Free ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address) - California

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address)

FOR COURT USE ONLY

TELEPHONE NO: ATTORNEY FOR (NAME):

FAX NO:

SUPERIOR COURT OF CALIFORNIA COUNTY OF YUBA 215 FIFTH STREET, SUITE 200 MARYSVILLE, CA 95901 (530) 749-7600 IN THE MATTER OF THE PETITION OF: TO ESTABLISH THE FACT OF BIRTH OF:

PETITION TO ESTABLISH FACT OF BIRTH [H&S § 103450]

CASE NUMBER:

The undersigned respectfully alleges: 1. 2. Petitioner is a resident of the County of Yuba, State of California. Petitioner seeks to establish the fact of birth of ___________________________, said birth having occurred _______________ in the County of __________________________, State of __________________________, or in the Country of . Said birth has not been registered in conformity with the provisions of law in effect at the time of said birth, or such record has been lost or destroyed after having been filed.

3.

WHEREFORE, Petitioner prays that an order of the Court be made establishing the fact of birth of _________________________ which occurred as set forth hereinabove, and for such other relief as the Court deems proper. Dated: ____________________

...................................
Type or Print Name

___________________________________
Signature of Petitioner

VERIFICATION I declare under penalty of perjury the laws of the State of California that the foregoing is true and correct. Dated: ____________________

...................................
Type or Print Name

___________________________________
Signature of Petitioner

Yuba County Superior Court Effective 8/10/05

PETITION TO ESTABLISH FACT OF BIRTH

FL05050

[H&S § 103450]