Free LOCAL FORMS - California

Superior Court of California, County of Imperial

Attorney or Party Without Attorney: Attorney for_______________________ SUPERIOR COURT FOR THE STATE OF CALIFORNIA COUNTY OF IMPERIAL, JUVENILE DIVISION ) ) ) ) CASE NO. ___________ DECLARATION RE NOTICE OF EX PARTE APPLICATION

______________________________ Name of Dependent Child _______________________________ I, the undersigned, declare:

1. I am [ ] counsel [ ] social worker [ ] mother [ ] father [ ] minor [ ] Department of Family and Children's Services or [ ] other (explain) ________________________________ _________________________ in this dependency action. 2. Pursuant to Juvenile Court Local Rules, I have given notice of, and a copy of this application for ex parte orders to, the following persons:________________________________________________ __________________________________________________________________ Notice to the above named persons was given in the following manner: [ ] telephone at ________ [ ] a.m. [ ] p.m. [ ] letter [ ] mailed [ ] hand delivered to (insert name and address): _______________________________________________________ ______________________________________, on _______________, _____. 3. I have received the following response: ____________________ _________________________________________________________________ . 4. I have not given notice of this application for ex parte orders for the following reason(s): [ ] a. Would frustrate the purpose of the orders requested. [ ] b. Minor child would suffer immediate and irreparable harm before the orders could issue. [ ] c. No significant burden or inconvenience to responding party will result from the orders requested. [ ] d. I made reasonable, good faith efforts to give notice, as follows: ______________________________________________ __________________________________________________________________ [ ] e. Other:_________________________________________ . I declare under penalty of perjury under the laws of the State of California the foregoing is true and correct. Executed at _______________, California, _______________________.
(DATE)

________________________ Declarant

Form Approved for Mandatory Use JV-02 (adopted 7/1/07)