Attorney or Party without Attorney Name, Address, Telephone No., State Bar Membership No. Court Use Only Attorney for (Name): Superior Court of California, County of Lake 255 N. Forbes Street, 4th Floor Lakeport, CA 95453 Petitioner/Plaintiff: Respondent/Defendant: Claimant/Other Parent: Case Number: DECLARATION REGARDING NOTICE OF EX PARTE REQUEST FOR TEMPORARY EMERGENCY COURT ORDER This Declaration is submitted by the undersigned to advise the court of the notice given to the other party of the intent to request the order, and the service of the papers of the request for order, or the efforts made to provide notice and service to the other party, or the reasons why notice and service of the papers of the request for order should not be required pursuant to Rules 5.151 and 5.165 of the California Rules of Court. DECLARATION I, _______________________________________________________________, declare: 1) Notice of the intent to request the temporary emergency order was given to the other party. (A) Notice was given as follows: · To the Person: _______________________________________________ · · · Date notice was given: ________________________________________ Time notice was given: ________________________________________ Manner of notice: _____ Telephone _____ Voicemail _____ In Writing (B) I informed the other party that the request would be presented to the court on _______________, ______, ________, in the Lake County Superior Court, 255 North Forbes Street, Lakeport, California, requesting the emergency orders as follows: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Optional Form Local Form LK-150 DECLARATION REGARDING NOTICE OF EX PARTE REQUEST FOR TEMPORARY EMERGENCY ORDERS Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com (C) I asked the other party whether there would be opposition or a response to the request and the other party stated as follows: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 2) Notice of the request has not been given. Notice was unable to be given to the other party despite the specific attempt(s) made to provide notice as described as follows: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 3) Notice of the request and service of the papers of the request for order should not be required by the court to be given and waived for the reason(s) that: ____ Giving notice would frustrate the purpose of the order; ____ Giving notice would result in the immediate and irreparable harm to the applicant or the child/children; ____ Giving notice would result in immediate and irreparable damage or loss of property; or ____ Reasonable and good faith attempts were made to give notice and further attempts would likely be futile and burdensome. ____ This request involves a matter not requiring notice pursuant to Rule 5.170 ____ The parties have agreed that notice is not required on this request and evidence of the agreement is provided. The facts supporting each reason are as follows: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Optional Form Local Form LK-150 DECLARATION REGARDING NOTICE OF EX PARTE REQUEST FOR TEMPORARY EMERGENCY ORDERS Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 4) The Request for Order and all moving papers were served on the other party or attorney of record as follows: Name of person served: ________________________________ Date of service: _______________________________________ Time of service: _________________________________A.M./P.M. Manner of service: __ Personal Service __ Fax __ Mail __ Overnight Carrier I have received confirmation that the other party has received the papers as follows: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ I declare under penalty of perjury the foregoing is true and correct: Date: _______________ Signed: ____________________________________________ Optional Form Local Form LK-150 DECLARATION REGARDING NOTICE OF EX PARTE REQUEST FOR TEMPORARY EMERGENCY ORDERS Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com