COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address): : :
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Index No. Calendar No.
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-againstSUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:
Defendant(s) : ............................................
DECLARATION FOR DEFAULT OR UNCONTESTED JUDGMENT
THE PEOPLE OF THE STATE OF NEW YORK
1. I declare that if I appeared in court and were sworn, I would testify to the truth of the facts in this declaration. TO 2. I request that proof will be by this declaration and that I will not appear before the court unless I am ordered by the court to appear. 3. All the information in the Petition or Complaint to Establish Parental Relationship Response or Answer Petition to Establish Custody and Support Response is true and correct. 4. Respondent and/or Petitioner is/are the parent(s) of the minor child(ren). 5. A Voluntary Declaration of Paternity form has has not been signed regarding this child (attach a copy if available). GREETINGS: 6. DEFAULT OR UNCONTESTED (Check a or b) a. The default of the respondent was entered or is being requested, beingam not seeking any relief not requested in the WE COMMAND YOU, that all business and excuses and I laid aside, you and each of you attend before petition. OR the Honorable at the Court b. County of The parties have stipulated that located at may proceed as an uncontested matter without notice, and the stipulation is the matter attached. in room , on the day of , 20 , at o'clock in the noon, and at any recessed 7. CHILD SUPPORT should be ordered as set forth in the proposed Judgment (form FL-250). or adjourned date, to testify and give evidence as a witness in this action on the part of the Petitioner Respondent is presently receiving public assistance (TANF); thus all support should be made a. payable to the local child support agency at (specify address):
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to b. NOTE: If a support order is requested, submit a completed Income and Expense Declaration (form FL-150), or the party on whose behalf this subpoena was issued for aamaximum penalty file.$50 and your best estimate of the a of Include all damages sustained as Financial Statement (Simplified) (form FL-155), unless current form is on resultother party's grosscomply. income. of your failure to monthly
8. 9. 10. 11. 12. ATTORNEY FEES should be ordered as set forth in the proposed Judgment (form FL-250). Witness, should be ordered as set forth in the proposed Judgment (form FL-250). the Justices of the , one of CHILD CUSTODY Honorable CHILD VISITATION should be ordereddayset forth in the proposed Judgment (form FL-250). as of Court in County, , 20 REASONABLE EXPENSES OF PREGNANCY AND BIRTH should be ordered as set forth in the proposed Judgment (form FL-250).
NAMES OF THE CHILDREN should be changed as set forth in the proposed Judgment (form FL-250). (Attorney must sign above and type name below) 13. This declaration may be reviewed by a commissioner sitting as a temporary judge who may determine whether to grant this request or require my appearance. 14. I have read and understand the Advisement and Waiver of Rights Re: Establishment of Parental Relationship (form FL-235), Attorney(s) for which is signed and attached to this declaration. 15. Other (specify):
Office and P.O. Address
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date:
Telephone No.: Facsimile No.: (TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT) E-Mail Address: Form Adopted for Mandatory Use DECLARATION FOR DEFAULT OR UNCONTESTED No.: Judicial Council of California Mobile Tel. JUDGMENT
FL-230 [Rev. January 1, 2003]
Page 1 of 1 Family Code, §§ 7600, 3120, 3900 et seq www.courtinfo.ca.gov.
(Uniform Parentage, Custody and Support)
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