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FL-105(A)/GC-120(A)
CASE NUMBER:
CASE NAME:
ATTACHMENT TO
DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA)
Place of birth
Date of birth
Sex
Child’s name
Residence information is the same as given on form
FL-105/GC-120 for child a. (If NOT the same, provide the
information below.)
Present address
Period of residence
Person child lived with (name and complete current address)
Relationship
Confidential
Confidential
to present
Person child lived with (name and complete current address)
Child's residence (City, State)
to
Person child lived with (name and complete current address)
Child's residence (City, State)
to
Child's residence (City, State)
Person child lived with (name and complete current address)
to
Place of birth
Date of birth
Sex
Child’s name
Residence information is the same as given on form
FL-105/GC-120 for child a. (If NOT the same, provide the
information below.)
Period of residence
Person child lived with (name and complete current address) Relationship
Address
Confidential
Confidential
to present
Child's residence (City, State)
Person child lived with (name and complete current address)
to
Child's residence (City, State)
Person child lived with (name and complete current address)
to
Child's residence (City, State)
Person child lived with (name and complete current address)
to
Place of birth
Date of birth
Sex
Child’s name
Residence information is the same as given on form
FL-105/GC-120 for child a. (If NOT the same, provide the
information below.)
Period of residence
Person child lived with (name and complete current address)
Relationship
Address
Confidential
Confidential
to present
Child's residence (City, State)
Person child lived with (name and complete current address)
to
Child's residence (City, State)
Person child lived with (name and complete current address)
to
Child's residence (City, State)
Person child lived with (name and complete current address)
to
Page____ of ____
ATTACHMENT TO
Form Adopted for Mandatory Use
Family Code, § 3400 et seq.;
Judicial Council of California
Probate Code, §§ 1510(f), 1512
DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION
FL-105(A)/GC-120(A)
[New January 1, 2009]
AND ENFORCEMENT ACT (UCCJEA)
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