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

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SHC-FL-03 (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 CUSTODY AND SUPPORT
OF A MINOR CHLID
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:
Respondent and I have legally adopted a child together.
I am married to the respondent, and no action is pending in any court for dissolution, legal separation, or nullity.
1.
Choose at least one box below to explain why you are using this form:
3.
A completed Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) (form FL-105) is attached.
2.
Child custody and visitation (parenting time). I request the following orders:4.
Form Adopted for Mandatory Use
Judicial Council of California
FL-260 [Rev. January 1, 2020]
Family Code, §§ 211, 3120, 3400, 3900,
7600 et seq.
www.courts.ca.gov
PETITION FOR CUSTODY
AND SUPPORT OF MINOR CHILDREN
Page 1 of 2
FL-260
PARTY WITHOUT ATTORNEY OR ATTORNEY
STATE BAR NUMBER:
NAME:
FIRM NAME:
STREET ADDRESS:
CITY: STATE: ZIP CODE:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER:
RESPONDENT:
PETITION FOR CUSTODY AND
SUPPORT OF MINOR CHILDREN
FOR COURT USE ONLY
CASE NUMBER:
b.
d. Respondent and I have been determined to be the parents in juvenile court or governmental child support.
c.
Respondent and I have signed a voluntary declaration of parentage or paternity regarding the minor children, and no
action regarding the children has been filed in any other court. A copy is attached.
a.
Child's name
Birthdate Age
See the attached form FL-311, Child Custody and Visitation (Parenting Time) Application Attachment.
NOTICE: This action will not terminate a marriage or domestic partnership and will not determine
a parental relationship.
I am the petitioner. The respondent and I are the parents of the following minor children:
Case number:
State: Country (if not the United States):County:
Visitation (parenting time) of children with:
d.
Physical custody of children to:
Legal custody of children to:
Petitioner Respondent Joint Other
b.
c.
a.
The proposed schedule for visitation (parenting time) is as follows:
FRQWLQXHGRQ$WWDFKPHQW
If "Other" is checked above, name of the other person is
(specify):
ORANGE
341 THE CITY DRIVE SOUTH
341 THE CITY DRIVE SOUTH
ORANGE, CA 92868
LAMOREAUX JUSTICE CENTER
Each party will pay their own attorney's fees.
RESPONDENT:
PETITIONER:
CASE NUMBER:
FL-260
Date:
(TYPE OR PRINT NAME)
4.
h. I request that joint legal custody orders set out in
Page 2 of 2
PETITION FOR CUSTODY
AND SUPPORT OF MINOR CHILDREN
FL-260 [Rev. January 1, 2020]
form FL-341(E) be approved.other
Fees and cost of litigation
7.
8.
Other (specify):
6. Child support. The court may make orders for support of the children and issue an earnings assignment without further notice to
either party.
5.
Attorney fees will be paid bya.
b.
petitioner respondent.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
I have read the restraining order on the back of the Summons (Uniform Parentage—Petition for Custody and Support)
(form FL-210) that is being filed with this petition, and I understand that it applies to me when this petition is filed.
NOTICE: If you have a child from this relationship, the court is required to order child support based on the
incomes of both parents. You should supply the court with information about your income. Otherwise, the
child support order will be based on information supplied by the other parent. Any party required to pay child
support must pay interest on overdue amounts at the "legal rate," which is currently 10 percent.
A blank Response to Petition for Custody and Support of Minor Children (form FL-270) must be served on the respondent with a copy
of this Petition.
(SIGNATURE OF PETITIONER)
i. I request that visitation (parenting time) be supervised for the following persons, with the following restrictions:
Continued on Attachment 4h.
j.
2WKHUVSHFLI\
e.
form FL-341(C)
I request that the child abduction prevention orders requested on form FL-312 be approved.
g. I request that additional orders regarding child custody set out in
f. I request that the proposed holiday schedule set out in be approved.other
form FL-341(D) be approved.other
FL-210
SUMMONS
(Parentage—Custody and Support)
CITACIÓN (Paternidad—Custodia y Manutención)
NOTICE TO RESPONDENT (Name):
FOR COURT USE ONLY
(SOLO PARA USO DE LA CORTE)
You have been sued. Read the information below and on the next page.
