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SUPERIOR COURT OF CALIFORNIA COUNTY OF ORANGE SELF-HELP (The Superior Court of California - County of Orange)

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SHC-FL-05 (Rev. 01/01/2020
)
Please visit our Self-Help Portal at: https://selfhelp.occourts.org
LamoreauxJusticeCenter
Room C-190
341TheCityDrive
Orange,CA
HarborJusticeCenter
R
oom107,Self‐HelpWindow
4601JamboreeRoad
NewportBeach,CA
Cen
tralJusticeCenter
RoomG‐100
700CivicCenterDrive
SantaAna,CA
SuperiorCourt
Ser
viceCenter
27573PuertaReal
MissionViejo,CA
NorthJusticeCenter
R
oom355
1275N.BerkeleyAvenue
Fullerton,CA
WestJusticeCenter
1
st
Floor
814113thStreet
Westminster,CA
SUPERIOR COURT OF CALIFORNIA
COUNTY OF ORANGE
SELF-HELP CENTER
www.occourts.org/self-help
PETITION FOR GRANDPARENT VISITATION
The Self-Help Center provides a free document review
service. To obtain an appointment to have your documents
reviewed, you must first fully complete the forms.
Pleaseuseblackink.
Self-Help Center Locations:
Page 1 of 2
Approved for Optional Use
L-0373 [New September 14, 2009]
PETITION FOR GRANDPARENT VISITATION
Family Code §§ 3102, 3103, 3104
Cal. Rules of Court 5.150, 5.154(b), 5.156, 5.158
ATTORNEY (Name & Address):
TELEPHONE NO.: FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name): BAR NO.:
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE
JUSTICE CENTER:
Lamoreaux – 341 The City Drive, Orange, CA 92868-3205
Central – 700 Civic Center Drive West, Santa Ana, CA 92701
PETITIONER:
RESPONDENT: 
PETITION FOR GRANDPARENT VISITATION
CASE NUMBER:
1. Petitioner’s relationship to minor child(ren) listed below:
grandmother grandfather
my son (name) is the parent of the child(ren).
my daughter (name) is the parent of the child(ren).
Child’s name
Birthdate
Currently living with
(relationship) / in (county)
Other Parent’s Name
2. The parents of the child(ren) (mark all boxes and complete all spaces which apply):
a.
are currently married or have a domestic partnership and living together.
b.
are divorced. A Judgment for Dissolution of Marriage or Domestic Partnership was entered on:
(specify date)
, in County, (state)
Case No.
.
c.
are currently involved in a divorce proceeding in County, Case No. .
d.
are currently married or have a domestic partnership and one of the parents has been absent for more
than one month without the other parent knowing the whereabouts of the absent parent.
e.
have never been married or in a domestic partnership.
f.
are currently living separate and apart on a permanent or indefinite basis.
g.
The mother father of the minor child(ren) is deceased.
h.
The child(ren) is/are not residing with either parent.
i.
The child(ren) has/have been adopted by a stepparent grandparent other (specify relationship
and name):
.
✔
CASE NAME:
CASE NUMBER:
Approved for Optional Use
L-0373 [New September 14, 2009]
PETITION FOR GRANDPARENT VISITATION
Page 2 of 2
Family Code §§ 3102, 3103, 3104
Cal. Rules of Court 5.150, 5.154(b), 5.156, 5.158
3. Describe the relationship between each child and the petitioner(s). Explain the reason why grandparent visitation
is in the best interest of each child:
continued in attached declaration.
4. Describe the duration and frequency of visitation that is being requested:
continued in attached declaration.
5.
A completed declaration under the Uniform Child Custody Jurisdiction and Enforcement Act, form FL-105, is
attached. (Not required if the Petition is filed within an open Family Law Case.)
6. Petitioner(s) requests that the court grant reasonable visitation with the above named child(ren), and such other
relief as the court may deem appropriate, pursuant to Family Code sections 3100, 3102, 3103 and 3104.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME)
(SIGNATURE OF PETITIONER)
(TYPE OR PRINT NAME)
(SIGNATURE OF PETITIONER)
PARENT CONSENT TO PETITIONER’S REQUEST FOR GRANDPARENT VISITATION
Mother Father hereby consents to and joins in this petition for Grandparent Visitation.
