FL-170
FOR COURT USE ONLY
PETITIONER:
RESPONDENT:
CASE NUMBER:
DECLARATION FOR DEFAULT OR UNCONTESTED
DISSOLUTION LEGAL SEPARATION
(NOTE: Items 1 through 12 apply to both dissolution and legal separation proceedings.)
I declare that if I appeared in court and were sworn, I would testify to the truth of the facts in this declaration.
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.
Petition Response is true and correct.
All the information in the
Default without agreement
No response has been filed and there is no written agreement or stipulated judgment between the parties;
a.
No response has been filed and the parties have agreed that the matter may proceed as a default matter without
notice; and
(2)
Default with agreement
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.
The following statement is true (check one):
Page 1 of 3
DECLARATION FOR DEFAULT OR UNCONTESTED
DISSOLUTION OR LEGAL SEPARATION
(Family Law)
Form Adopted for Mandatory Use
Judicial Council of California
FL-170 [Rev. July 1, 2012]
Family Code, § 2336
www.courts.ca.gov
1.
2.
3.
b.
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
TELEPHONE NO.:
ATTORNEY FOR (Name):
FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
The default of the respondent was entered or is being requested, and I am not seeking any relief not requested in the
petition; and
Type of case (check a, b, or c):4.
(1)
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
(B)
division of the property and debts, or if there is a negative estate, the debts are assigned fairly and equitably.
There are no assets or debts to be disposed of by the court.
(3)
(A)
(2)
(1)
Both parties have appeared in the case; and
Uncontested
c.
(2)
(1)
Declaration of disclosure (check a, b, or c):
Both the petitioner and respondent have filed, or are filing concurrently, a Declaration Regarding Service of Declaration
a.
of Disclosure (form FL-141) and an Income and Expense Declaration (form FL-150).
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
b.
FL-140) from the respondent.
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
another, separate stipulation.
c.
5.
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.
amended
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