NAME AND ADDRESS OF PARTY OR ATTORNEY FOR PARTY: TELEPHONE NUMBER: FOR COURT USE ONLY ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF AMADOR STREET ADDRESS: MAILING ADDRESS: CITYAND ZIP CODE: BRANCH NAME: PETITIONER: RESPONDENT: CASE NUMBER: DECLARATION IN SUPPORT OF EX PARTE APPLICATION FOR ORDERS I, the undersigned, declare: 1. I am (choose one): a. attorney for Petitioner b. self-represented Petitioner c. other (explain): 2. DEPARTMENT NUMBER: FCS NUMBER: attorney for Respondent self-represented Respondent attorney for child(ren) Yes No The opposing party or minor children is represented by an attorney: (If you checked "Yes", fill in the name, address, and telephone number of all attorneys. If you checked "No", fill in the other party's name address, and telephone number.) Party/Attorney name: Address/Telephone number: Child's attorney name and address: 3. 4. 5. OTHER CASES: Have the parties to this case been involved in another Family, Probate Juvenile, or Criminal Court Case? Yes No If there has been another case, fill in the case number: have have not made previous application(s) on the same issue. OTHER APPLICATIONS: I or another party Orders were were not granted on the prior application(s). Explain in your declaration. NOTICE a. I HAVE given notice to all opposing parties and/or their attorney by the following method: Personal delivery Fax Overnight Carrier First Class Mail Other: Date: Time: Person who received: I have received confirmation that the other party has received my papers as follows: (Check one below) In person/telephone (describe): Written confirmation of receipt b. I ask the Court not to require notice of the ex parte request for orders because (Check all that apply. In the space provided below in 5.c. and on any attached pages or a separate sworn declaration, you must give facts that support a request not to give notice for each box you check in 5.b. (except for Domestic Violence Prevention Act (DVPA) restraining orders): This is an application for Domestic Violence Prevention Act (DVPA) restraining orders. This application involves a matter not requiring notice under State Rules, Rule 5.170; Giving notice would frustrate the purpose of the order; Giving notice would result in immediate and irreparable harm to the applicant or the children who may be affected by the order sought; Giving notice would result in immediate and irreparable damage to or loss of property subject to disposition in the case; The parties agreed in advance that notice will not be necessary with respect to the matter that is the subject of the request for emergency orders. Provide documentation of this agreement; and/or, DECLARATION IN SUPPORT OF EX PARTE APPLICATION FOR ORDERS Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com FCS-004 REV 08/26/14 PETITIONER: RESPONDENT: CASE NUMBER The party made reasonable and good faith efforts to give notice to the other party, and further efforts to give notice would probably be futile or unduly burdensome (describe those efforts in detail below). Other: c. Further Explanation for Asking the Court NOT to Require Notice: Additional pages are attached. Total number of attached pages: Provide detailed factual explanation of any box checked under Paragraph 5.b. above. If you do not have enough room, attach additional pages or a separate sworn declaration of good cause: I declare under penalty of perjury that the forgoing and any statement on attached pages are true and correct. Date Print Name Signature of Declarant FCS-004 REV 08/26/14 DECLARATION IN SUPPORT OF EX PARTE APPLICATION FOR ORDERS Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com ATTACHMENT PETITIONER: RESPONDENT: CASE NUMBER INSTRUCTIONS For more information please refer to Superior Court of California, County of AMADOR Local Rules 11.26 and California State Rules, Rules 5.151, 5.165, 5.167, and 5.170. This form is required in AMADOR County, if you are asking the Judge to make immediate orders (also know as emergency or ex parte orders) without the other party being present for a hearing. This form must be completed in any case where ex parte orders or emergency orders are requested. If you are required to give notice, notice must be given before 10:00 a.m. on the court day before the Judge reviews the application, or the application will be delayed another 24 hours. Notice means providing the other side of the case, either all other attorneys or any self-represented party, with copies of any papers that you want the Judge to review and any orders that you are requesting. If you have given notice to the other side of your case, you must state the form of notice given. If you ask the Court to not require notice, you must explain why. Sometimes notice is not required, such as cases involving allegations of domestic violence or where the safety of a party or a child might be at risk if notice is given. It is up to the Judge in your case to determine whether notice will be required or not. SECTION #1 State whether you are the Petitioner or the Respondent in the case. Once a case is filed, the parties keep the same status in the case. You do not change from the Respondent to the Petitioner by filing a new motion in the case. If you do not have an attorney, you are considered self-represented. SECTION #2 If any other party is represented by an attorney, you must provide the Court with the attorney's name and address. If the other party is not represented by an attorney, you must provide the Court with the other party's address. SECTION #3 It is very important to list all other cases in which you and the other party have been involved with the courts. This would include other Family Law, Probate, Juvenile, Restraining Order, Child Support, Civil, or Criminal matters. If you do not have the case number, please put "unknown" and list the county and the year of the filing, if possible. SECTION #5a. Unless notice is excused by the Court, you must provide notice of this application to all other parties and attorneys before you deliver a copy to the Court. When you give such notice, specify how you did it (by fax, courier, or personally, for example), who received it and at what time and on which date. Also, please explain how you know that the other side received copies of your papers and what response you were given. SECTION #5c. If you believe that you should not be required to give notice of this application and are asking the Court not to require notice, explai