Date:
(TYPE OR PRINT NAME) (SIGNATURE OF PARENT OF MINOR CHILD(REN))
SUMMONS
(CITACION JUDICIAL)
FOR COURT USE ONLY
NOTICE TO DEFENDANT:
(AVISO AL DEMANDADO):
(SOLO PARA USO DE LA CORTE)
CASE NUMBER:
(Número del Caso):
The name, address, and telephone number of plaintiff's attorney, or plaintiff without an attorney, is:
(El nombre, la dirección y el número de teléfono del abogado del demandante, o del demandante que no tiene abogado, es):
, Deputy
Clerk, by
(Adjunto)
(Secretario)
NOTICE TO THE PERSON SERVED: You are served
as an individual defendant.1.
2.
3.
on behalf of (specify):
CCP 416.10 (corporation)
CCP 416.20 (defunct corporation)
CCP 416.40 (association or partnership)
under:
4.
by personal delivery on (date):
Form Adopted for Mandatory Use
Judicial Council of California
SUM-100 [Rev. July 1, 2009]
SUMMONS
Code of Civil Procedure §§ 412.20, 465
www.courtinfo.ca.gov
[SEAL]
SUM-100
Page 1 of 1
NOTICE! You have been sued. The court may decide against you without your being heard unless you respond within 30 days. Read the information
below.
You have 30 CALENDAR DAYS after this summons and legal papers are served on you to file a written response at this court and have a copy
served on the plaintiff. A letter or phone call will not protect you. Your written response must be in proper legal form if you want the court to hear your
case. There may be a court form that you can use for your response. You can find these court forms and more information at the California Courts
Online Self-Help Center (www.courtinfo.ca.gov/selfhelp), your county law library, or the courthouse nearest you. If you cannot pay the filing fee, ask
the court clerk for a fee waiver form. If you do not file your response on time, you may lose the case by default, and your wages, money, and property
may be taken without further warning from the court.
There are other legal requirements. You may want to call an attorney right away. If you do not know an attorney, you may want to call an attorney
referral service. If you cannot afford an attorney, you may be eligible for free legal services from a nonprofit legal services program. You can locate
these nonprofit groups at the California Legal Services Web site (www.lawhelpcalifornia.org), the California Courts Online Self-Help Center
(www.courtinfo.ca.gov/selfhelp), or by contacting your local court or county bar association. NOTE: The court has a statutory lien for waived fees and
costs on any settlement or arbitration award of $10,000 or more in a civil case. The court's lien must be paid before the court will dismiss the case.
as the person sued under the fictitious name of (specify):
¡AVISO! Lo han demandado. Si no responde dentro de 30 días, la corte puede decidir en su contra sin escuchar su versión. Lea la información a
continuación.
Tiene 30 DÍAS DE CALENDARIO después de que le entreguen esta citación y papeles legales para presentar una respuesta por escrito en esta
corte y hacer que se entregue una copia al demandante. Una carta o una llamada telefónica no lo protegen. Su respuesta por escrito tiene que estar
en formato legal correcto si desea que procesen su caso en la corte. Es posible que haya un formulario que usted pueda usar para su respuesta.
Puede encontrar estos formularios de la corte y más información en el Centro de Ayuda de las Cortes de California (www.sucorte.ca.gov), en la
biblioteca de leyes de su condado o en la corte que le quede más cerca. Si no puede pagar la cuota de presentación, pida al secretario de la corte
que le dé un formulario de exención de pago de cuotas. Si no presenta su respuesta a tiempo, puede perder el caso por incumplimiento y la corte le
podrá quitar su sueldo, dinero y bienes sin más advertencia.
