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).
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.
a.
c. Uncontested
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.
Default with agreementb.
Default without agreement
There are no assets or debts to be disposed of by the court.
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.
Form Approved for Mandatory Use
Judicial Council of California
FL-170 [Rev. January 17, 2020]
Family Code, § 2336
www.courts.ca.gov
Page 1 of 3
LEGAL SEPARATION
DECLARATION FOR DEFAULT OR UNCONTESTED
DISSOLUTION
FOR COURT USE ONLY
ATTORNEY FOR (name):
E-MAIL ADDRESS:
FAX NO.:TELEPHONE NO.:
ZIP CODE:STATE:CITY:
STREET ADDRESS:
FIRM NAME:
NAME:
PARTY WITHOUT ATTORNEY OR ATTORNEY
STATE BAR NUMBER:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
RESPONDENT:
PETITIONER:
CASE NUMBER:
FL-170
(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.
is true and correct.All the information in the
No response has been filed and there is no written agreement or stipulated judgment between the parties;
(2)
The following statement is true (check one):
1.
2.
3.
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)
(B)
(3)
(A)
Petition
Responseamended
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.
(2)
(1)
Both parties have appeared in the case; and
(2)
(1)
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.
Declaration of disclosure (check a, b, c, or d):
a.
b.
c.
5.
DECLARATION FOR DEFAULT OR UNCONTESTED
DISSOLUTION OR LEGAL SEPARATION
(Family Law)
The facts that support the requested judgment are (In a default case, state your reasons below):
The current custody and visitation (parenting time) previously ordered in this case, or the current schedule is (specify):
Child support is being enforced in another case in
I request that this order be based on the
The information in the child support calculation attached to the proposed judgment is correct based on my personal
knowledge.
FL-170 [Rev. January 17, 2020]
Page 2 of 3
DECLARATION FOR DEFAULT OR UNCONTESTED
DISSOLUTION OR LEGAL SEPARATION
(Family Law)
RESPONDENT:
PETITIONER:
CASE NUMBER:
FL-170
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.
has
d.
Contained on Attachment 6d.
Contained on Attachment 6c.
has not
6.
a.
Child support should be ordered as set forth in the proposed Judgment (form FL-180).
7.
changed since it was last filed with the court. (If changed, attach updated form.)
(county):
c.
The case number is (specify):
Child custody and visitation (parenting time) should be ordered as set forth in the proposed Judgment (form FL-180).
a.
b.
The information in Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) (form FL-105)
There is an existing court order for custody/parenting time in another case in
If there are minor children, check and complete item (1) if applicable and item (2) or (3):
earning ability. The facts in (3)
support of my estimate of earning ability are (specify):
(2)
Complete items (1) and (2) regarding public assistance.
(county):
The case number is (specify):
(1)
Petitioner's Respondent's
Contained on Attachment 7a(3).
b.
(1) I am receiving
am not receiving intend to apply for
To the best of my knowledge, the other party
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.
listed in the proposed order.
(2)
Spousal, Partner, and Family Support (If a support order or attomey 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.
b.
c.
Family support should be ordered as set forth in the proposed Judgment (form FL-180).
e.
f.
d.
8.
public assistance for the child or children
is
is not receiving public assistance.
Petitioner
Respondent is presently receiving public assistance, and all support should be made payable
I knowingly give up forever any right to receive spousal or partner support.
I ask the court to terminate forever spousal or partner support for:
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:
I ask the court to reserve jurisdiction to award spousal or partner support in the future to:
Petitioner Respondent
Petitioner Respondent
Spousal or Partner Support Declaration Attachment (form FL-157)
attached declaration (Attachment 8d)
written agreement
Other
(specify):
The facts in support of this request are on Request for Attorney's Fees and Costs Attachment (form FL-319).
FL-170 [Rev. January 17, 2020]
Page 3 of 3
DECLARATION FOR DEFAULT OR UNCONTESTED
DISSOLUTION OR LEGAL SEPARATION
(Family Law)
Date:
RESPONDENT:
PETITIONER:
CASE NUMBER:
FL-170
(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.
12.
requests restoration of the former name as set forth in the proposed Judgment (form FL-180)
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.
Petitioner Respondent
STATEMENTS IN THIS BOX APPLY ONLY TO DISSOLUTIONS
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.
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.
17.
15.
16.
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.
13.
14.
(proceedings for dissolution or nullity of marriage only).
THIS STATEMENT APPLIES ONLY TO LEGAL SEPARATIONS
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 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.
18.
19. Other
(specify):
(SIGNATURE OF DECLARANT)
9.
10.
The judgment should be entered nunc pro tunc for the following reasons (specify):
11.
(county):
a.
b.
A voluntary declaration of parentage or paternity is attached.
The written agreement of the parties regarding parentage is attached here (Attachment 9b) or to the proposed Judgment
(form FL-180).
Parentage was previously established by the court in
The case number is (specify):
Attorney fees should be ordered as set forth in the proposed Judgment (form FL-180).
Other (specify facts below):
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).
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