residence (City, State)
Child's residence (City, State)
Period of residence
Address
Person child lived with (name and complete current address) Relationship
Confidentialto present
to
to
to
Child's residence (City, State)
Child's residence (City, State)
Child's residence (City, State)
Period of residence
Address
Relationship
Confidentialto present
to
to
to
Child's residence (City, State)
Child's residence (City, State)
Child's residence (City, State)
Confidential
Confidential
Confidential
Confidential
Person child lived with (name and complete current address)
Person child lived with (name and complete current address)
Person child lived with (name and complete current address)
Person child lived with (name and complete current address)
Person child lived with (name and complete current address)
Person child lived with (name and complete current address)
Person child lived with (name and complete current address)
Person child lived with (name and complete current address)
Person child lived with (name and complete current address)
Person child lived with (name and complete current address)
Person child lived with (name and complete current address)
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