ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
TELEPHONE NO.: FAX NO.:
EMAIL ADDRESS:
ATTORNEY FOR (Name):
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
IN THE MATTER OF THE PETITION OF:
PETITION FOR DECLARING CHILD(REN) FREE FROM PARENTAL
CUSTODY AND CONTROL
CASE NUMBER:
1. The petitioner(s) _________________________________________ respectfully represent(s) and allege(s) that the
child(ren) listed below is/are a person(s) under the age of eighteen and that said person(s) is/are within the county of
San Bernardino:
Name: ______________________________ Date of Birth: __ ___________ City/State of Birth_____________________
Name: ______________________________ Date of Birth _______________ City/State of Birth ____________________
2. Petitioner(s) request a judgment declaring the child(ren) free from the custody and control of:
______________________________________________________________________ pursuant to Family Code §:
7822 Abandonment
The child has been left without provision for the child’s identification by the child’s parent(s)
The child has been left by the parent(s) named above in the care and custody of a non-parent for a period of
six months without any provision for the child’s support, or without communication from the parent(s), with the
intent on the part of the parent(s) to abandon the child
The parent named above has left the child in the care and custody of the other parent for a period of one
year without any provision for the child’s support, or without communication from the parent, with the intent
on the part of the parent to abandon the child
7825 The parent(s) named above are convicted of a felony, the facts of which are of such a nature so as to prove the
unfitness of the parent(s) to have the future custody and control of the child
7826 The parent(s) named above have been declared by a court of competent jurisdiction, wherever situated, to be
developmentally disabled or mentally ill
7827 The parent(s) named above are mentally disabled and are likely to remain so in the foreseeable future
SB-9006 PETITION DECLARING CHILD(REN) FREE FROM PARENTAL CUSTODY AND CONTROL Family Code §7800
Revised 6/24/2016 Page 1 of 2
Case Short Title:
Case Number:
3. The names and addresses of parent(s), guardian and relative are:
Father: ____________________________________________________________________________________________
Mother: ___________________________________________________________________________________________
Guardian:__________________________________________________________________________________________
Relative(s):_________________________________________________________________________________________
Additional facts in support of allegations: (Give additional facts in detail, added pages may be used for this purpose)
It is in the best interest of the child(ren) to be declared free from the custody and control of the above-named
parent(s).
Wherefore, petitioner(s) request(s) that this court inquire into such matter, and that said child(ren) be declared free
from the custody and control of the above-named parent(s) are provided in Family Code § 7800 et seq, and for such
other and further relief as the court may deem proper.
Date: ________________________ Print Name: __________________________________________
Signature: ___________________________________________
Date: ________________________ Print Name: __________________________________________
Signature: ___________________________________________
VERIFICATION
I am the petitioner(s) in the above-entitled matter; I have read the foregoing petition and know the contents thereof
and that the same is true of my own knowledge except as to those matters which are therein stated upon information
and belief, and as to those matters that I believe to be true.
I declare under penalty of perjury that the foregoing is true and correct.
Executed on ________________________ at ____________________________________________________, California
_______________________________________ _______________________________________
Signature of Petitioner Signature of Petitioner
_______________________________________
Signature of Attorney for Petitioner
SB-9006 Family Code §7800
Revised 6/24/2016 Page 2 of 2
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