1 | Page LCS Form 1C Mandatory Form, Effective 01/01/2013 Revised 10/01/17 ATTORNEY OR PARTY WITHOUT ATTORNEY Name: Address: Phone Number: Bar Number: Attorney For: FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF LASSEN PLAINTIFF: DEFENDANT: DECLARATION OF NOTICE REGARDING REQUEST FOR EX - PARTE ORDERS CASE NUMBER: Hearing Date: Time: a.m. p.m. 1. Type of relief requested: 2. Reason(s) ex parte relief is necessary: 3. Name of opposing parties (or attorneys): 4. W as Notice of the ex parte application given to the opposing parties? [ ] Yes [ ] No 5. [ ] NOTICE GIVEN : The opposing parties were notified of the relief request and that the ex parte application would be heard by the court on ( date) , at ( time )[ ] a.m. [ ] p.m., as indicated below: a. Notice was given to the [ ] attorney for the [ ] plaintiff /petitioner [ ] defendant/respondent. b. Notification occurred on ( date ):, at ( time )[ ] a.m. [ ] p.m. c. I gave notice by this method: [ ] personally on ( date ): , at ( location ):, California; at [] a.m. [] p.m. [ ] telephone on ( date ): , telephone no.: , at [] a.m. [] p.m. [ ] voicemail on ( date ):,voicemail no.:,at [] a.m. [] p.m. [ ] fax machine on ( date ):,fax no.:,at [] a.m. [] p.m. d. I notified the person in 3 that the following temporary emergency orders are being requested ( specify orders being requested ) American LegalNet, Inc. www.FormsWorkFlow.com 2 | Page LCS Form 1C Mandatory Form, Effective 01/01/2013 Revised 10/01/17 e. The person in 3 responded as follows: f. I [ ] do [ ] do not believe that the person in 3 will oppose the request for temporary emergency orders. 6. [ ]I d id not give notice about the request for temporary emergency orders. I request that the court waive notice to the other party due to the following exceptional circumstances ( check all that apply ): (1) [ ] To help prevent an immediate danger or irrepar able harm to myself (or my client) or to the children in the case. (2) [ ] There is an immediate risk that the children in the case will be removed from the state of California. (3) [ ] To help prevent immediate loss or damage to property subject to disp osition in the case. (4) [ ] Other exceptional circumstances ( specify ): 7 . Have you appeared ex parte before for the same relief? [ ] Yes [ ] No. If yes, relief was [ ] granted [ ] denied I declare under penalty of perjury under the laws of the State of California that the above information and all att achments are true and correct. Date: Signature American LegalNet, Inc. www.FormsWorkFlow.com