Fillable SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO (Superior Court of California)

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SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO (Superior Court of California)

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  • 15 check-boxes
  • 42 other fields

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File type: PDF

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Page 1 of 2
SB-9007
Rev. 10-2019
Optional
Name of Citee: _____________________________________________
Aliases of Citee: ____________________________________________
____________________________________________
Please complete the following questions regarding the above named Citee.
State of California, County of San Bernardino
I, ________________________________________________ say:
(Your Name)
I am a party to this proceeding I am not a party to this proceeding.
I reside at: ___________________________________________________________________
My occupation is: ______________________________________________________________
1. I personally know the citee Do not know the citee.
2. I have known said citee: ______ years ______months.
3. The last known address of said citee is:________________________________________
_________________________________________
4. The approximate age of the said citee is: __________.
5. The last date I saw the said citee was: ____________.
6. The occupation of said citee is: __________________________________________________
7. The name of said citee’s employer is: _____________________________________________
8. The last know physical incapacity of said citee is:____________________________________
___________________________________________________________________________
PARTY WITHOUT ATTORNEY OR ATTORNEY STATE BAR NUMBER:
NAME:
FI
RM NAME:
STREET ADDRESS:
CITY: STATE: ZIP CODE:
TELEPHONE NO: FAX NO:
E-MAIL ADDRESS:
ATTONREY 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 ADOPTION PETITION OF:
Affidavit / Certificate / Declaration
Re: Military Service in an Adoption and Related Matters
CASE NUMBER:
Page 2 of 2
SB-9007
Rev. 10-2019
Optional
9. I know the citee is or is not (check below) an active duty member of the following military service
branch:
a. is or is not --- Army of the United States
b. is or is not --- United States Navy
c. is or is not --- United States Marine Corps
d. is or is not --- United States Coast Guard
e. is or is not --- United States Air Force
f. Other: _________________________________
10. Known facts tending to show that said citee is not in the Military service: _________________
___________________________________________________________________________
------------------------------------------------------------------
This form is designed for use either as an affidavit or an unsworn statement made under penalty of perjury.
a. If an affidavit, should sign where indicated below.
b. If an unsworn statement, they should sign where indicated below.
-----------------------------------------------------------------
AFFIDAVIT
Declaration is to be signed only if declarant is within the State of California.
Signature of Affiant: ___________________________________ Dated: _________________
Subscribed and sworn to before me on ____________________________________
____________________________________
Signature of Notary Public in and for the
County of ______________, State of California
---------------------------------------------------------------
UNSWORN STATEMENT
Declaration
I certify or declare under penalty of perjury that the foregoing it true and correct.
Signature of Declarant: __________________________________
Executed at _______________________ on: _________________
Disclaimer: “Any person who shall make or use an affidavit or declaration required under this section
knowing it to be false shall be guilty of a misdemeanor and shall be punishable by imprisonment not to
exceed one year or by fine not to exceed $1,000 or both.” Soldiers’ and Sailors’ Civil Relief Act of 1940,
as amended
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SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO (Superior Court of California)

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Completed 20 November 2020

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