COURT
COUNTY
OF
. . .OR. PARTY
. . . . WITHOUT
. . . . . .ATTORNEY
. . . . . .(Name
. . . and
. . .Mailing
. . . Address):
. . . . . . . . . . . . . . . . . . . .TELEPHONE
. . . . . NO.:
ATTORNEY
:
Index No.
Plaintiff(s)
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
-against-
STREET ADDRESS:
FL-105/GC-120
FOR COURT USE ONLY
:
Calendar No.
:
JUDICIAL SUBPOENA
:
MAILING ADDRESS:
:
CITY AND ZIP CODE:
BRANCH NAME:
:
CASE NAME:
Defendant(s)
:
......................................................
DECLARATION UNDER UNIFORM CHILD CUSTODY
JURISDICTION AND ENFORCEMENT ACT (UCCJEA)
CASE NUMBER:
1. I am a party to this proceeding to determine custody of a child.
THE PEOPLE OF THE STATE OF NEW YORK
Declarant's present address is not disclosed. It is confidential under Family Code section 3429. The address of children
2.
presently residing with declarant is identified on this declaration as confidential.
TO
3. (Number):
minor children are subject to this proceeding as follows:
(Insert the information requested below. The residence information must be given for the last FIVE years.)
a. Child's name
Place of birth
GREETINGS:
Period of residence
Date of birth
Address
Sex
Person child lived with (name and present address)
Relationship
all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
located at
County of
to
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
to
present
Confidential
WE COMMAND
YOU, that
to
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
to
the party
on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
to
b. Child's name
Court in
Witness, Honorable
County,
, Date
oneofof
the Justices of the
birth
Place of birth
day of
Sex
, 20
Residence information is the same as given above for child a.
(If NOT the same, provide the information below.)
Period of residence
to
Address
present
Person child lived with (name and present address)
Relationship
(Attorney must sign above and type name below)
Confidential
Attorney(s) for
to
to
Office and P.O. Address
to
c.
TelephoneforNo.:
Additional children are listed on Attachment 3c. (Provide requested information
additional children on an attachment.)
Form Approved for Optional Use
Judicial Council of California
FL-105/GC-120 [Rev. January 1, 2003]
Facsimile No.:
E-Mail Address:
DECLARATION UNDER UNIFORM CHILD CUSTODY
Mobile
Tel. No.:
JURISDICTION AND ENFORCEMENT ACT
(UCCJEA)
Page 1 of 2
Family Code, § 3400 et seq.
Probate Code, §§ 1510(f), 1512
www.courtinfo.ca.gov
American LegalNet, Inc.
www.USCourtForms.com
CASE NUMBER:
SHORT TITLE:
4. Have you participated as a party or a witness or in some other capacity in another litigation or custody proceeding, in California or
elsewhere, concerning custody of a child subject to this proceeding?
No
Yes (If yes, provide the following information:)
a. Name of each child:
b. Capacity of declarant:
party
c. Court (specify name, state, location):
witness
other (specify):
d. Court order or judgment (date):
5. Do you have information about a custody proceeding pending in a California court or any other court concerning a child subject to
this proceeding, other than that stated in item 4?
No
Yes (If yes, provide the following information:)
a. Name of each child:
b. Nature of proceeding:
dissolution or divorce
guardianship
adoption
other (specify):
c. Court (specify name, state, location):
d. Status of proceeding:
6. 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 subject to this proceeding?
Yes (If yes, provide the following information:)
No
a. Name and address of person
b. Name and address of person
c. Name and address of person
Has physical custody
Claims custody rights
Claims visitation rights
Has physical custody
Claims custody rights
Claims visitation rights
Has physical custody
Claims custody 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)
7.
(SIGNATURE OF DECLARANT)
Number of pages attached after this page:
NOTICE TO DECLARANT: You have a continuing duty to inform this court if you obtain any information about a custody
proceeding in a California court or any other court concerning a child subject to this proceeding.
FL-105/GC-120 [Rev. January 1, 2003]
DECLARATION UNDER UNIFORM CHILD CUSTODY
JURISDICTION AND ENFORCEMENT ACT (UCCJEA)
Page 2 of 2