Lo han demandado. Lea la información a continuación y en la página siguiente.
Petitioner's name:
CASE NUMBER: (Número de caso)
AVISO AL DEMANDADO (Nombre):
El nombre del demandante:
You have 30 calendar days after this Summons and Petition
are served on you to file a Response (form FL-220 or FL-270)
at the court and have a copy served on the petitioner. A
letter, phone call, or court appearance will not protect you.
If you do not file your Response on time, the court may make
orders affecting your right to custody of your children. You
may also be ordered to pay child support and attorney fees
and costs.
For legal advice, contact a lawyer immediately. Get help
finding a lawyer at the California Courts Online Self-Help
Center (www.courts.ca.gov/selfhelp), at the California Legal
Services website (www.lawhelpca.org), or by contacting your
local bar association.
Tiene 30 dias de calendario después de habir recibido la entrega legal
de esta Citación y Petición para presentar una Respuesta (formulario
FL-220 o FL-270) ante la corte y efectuar la entrega legal de una copia
al demandante. Una carta o llamada telefónica o una audiencia de la
corte no basta para protegerlo.
Si no presenta su Respuesta a tiempo, la corte puede dar órdenes que
afecten la custodia de sus hijos. La corte también le puede ordenar que
pague manutención de los hijos, y honorarios y costos legales.
Para asesoramiento legal, póngase en contacto de inmediato con un
abogado. Puede obtener información para encontrar un abogado en el
Centro de Ayuda de las Cortes de California (www.sucorte.ca.gov), en
el sitio web de los Servicios Legales de California (www.lawhelpca.org),
o poniéndose en contacto con el colegio de abogados de su condado.
NOTICE: The restraining order on page 2 remains in effect
against each parent until the petition is dismissed, a judgment
is entered, or the court makes further orders. This order is
enforceable anywhere in California by any law enforcement
officer who has received or seen a copy of it.
AVISO: La órden de protección que aparecen en la pagina 2
continuará en vigencia en cuanto a cada parte hasta que se emita un
fallo final, se despida la petición o la corte dé otras órdenes. Cualquier
agencia del orden público que haya recibido o visto una copia de estas
orden puede hacerla acatar en cualquier lugar de California.
, Deputy (Asistente)
Clerk, by (Secretario, por)
[SEAL]
Page 1 of 2
Family Code, §§ 232, 233, 7700;
Cal. Rules of Court, rule 5.50
www.courts.ca.gov
Form Adopted for Mandatory Use
Judicial Council of California
FL-210 [Rev. January 1, 2015]
SUMMONS
(Parentage—Custody and Support)
Date (Fecha):
1.
2.
The name and address of the court are: (El nombre y dirección de la corte son:)
The name, address, and telephone number of petitioner’s attorney, or petitioner without an
attorney, are: (El nombre, la dirección y el número de teléfono del abogado del demandante, o del
demandante si no tiene abogado, son:)
FEE WAIVER: If you cannot pay the filing fee, ask the clerk
for a fee waiver form. The court may order you to pay back all
or part of the fees and costs that the court waived for you or
the other party.
EXENCIÓN DE CUOTAS: Si no puede pagar la cuota de presentación,
pida al secretario un formulario de exención de cuotas. La corte puede
ordenar que usted pague, ya sea en parte o por completo, las cuotas y
costos de la corte previamente exentos a petición de usted o de la otra
parte.
Superior Court of California, County of Orange
341 THE CITY DRIVE ORANGE CA 92868
LAMOREAUX JUSTICE CENTER
ORDEN DE RESTRICCIÓN ESTÁNDAR
(Paternidad—Custodia y Manutención)
Starting immediately, you and every other party are restrained from removing from the state, or applying for a
passport for, the minor child or children for whom this action seeks to establish a parent-child relationship or
a custody order without the prior written consent of every other party or an order of the court.
