Fillable FL-170 SUPERIOR COURT OF CALIFORNIA, COUNTY OF (CEB)

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FL-170 SUPERIOR COURT OF CALIFORNIA, COUNTY OF (CEB)

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SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
FOR COURT USE ONLY
PETITIONER:
FL-170
RESPONDENT:
DECLARATION FOR DEFAULT OR UNCONTESTED CASE NUMBER:
DISSOLUTION LEGAL SEPARATION
(NOTE: Items 1 through 12 apply to both dissolution and legal separation proceedings.)
1. I declare that if I appeared in court and were sworn, I would testify to the truth of the facts in this declaration.
2. I agree that my case will be proven by this declaration and that I will not appear before the court unless I am ordered by the court to
do so.
3. All the information in the Petition Response is true and correct.amended
b. Default with agreement
(1)
(2)
No response has been filed and the parties have agreed that the matter may proceed as a default matter without notice;
and
The parties have entered into a written agreement regarding their property and their marriage or domestic partnership
rights, including support, the original of which is being or has been submitted to the court. I request that the court approve
the agreement.
4. Type of case (check a, b, or c):
a. Default without agreement
(1)
(2)
(3) The following statement is true (check one):
(A) There are no assets or debts to be disposed of by the court.
(B)
No response has been filed and there is no written agreement or stipulated judgment between the parties;
The default of the respondent was entered or is being requested, and I am not seeking any relief not requested in the
petition; and
The community and quasi-community assets and debts are listed on the completed current Property
Declaration (form FL-160), which includes an estimate of the value of the assets and debts that I propose to
be distributed to each party. The division in the proposed Judgment (form FL-180) is a fair and equal division
of the property and debts, or if there is a negative estate, the debts are assigned fairly and equitably.
c. Uncontested
(1) Both parties have appeared in the case; and
(2) The parties have entered into a written agreement regarding their property and their marriage or domestic partnership
rights, including support, the original of which is being or has been submitted to the court. I request that the court approve
the agreement.
5. Declaration of disclosure (check a, b, c, or d):
a. Both the parties have filed, or are filing concurrently, a Declaration Regarding Service of Declaration of Disclosure (form
FL-141) and an Income and Expense Declaration (form FL-150).
b. This matter is proceeding by default. I am the petitioner in this action and have filed a proof of service of the preliminary
Declaration of Disclosure (form FL-140) with the court. I hereby waive receipt of the final Declaration of Disclosure (form
FL-140) from the respondent.
c. This matter is proceeding by default. I am the petitioner in this action, and service of the summons on respondent was
done by publication or posting under court order. Service of the preliminary Declaration of Disclosure (form FL-140) is not
required. I hereby waive receipt of the final Declaration of Disclosure (form FL-140) from the respondent.
Form Approved for Mandatory Use
Judicial Council of California
FL-170 [Rev. January 17, 2020]
(Family Law)
DECLARATION FOR DEFAULT OR UNCONTESTED
DISSOLUTION OR LEGAL SEPARATION
Page 1 of 3
Family Code, § 2336
www.courts.ca.gov
PARTY WITHOUT ATTORNEY OR ATTORNEY STATE BAR NUMBER:
NAME:
FIRM NAME:
STREET ADDRESS:
CITY: STATE: ZIP CODE:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
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PETITIONER: CASE NUMBER:
FL-170
RESPONDENT:
6.
a. The information in Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) (form FL-105)
b. There is an existing court order for custody/parenting time in another case in (county):
The case number is (specify):
Child custody and visitation (parenting time) should be ordered as set forth in the proposed Judgment (form FL-180).
The current custody and visitation (parenting time) previously ordered in this case, or the current schedule is (specify):c.
has has not changed since it was last filed with the court. (If changed, attach updated form.)
Contained on Attachment 6c.
d.
Contained on Attachment 6d.
The facts that support the requested judgment are (In a default case, state your reasons below):
7.
a.
Child support should be ordered as set forth in the proposed Judgment (form FL-180).
If there are minor children, check and complete item (1) if applicable and item (2) or (3):
(1) Child support is being enforced in another case in (county):
The case number is (specify):
(2) The information in the child support calculation attached to the proposed judgment is correct based on my personal
knowledge.
(3) I request that this order be based on the Petitioner's Respondent’s earning ability. The facts in
support of my estimate of earning ability are (specify):
Continued on Attachment 7a(3).
b. Complete items (1) and (2) regarding public assistance.
(1) am receiving am not receiving intend to apply for public assistance for the child or children
