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:
ORDER ESTABLISHING FACT OF BIRTH [H&S § 103450]
CASE NUMBER:
THE COURT FINDS as follows: 1. 2. Petitioner is a resident of the County of Yuba, State of California. _______________________ was born on ________________________________ [ of __________________________, State of __________________________ or [ ____________________________________. 3. Said birth was not registered in conformity with the provisions of law in effect at the time of said birth, or such record was lost or destroyed after having been filed. THE COURT ORDERS that the birth of _______________________ which occurred as set forth hereinabove, is hereby verified and established by this Court. Dated: ____________________ JUDGE OF THE SUPERIOR COURT ] in the County
] in the Country of
Yuba County Superior Court Effective 8/10/05
ORDER ESTABLISHING FACT OF BIRTH
FL05052
[H&S § 103450]