This restraining order takes effect against the petitioner when he or she files the petition and against the respondent
when he or she is personally served with the Summons and Petition OR when he or she waives and accepts service.
This restraining order remains in effect until the judgment is entered, the petition is dismissed, or the court makes
other orders.
This order is enforceable anywhere in California by any law enforcement officer who has received or seen a copy of it.
En forma inmediata, usted y cada otra parte tienen prohibido llevarse del estado a los hijos menores para
quienes esta acción judicial procura establecer una relación entre hijos y padres o una orden de custodia, ni
pueden solicitar un pasaporte para los mismos, sin el consentimiento previo por escrito de cada otra parte o
sin una orden de la corte.
Esta orden de restricción entrará en vigencia para el demandante una vez presentada la petición, y para el
demandado una vez que éste reciba la notificación personal de la Citación y Petición, o una vez que renuncie su
derecho a recibir dicha notificación y se dé por notificado.
Esta orden de restricción continuará en vigencia hasta que se emita un fallo final, se despida la petición o la corte dé
otras órdenes.
Cualquier agencia del orden público que haya recibido o visto una copia de esta orden puede hacerla acatar en
cualquier lugar de California.
Page 2 of 2
SUMMONS
(Parentage—Custody and Support)
FL-210 [Rev. January 1, 2015]
STANDARD RESTRAINING ORDER
(Parentage—Custody and Support)
FL-210
NOTICE—ACCESS TO AFFORDABLE HEALTH
INSURANCE Do you or someone in your household need
affordable health insurance? If so, you should apply for
Covered California. Covered California can help reduce the
cost you pay toward high-quality, affordable health care.
For more information, visit www.coveredca.com. Or call
Covered California at 1-800-300-1506.
AVISO
—ACCESO A SEGURA DE SALUD MÁS
ECONOMICO Necessita seguro de salud a un costo
asequible, ya sea para usted o alguien en su hogar? Si es
asi, puede presentar una solicitud con Covered California.
Covered California lo puede ayudar a reducir al costo que
paga por seguro de salud asequible y de alta calidad. Para
obtener más información, visite www.coveredca.com. O
llame a Covered California al 1-800-300-0213.
(If you need more space to answer any questions on this form, attach an 8 1/2-by-11-inch sheet of paper and write the
question number before your answer.)
1.
Employment (Give information on your current job or, if you're unemployed, your most recent job.)
Form Adopted for Mandatory Use
Judicial Council of California
FL-150 [Rev. January 1, 2019]
INCOME AND EXPENSE DECLARATION
Family Code, §§ 2030–2032, 2100–2113,
3552, 3620–3634, 4050–4076, 4300–4339
www.courts.ca.gov
Page 1 of 4
Employer:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
FOR COURT USE ONLY
CASE NUMBER:
INCOME AND EXPENSE DECLARATION
PARTY WITHOUT ATTORNEY OR ATTORNEY
STATE: ZIP CODE:CITY:
STREET ADDRESS:
FIRM NAME:
NAME:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
STATE BAR NUMBER:
FL-150
Attach copies
of your pay
stubs for last
two months
(black out
Social
Security
numbers).
a.
Employer's address:
b.
Employer's phone number:
c.
Occupation:
d.
Date job started:
e.
If unemployed, date job ended:
f.
g. I work about hours per week.
h. I get paid $ gross (before taxes)
(If you have more than one job, attach an 8 1/2-by-11-inch sheet of paper and list the same information as above for your other
jobs. Write "Question 1—Other Jobs" at the top.)
2.
Age and education
My age is (specify):
a.
b.
I have completed high school or the equivalent:
Yes
No
If no, highest grade completed (specify):
Number of years of college completed (specify):
c.
Degree(s) obtained
(specify):
Number of years of graduate school completed (specify):
d.
Degree(s) obtained
(specify):
e. I have: professional/occupational license(s)
(specify):
vocational training
(specify):
3.
Tax information
a.
I last filed taxes for tax year
(specify year):
b.
My tax filing status is
single
head of household married, filing separately
married, filing jointly with
(specify name):
c.