listed in the proposed order.
I
(2) isTo the best of my knowledge, the other party is not receiving public assistance.
Petitioner Respondent is presently receiving public assistance, and all support should be made payable
to the local child support agency at the address set forth in the proposed judgment. A representative of the local child
support agency has signed the proposed judgment.
FL-170 [Rev. January 17, 2020]
DECLARATION FOR DEFAULT OR UNCONTESTED
DISSOLUTION OR LEGAL SEPARATION
Page 2 of 3
(Family Law)
8. Spousal, Partner, and Family Support (If a support order or attorney fees are requested, submit a completed Income and
Expense Declaration (form FL-150) unless a current form is on file. Include your best estimate of the other party’s income.
Check at least one of the following.)
a. I knowingly give up forever any right to receive spousal or partner support.
b. I ask the court to reserve jurisdiction to award spousal or partner support in the future to:
d. Spousal support or domestic partner support should be ordered as set forth in the proposed Judgment (form FL-180)
based on the factors described in:
c. I ask the court to terminate forever spousal or partner support for: Petitioner Respondent
Spousal or Partner Support Declaration Attachment (form FL-157)
written agreement
attached declaration (Attachment 8d)
e. Family support should be ordered as set forth in the proposed Judgment (form FL-180).
f. Other (specify):
d. This matter is proceeding as an uncontested action. Service of the final Declaration of Disclosure (form FL-140) is
mutually waived by both parties. A waiver provision executed by both parties under penalty of perjury is contained on the
Stipulation and Waiver of Final Declaration of Disclosure (form FL-144), in the settlement agreement or proposed
judgment, or in another, separate stipulation.
Petitioner Respondent
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12.
13.
14.
Petitioner
(proceedings for dissolution or nullity of marriage only).
15.
16.
17.
18.
19. Other (specify):
STATEMENTS IN THIS BOX APPLY ONLY TO DISSOLUTIONS
THIS STATEMENT APPLIES ONLY TO LEGAL SEPARATIONS
Date:
(TYPE OR PRINT NAME)
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
(SIGNATURE OF DECLARANT)
FL-170 [Rev. January 17, 2020]
DECLARATION FOR DEFAULT OR UNCONTESTED
DISSOLUTION OR LEGAL SEPARATION
Respondent
Irreconcilable differences have led to the irremediable breakdown of the marriage or domestic partnership, and there is no
possibility of saving the marriage or domestic partnership through counseling or other means.
This declaration may be reviewed by a commissioner sitting as a temporary judge, who may determine whether to grant this
request or require my appearance under Family Code section 2336.
If this is a dissolution of a marriage or domestic partnership created in another state, the petitioner or the respondent has
been a resident of this county for at least three months and of the state of California for at least six months continuously and
immediately preceding the date of the filing of the petition for dissolution of marriage or domestic partnership.
Status only judgment: This declaration is only for the termination of marital or domestic partner status. I ask the court to
reserve jurisdiction over all other issues not requested in this declaration for later determination.
I ask that the court grant the request of a judgment for legal separation based on irreconcilable differences and that the court
make the orders set forth in the proposed Judgment (form FL-180) submitted with this declaration.
I ask that the court grant the request for a judgment of dissolution of marriage or domestic partnership based on irreconcilable
differences and that the court make the orders set forth in the proposed Judgment (form FL-180) submitted with this declaration.
(Family Law)
Page 3 of 3
10. Attorney fees should be ordered as set forth in the proposed Judgment (form FL-180).
The facts in support of this request are on Request for Attorney's Fees and Costs Attachment (form FL-319).
Other (specify facts below):
11. The judgment should be entered nunc pro tunc for the following reasons (specify):
9.
A voluntary declaration of parentage or paternity is attached.
Parentage of the children of the petitioner and respondent born prior to their marriage or domestic partnership should be
ordered as set forth in the proposed Judgment (form FL-180).
Parentage was previously established by the court in (county):
The case number is (specify):
a.
b.
The written agreement of the parties regarding parentage is attached here (Attachment 9b) or to the proposed Judgment
(form FL-180).
PETITIONER: CASE NUMBER:
FL-170
RESPONDENT:
I understand that a judgment of legal separation does not terminate a marriage or domestic partnership, and that I am
still married or a partner in a domestic partnership.
requests restoration of the former name as set forth in the proposed Judgment (form FL-180)
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FL-170 SUPERIOR COURT OF CALIFORNIA, COUNTY OF (CEB)

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Completed 1 April 2021

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