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ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME, ADDRESS, PHONE)

FOR COURT USE ONLY

Attorney for:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS

Street Address:

800 11th Street, Modesto, CA 95354

Civil Clerk’s Office: 1100 I Street, P.O. Box 1098, Modesto, CA 95353

Petitioner/Plaintiff:

Respondent/Defendant:

DECLARATION RE: NOTICE UPON EX PARTE

Case Number:

APPLICATION FOR ORDERS

I, the undersigned, declare:

1. I am: ( 1 ) counsel for petitioner/plaintiff

respondent/defendant

( 2 ) unrepresented petitioner/plaintiff

unrepresented respondent/defendant

( 3 ) other (explain): _______________________________________________________________

Unknown. If you checked yes, fill in attorney’s name,

2. The opposing party is represented by counsel:

YES

address, and telephone number:

The parties in this have not been involved in another Family, Domestic Violence (family or criminal), Probate, or

Juvenile Court case.

The parties have been involved in another Family, Domestic Violence (family or criminal),

Probate or Juvenile case as listed below:

Case No. /County where filed:

Was a Restraining Order Issued?

Type of Case:

Names of Parties in case:

4. I have given 24 hour notice of this ex parte application

yes

no (skip #5, 6 and complete #7 below).

Pursuant to Local Rule 7.14, a copy of these pleadings were given to: _________________________________

By:

personal delivery

overnight mail or other overnight carrier

fax transmission

other (explain): ______________________________

Date and time of notice: ____________________, 20___, at __________ a.m./p.m.

A written response is attached, or I have received the following oral response: ___________________________

________________________________________________________________________________________

Unless a written response is attached, I understand the Court will not consider my request until the

Expiration of the 24 hour period.

I have not given notice of the present application for ex parte orders because:

A. Notice would frustrate the purpose of the orders sought.

B. Applicant would suffer immediate and irreparable harm before the court orders could issue.

C. No significant burden or inconvenience to the responding party will result.

D. The orders requested are those permitted without notice by Local Rule 7.15.

E. I made reasonable, good faith efforts to give notice, as follows: ______________________

F. Other: _________________________________________________________________

You must explain why you checked 7a, b, c, d, or e: _______________________________________

________________________________________________________________________________

I declare under penalty of perjury under the laws of the State of California the foregoing is true and correct, at

_______________, California, this _______ day of ____________, 20____, at __________a.m./p.m.

Signature of Declarant:

FL004 (Mandatory Form)

DECLARATION RE: NOTICE UPON EX PARTE APPLICATION FOR ORDERS

Rev 6/11

Form Fl004 - Declaration Re: Notice Upon Ex Parte Application For Orders - Superior Court Of California, County Of Stanislaus

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