I file state tax returns in
California other
(specify state):
I claim the following number of exemptions (including myself) on my taxes (specify):
d.
Other party's income. I estimate the gross monthly income (before taxes) of the other party in this case at (specify): $
4.
This estimate is based on (explain):
Number of pages attached:
I declare under penalty of perjury under the laws of the State of California that the information contained on all pages of this form and
any attachments is true and correct.
(SIGNATURE OF DECLARANT)
Date:
(TYPE OR PRINT NAME)
per month per week
per hour.
341 The City Drive
Orange, CA 92868
Lamoreaux Justice Center
Spousal support
Spousal support that I pay by court order from a different marriage ..........................
Attach copies of your pay stubs for the last two months and proof of any other income. Take a copy of your latest federal tax
return to the court hearing. (Black out your Social Security number on the pay stub and tax return.)
Income (For average monthly, add up all the income you received in each category in the last 12 months
and divide the total by 12.)
FL-150 [Rev. January 1, 2019] Page 2 of 4
INCOME AND EXPENSE DECLARATION
All other property, (estimate fair market value minus the debts you owe).....
c. real and
personal
* Check the box if the spousal support order or judgment was executed by the parties and the court before January 1, 2019, or if a court-ordered change
maintains the spousal support payments as taxable income to the recipient and tax deductible to the payor.
$
FL-150
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
5.
Salary or wages (gross, before taxes).....................................................................................................a.
Overtime (gross, before taxes)................................................................................................................b.
Commissions or bonuses.........................................................................................................................c.
Public assistance (for example: TANF, SSI, GA/GR) ..................................d.
e.
Partner supportf.
currently receiving
f
rom this marriage
from a different marriage
from this domestic partnership from a different domestic partnership
Pension/retirement fund payments..........................................................................................................g.
Social Security retirement (not SSI).........................................................................................................h.
Disability:i. Social Security (not SSI)
State disability (SDI) Private insurance
Unemployment compensation.................................................................................................................j.
Workers' compensation............................................................................................................................k.
l.
Other (military allowances, royalty payments) (specify):
Investment income (Attach a schedule showing gross receipts less cash expenses for each piece of property.)
6.
Dividends/interest....................................................................................................................................a.
Rental property income...........................................................................................................................b.
Trust income............................................................................................................................................c.
d.
Other (specify):
Income from self-employment, after business expenses for all businesses.........................................7.
I am the owner/sole proprietor
business partner other
(specify):
Number of years in this business (specify):
Name of business (specify):
Type of business (specify):
Attach a profit and loss statement for the last two years or a Schedule C from your last federal tax return. Black out your
Social Security number. If you have more than one business, provide the information above for each of your businesses.
Additional income. I received one-time money (lottery winnings, inheritance, etc.) in the last 12 months (specify source and
amount):
8.
Change in income. My financial situation has changed significantly over the last 12 months because (specify):
9.
10.
Deductions
Required union dues....................................................................................................................................................a.
Required retirement payments (not Social Security, FICA, 401(k), or IRA)..................................................................b.
Medical, hospital, dental, and other health insurance premiums (total monthly amount).............................................
c.
Child support that I pay for children from other relationships.......................................................................................d.
e.
Partner support that I pay by court order from a different domestic partnership..........................................................f.
Necessary job-related expenses not reimbursed by my employer (attach explanation labeled "Question 10g").........
g.
11.
Assets
Cash and checking accounts, savings, credit union, money market, and other deposit accounts...............................a.
Stocks, bonds, and other assets I could easily sell.......................................................................................................b.
$
$
$
$
$
$
$
$
$
$
$
$
Last month
Average
monthly
$
$
$
$
$
Last month
Total
federally taxable*
federally tax deductible*
$
$
$
$
$
$
$
$
$
The following people live with me:
FL-150 [Rev. January 1, 2019] Page 3 of 4
INCOME AND EXPENSE DECLARATION
FL-150
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
12.
Attorney fees (This information is required if either party is requesting attorney fees):
15.
a.
b.
c.
d.
My attorney's hourly rate is (specify):
I confirm this fee arrangement.