Hay otros requisitos legales. Es recomendable que llame a un abogado inmediatamente. Si no conoce a un abogado, puede llamar a un servicio de
remisión a abogados. Si no puede pagar a un abogado, es posible que cumpla con los requisitos para obtener servicios legales gratuitos de un
programa de servicios legales sin fines de lucro. Puede encontrar estos grupos sin fines de lucro en el sitio web de California Legal Services,
(www.lawhelpcalifornia.org), en el Centro de Ayuda de las Cortes de California, (www.sucorte.ca.gov) o poniéndose en contacto con la corte o el
colegio de abogados locales. AVISO: Por ley, la corte tiene derecho a reclamar las cuotas y los costos exentos por imponer un gravamen sobre
cualquier recuperación de $10,000 ó más de valor recibida mediante un acuerdo o una concesión de arbitraje en un caso de derecho civil. Tiene que
pagar el gravamen de la corte antes de que la corte pueda desechar el caso.
other (specify):
(For proof of service of this summons, use Proof of Service of Summons (form POS-010).)
(Para prueba de entrega de esta citatión use el formulario Proof of Service of Summons, (POS-010)).
CCP 416.60 (minor)
CCP 416.70 (conservatee)
CCP 416.90 (authorized person)
YOU ARE BEING SUED BY PLAINTIFF:
(LO ESTÁ DEMANDANDO EL DEMANDANTE):
The name and address of the court is:
(El nombre y dirección de la corte es):
DATE:
(Fecha)
LAMOREAUX JUSTICE CENTER
341 The City Drive
Orange, CA 92868
Form Approved for Optional Use
Judicial Council of California
MC-031 [Rev. July 1, 2005]
ATTACHED DECLARATION
PLAINTIFF/PETITIONER:
CASE NUMBER:
DEFENDANT/RESPONDENT:
MC-031
(This form must be attached to another form or court paper before it can be filed in court.)
DECLARATION
Date:
(SIGNATURE OF DECLARANT)
(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.
Plaintiff
Other (Specify):
Defendant
Attorney for
Petitioner
Respondent
Page 1 of 1
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)
Additional children are listed on form FL-105(A)/GC-120(A). (Provide all requested information for additional children.)
FL-105/GC-120
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
CASE NUMBER:
DECLARATION UNDER UNIFORM CHILD CUSTODY
JURISDICTION AND ENFORCEMENT ACT (UCCJEA)
1. I am a party to this proceeding to determine custody of a child.
2. My present address and the present address of each child residing with me is confidential under Family Code section 3429 as
I have indicated in item 3.
3. There are (specify number):
(Insert the information requested below. The residence information must be given for the last FIVE years.)
a. Child’s name
Place of birth Date of birth Sex
Period of residence
Address
Relationship
Confidentialto present
to
to
to
b. Child’s name
Place of birth Date of birth Sex
Residence information is the same as given above for child a.
(If NOT the same, provide the information below.)
Period of residence
Address
Relationship
Confidential
to present
to
to
to
Additional residence information for a child listed in item a or b is continued on attachment 3c.
c.
Page 1 of 2
Family Code, § 3400 et seq.; Form Adopted for Mandatory Use
Judicial Council of California
FL-105/GC-120 [Rev. January 1, 2009]
DECLARATION UNDER UNIFORM CHILD CUSTODY
JURISDICTION AND ENFORCEMENT ACT (UCCJEA)
Probate Code, §§ 1510(f), 1512
minor children who are subject to this proceeding, as follows:
www.courtinfo.ca.gov
TELEPHONE NO.:
FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
PETITIONER:
RESPONDENT:
GUARDIANSHIP OF (Name):
Minor
OTHER PARTY:
Child's residence (City, State)
Child's residence (City, State)
Child's residence (City, State)
d.
Child's residence (City, State)
Child's residence (City, State)
Child's residence (City, State)
(This section applies only to family law cases.)
(This section apples only to guardianship cases.)