Average monthly expenses13. Estimated expenses
Actual expenses Proposed needs
Installment payments and debts not listed above14.
To date, I have paid my attorney this amount for fees and costs (specify): $
The source of this money was (specify):
I still owe the following fees and costs to my attorney (specify total owed): $
(SIGNATURE OF DECLARANT)
Date:
(TYPE OR PRINT NAME)
Name
Age
How the person is
related to me (ex: son)
That person's gross
monthly income
Pays some of the
household expenses?
a.
b.
c.
d.
e.
Yes
No
Yes No
Yes No
Yes No
Yes No
a.
Home:
(1) Rent or
mortgage..........
$
$
$
$
$
$
If mortgage:
(a) average principal:
$
(b) average interest:
$
(2) Real property taxes..................................
(3)
Homeowner's or renter's insurance
(if not included above)..............................
(4) Maintenance and repair...........................
b.
Health-care costs not paid by insurance........
c.
Child care.......................................................
$
d.
Groceries and household supplies.................
$
e.
Eating out.......................................................
$
f.
Utilities (gas, electric, water, trash)................
$
g.
Telephone, cell phone, and e-mail.................
$
$
h.
Laundry and cleaning.....................................
i.
Clothes...........................................................
$
j.
Education.......................................................
$
k.
Entertainment, gifts, and vacation..................
$
l.
Auto expenses and transportation
(insurance, gas, repairs, bus, etc.).................
$
m.
Insurance (life, accident, etc.; do not include
auto, home, or health insurance)...................
$
$
$
$
$
n.
Savings and investments...............................
o.
Charitable contributions..................................
p.
Monthly payments listed in item 14
(itemize below in 14 and insert total here).....
q.
Other (specify):
r.
TOTAL EXPENSES (a–q) (do not add in
the amounts in a(1)(a) and (b))
$
s.
Amount of expenses paid by others
Paid to For Amount Balance Date of last payment
$
$
$
$
$
$
$
$
$
$
$
$
CHILD SUPPORT INFORMATION
(NOTE: Fill out this page only if your case involves child support.)
FL-150 [Rev. January 1, 2019]
Page 4 of 4
INCOME AND EXPENSE DECLARATION
FL-150
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
a.
b.
d.
(Do not include the amount your employer pays.)
Number of children16.
I do
I do not
I have (specify number): children under the age of 18 with the other parent in this case.
a.
Name of insurance company:
The monthly cost for the children's health insurance is or would be (specify): $
The children spend percent of their time with me and percent of their time with the other parent.
b.
Children's health-care expenses17.
have health insurance available to me for the children through my job.
c.
Additional expense for the children in this case18.
Childcare so I can work or get job training....................................................................a.
Children's health care not covered by insurance...........................................................b.
Travel expenses for visitation........................................................................................c.
Special hardships. I ask the court to consider the following special financial circumstances19.
Extraordinary health expenses not included in 18b...................................a.
Major losses not covered by insurance (examples: fire, theft, other
insured loss)...............................................................................................
b.
Expenses for my minor children who are from other relationships and
are living with me..................................................................................
c.
d.
Children's educational or other special needs (specify below):.....................................
(attach documentation of any item listed here, including court orders):
(1)
Names and ages of those children (specify):
(2)
Child support I receive for those children...............................................(3)
20.
(If you're not sure about percentage or it has not been agreed on, please describe your parenting schedule here.)
Address of insurance company:
Amount per month
Other information I want the court to know concerning support in my case (specify):
The expenses listed in a, b, and c create an extreme financial hardship because (explain):
Amount per month
For how many months?
$
$
$
$
$
$
$
$
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 CITY DRIVE
ORANGE, CA 92868
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 ADDRE
SS (Optional):
ATT
ORNEY 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)
✔
ORANGE
341 THE CITY DRIVE
LAMOREAUX JUSTICE CENTER
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SUPERIOR COURT OF CALIFORNIA OF ORANGE COUNTY SELF-HELP (The Superior Court of California - County of Orange)

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Completed 8 February 2021

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