Confidential
Confidential
ORANGE
341 The Cit
y
Drive
Post Office Box 14710
Oran
g
e, California 92868-1570
LAMOREAUX JUSTICE CENTER
Juvenile Delinquency/
Juvenile Dependency
and provide the following information):
5. One or more domestic violence restraining/protective orders are now in effect. (Attach a copy of the orders if you have one
a. Criminal
b. Family
d. Other
Court State
Case number (if known) County Orders expire (date)
Court
(name, state, location)
Court order
or judgment
(date)
Case status
b. Guardianship
c. Other
Name of each child
a. Family
Case number
Court (name, state, location)
e. Adoption
Juvenile Delinquency/
Juvenile Dependency
Case Number
Your
connection to
the case
CASE NUMBER:
SHORT TITLE:
Do you have information about, or have you participated as a party or as a witness or in some other capacity in, another court case
or custody or visitation proceeding, in California or elsewhere, concerning a child subject to this proceeding?
Yes
(If yes, attach a copy of the orders (if you have one) and provide the following information):
Do you know of any person who is not a party to this proceeding who has physical custody or claims to have custody of or
visitation rights with any child in this case?
(If yes, provide the following information):Yes
a. Name and address of person
b. Name and address of person
c. Name and address of person
Has physical custody
Has physical custody
Has physical custody
Claims custody rights
Claims custody rights
Claims custody rights
Claims visitation rights
Claims visitation rights
Claims visitation rights
Name of each child Name of each child Name of each child
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)
7. Number of pages attached:
NOTICE TO DECLARANT: You have a continuing duty to inform this court if you obtain any information about a custody
FL-105/GC-120 [Rev. January 1, 2009]
Page 2 of 2
DECLARATION UNDER UNIFORM CHILD CUSTODY
JURISDICTION AND ENFORCEMENT ACT (UCCJEA)
4.
6.
No
proceeding in a California court or any other court concerning a child subject to this proceeding.
No
FL-105/GC-120
Proceeding
Proceeding
c.
d.
Page 1 of 1
Approved for Optional Use
Form # L-1120
Rev. May 5, 2010
FAMILY LAW NOTICE RE RELATED CASE
Superior Court of Orange County
Local Rule 701.5
www.occourts.org
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name & Address):
TELEPHONE NO.: FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name): BAR NO.:
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE
JUSTICE CENTER:
Central - 700 Civic Center Dr. West, Santa Ana, CA 92701-4045
Lamoreaux - 341 The City Drive, Orange, CA 92868-3205
PLAINTIFF/PETITIONER:
DEFENDANT/RESPONDENT:
FAMILY LAW NOTICE RE RELATED CASE
CASE NUMBER:
The parties must file this form with the Superior Court of Orange County, when a family law case is filed with the
Court and when a party discovers that there is a related case. A related case means one or both parties and/or
minor children of the parties are involved in other cases. Examples of related cases include another family law
case, a domestic violence case, a child support collection case, a criminal case, and a juvenile case involving a
minor child of one or both of the parties.
Fill in the requested information:
1. I also used the name(s):
2. The other party’s name is:
;
He/She has also used the name(s):
3.
Other court cases involving either party or a child of either party:
(If known, please include the case numbers)
Court Location/
Case Number Case Name Justice Center Person Involved
a.
b.
c.
d.
4.
There are no other court cases involving either party or a child of either party.
Date:
(TYPE OR PRINT NAME OF PARTY OR ATTORNEY)
(SIGNATURE OF PARTY OR ATTORNEY)
At the time of service I was at least 18 years of age and not a party to this action.
PROOF OF SERVICE OF SUMMONS
Form Adopted for Mandatory Use
Judicial Council of California
POS-010 [Rev. January 1, 2007]
POS-010
PROOF OF SERVICE OF SUMMONS
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PLAINTIFF/PETITIONER:
DEFENDANT/RESPONDENT:
CASE NUMBER:
ATTORNEY FOR (Name):
TELEPHONE NO.: FAX NO. (Optional):
E–MAIL ADDRESS (Optional):
1.
4. Address where the party was served:
a.
5. I served the party (check proper box)
by personal service. I personally delivered the documents listed in item 2 to the party or person authorized to
receive service of process for the party (1) on (date): (2) at (time):
b.
(business) a person at least 18 years of age apparently in charge at the office or usual place of business
of the person to be served. I informed him or her of the general nature of the papers.
(1)
(home) a competent member of the household (at least 18 years of age) at the dwelling house or usual
place of abode of the party. I informed him or her of the general nature of the papers.
(2)
by substituted service. On (date): at (time): I left the documents listed in item 2 with or
in the presence of (name and title or relationship to person indicated in item 3):
Page 1 of 2
Code of Civil Procedure, § 417.10
Ref. No. or File No.:
a. Party served (specify name of party as shown on documents served):3.
b. Person (other than the party in item 3a) served on behalf of an entity or as an authorized agent (and not a person
under item 5b on whom substituted service was made) (specify name and relationship to the party named in item 3a):
(3)
(physical address unknown) a person at least 18 years of age apparently in charge at the usual mailing
address of the person to be served, other than a United States Postal Service post office box. I informed
him or her of the general nature of the papers.
(Separate proof of service is required for each party served.)
b.
c.
d.
complaint
Alternative Dispute Resolution (ADR) package
Civil Case Cover Sheet (served in complex cases only)
I served copies of: 2.
e.
f.
cross-complaint
other (specify documents):
a.
summons
(5)
(4)
I thereafter mailed (by first-class, postage prepaid) copies of the documents to the person to be served
at the place where the copies were left (Code Civ. Proc., § 415.20). I mailed the documents on
(date): from (city): or a declaration of mailing is attached.
I attach a declaration of diligence stating actions taken first to attempt personal service.
ORANGE
341 The City Drive
Post Office Box 14710
Orange, CA 92868-1570
LAMOREAUX JUSTICE CENTER
✔
✔
Petition for Grandparent Visitation (L-0373); Declaration (MC-031); and
Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act (FL-105); Family Law Notice re Related Case
Person who served papers
The fee for service was: $
not a registered California process server.
exempt from registration under Business and Professions Code section 22350(b).
a registered California process server:
(1)
(2)
(i)
Registration No.:
County:
8.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
9.
Date:
(SIGNATURE )
PROOF OF SERVICE OF SUMMONS
POS-010 [Rev. January 1, 2007]
CASE NUMBER:
PLAINTIFF/PETITIONER:
DEFENDANT/RESPONDENT:
7.
I am a California sheriff or marshal and I certify that the foregoing is true and correct.
e. I am:
(iii)
(ii)
by mail and acknowledgment of receipt of service. I mailed the documents listed in item 2 to the party, to the
address shown in item 4, by first-class mail, postage prepaid,
c.
(2) from (city):
with two copies of the Notice and Acknowledgment of Receipt and a postage-paid return envelope addressed
to me. (Attach completed Notice and Acknowledgement of Receipt.) (Code Civ. Proc., § 415.30.)
(3)
(4)
by other means (specify means of service and authorizing code section):
d.
a.
b.
(1) on (date):
to an address outside California with return receipt requested. (Code Civ. Proc., § 415.40.)
Additional page describing service is attached.
6. The "Notice to the Person Served" (on the summons) was completed as follows:
as an individual defendant.
as the person sued under the fictitious name of (specify):
(NAME OF PERSON WHO SERVED PAPERS/SHERIFF OR MARSHAL)
or
a. Name:
b. Address:
c. Telephone number:
d.
Page 2 of 2
(3)
416.10 (corporation)
416.60 (minor)
416.30 (joint stock company/association)
416.70 (ward or conservatee)
416.90 (authorized person)
d.
under the following Code of Civil Procedure section:
other:
415.95 (business organization, form unknown)
415.46 (occupant)
416.20 (defunct corporation)
On behalf of (specify):
416.40 (association or partnership)
416.50 (public entity)
c.
as occupant.
employee independent contractor.
owner
5.
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SUPERIOR COURT OF CALIFORNIA COUNTY OF ORANGE SELF-HELP (The Superior Court of California - County of Orange)

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Completed 8 February 2021

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