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Child Custody Visitation And Support Request (Domestic Violence Prevention) Form. This is a California form and can be use in Domestic Violence Prevention Judicial Council.
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Tags: Child Custody Visitation And Support Request (Domestic Violence Prevention), DV-105, California Judicial Council, Domestic Violence Prevention
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
Child Custody, Visitation, and :
DV-105
Support Request
Case Number:
Index No.
:
1
This form is attached to DV-100, Item 9.
Plaintiff(s)
Your name:
-against-
2
Other parent’s name:
3
Calendar No.
:
JUDICIAL SUBPOENA
:
Mom
Dad
Other
Mom
Dad
Other
Change of Current Court Orders
:
:
I want to change a current child custody or visitation court order.
Defendant(s)
:
. . . . .Explain .your . . . . . . order .and.why. you want. a .change. .Then .skip. to 5 and finish the form. If you do not want a change,
. . . . . . . . current . . . . . . . . . . . . . . . . . . . . . . . . . .
skip to 4 and finish the form.
THE PEOPLE OF THE STATE OF NEW YORK
I want to keep my current child custody court order without any changes. If there are no court orders for custody,
4
TO you cannot check this box. If you check this box, skip the rest of this form. If you have a copy of the current court order,
attach it.
5
Child Custody
I ask the
GREETINGS:court for custody as follows:
Legal Custody to: (Person
Physical Custody to:
who makes decisions about health, (Person the child lives
education, etc. Check at you and with. Check at least one.)
WE COMMAND YOU, that all business and excuses being laid aside,least one.)each of you attend before
the Honorable
at the
Court
Child’s Name
Date of Birth Mom Dad Other*
Mom Dad
Other* ,
located at
County of
a.
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
b.
or adjourned date, to testify and give evidence as a witness in this action on the part of the
c.
If more children, check here. Attach a sheet of paper and write “DV-105, Item 5 — Child Custody” by your request.
*If Other, specify relationship to this subpoena is punishable as a contempt of court and will make you liable to
Your failure to comply with child and name of person:
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
6 result of your failure to comply.
Child’s Address
Where has the child in 5 a lived for the last 5 years? Give each address unless it is private. Start with where
the child lives now and work backwards in time.
Witness, Honorable
, one of
Child 5 a lived with: the Justices of the
Court Child 5 a’s addresses:
in
County,
day of
, 20 Mom Dad Other* Dates lived there:
to present
to
(Attorney must sign above and type name below)
to
to
*If Other, specify relationship to child and name of person:
7
Attorney(s) for
Other Children’s Addresses
Check here if the other child’s (or children’s) address information is the same as listed in 6 .
If it is different, check here. Attach a sheet of paper and write “DV-105,and P.O. Address
Office Item 7 — Other Children’s Addresses” by your
list. List other children’s address information, including dates, and name of person child lived with.
Judicial Council of California
www.courtinfo.ca.gov
Rev. January 1, 2004, Mandatory Form
Family Code, § 6200 et seq.
Telephone No.:
Facsimile
This is not a Court Order. No.:
E-Mail Address:
Child Custody, Visitation, and Support Request
Mobile Tel. No.:
DV-105, Page 1 of 3
(Domestic Violence Prevention)
American LegalNet, Inc.
www.USCourtForms.com
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Your name:
:
8
Case Number:
Index No.
Calendar No.
Other custody case?
:
JUDICIAL SUBPOENA
Plaintiff(s)
Were you involved in, or do you know of, any other custody case for any child listed in this form?
:
No
Yes If yes, fill-againstout below:
a. Name of each child in other custody case:
:
:Juvenile
b. Type of case:
Divorce
Guardianship
Adoption
c. I was a
Defendant(s)
Witness
Other (specify):
Party
:
......................................................
d. Court (name):
Address:
Other (specify):
City:
State:
e. Date of court order:
THE PEOPLE OF THE STATE OF NEW YORK
9
Other people claim to have custody?
TO
Do you know of anyone who is not involved in this case who has or claims to have custody or visitation rights
No
Yes If yes, fill out below:
with any child listed on this form?
Name and address of that person:
GREETINGS:
Has custody
Claims custody all business and excuses being laid aside, you and each of you attend before
Claims visitation rights
WE COMMAND YOU, thatrights
,
the Honorable
at the
Court
located
For these
County of children (name of each child): at
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Check here if you need more space. Attach a sheet of paper and write “DV-105, Item 9” by your statement.
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
10
Visitation
result of your failure to comply.
I ask the court to order that the person in 2 have the following temporary visitation rights:
(Check all that apply)
a.
Court in
b.
c.
Witness, Honorable
No visitation until the hearing of
County,
day
, 20
No visitation after the hearing
The following visitation
until the hearing
(1)
Weekends (starting):
1st
from
(2)
(day of week)
after the hearing
(The 1st weekend of mustmonth is the 1st weekendbelow)a Saturday.)
(Attorney the sign above and type name with
3rd
at
4th
(time)
5th weekend of month
a.m.
p.m. to
(day of
Attorney(s) for week)
at
a.m.
at
(time)
a.m.
p.m.
a.m.
p.m.
Weekdays (starting):
from:
(3)
2nd
, one of the Justices of the
(day of week)
Other Visitation
at
(time)
p.m. to
(day of week)
(time)
Office and P.O. Address
Attach a sheet of paper with other visitation days and times, like holidays, birthdays, sports events. List dates
and times. Write “DV-105, Item 10 — Visitation” by your statement.
Rev. January 1, 2004
Telephone No.:
Facsimile
This is not a Court Order. No.:
E-Mail Address:
Child Custody, Visitation, and Mobile Tel.Request
Support No.:
DV-105, Page 2 of 3
(Domestic Violence Prevention)
American LegalNet, Inc.
www.USCourtForms.com
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Your name:
:
Case Number:
Index No.
Calendar No.
Supervised Visitation
11
:
JUDICIAL SUBPOENA
Plaintiff(s)
a. I ask that the visitation in 10 be supervised by (write name and telephone number):
-against:
b. I ask that any costs for supervision be paid as follows:
Mom
%
Dad
%
:
Other (name)
%
:
12
Responsibility for Transportation for Visitation
Defendant(s)
:
. . . . “Responsibility. for .transportation” means . . . parent. will take.or.pick up the child or make arrangements for someone
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . the . . . . . . . . . . . . .
else to do so.
a.
Other (name):
Mom
Dad
Mom
Dad
b.
Other (name):
THE PEOPLE OF THE STATE OF NEW YORK
c.
Drop-off / pick-up of children will be at (address):
to the visits.
from the visits.
TO
13
Travel With Children
Other (name):
Mom
Dad
GREETINGS:other parent, or a court order, to take the children outside of:
from the
MUST have written permission
a. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
The State of California.
b.
Other place(s) (list):
,
the Honorable
at the
Court
located at
County of
Child Abduction
14 in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testifyis a risk the other parentwitness inour child out ofthe part of the
I believe that there and give evidence as a will take this action on California without my permission.
If you check this box you must fill out and attach form DV-108.
15
Child Support to comply with this subpoena is punishable as a contempt of court and will make you liable to
Your failure
a.
I whose behalf this subpoena was issued for a and file FL-150 or FL-155 before your hearing.
the party onask the court for child support. You must fill out maximum penalty of $50 and all damages sustained as a
resultb. your failure to comply. applied for TANF, Welfare, CalWORKS, or Medi-Cal.
of I now receive or have
I already have a child support order, but I want it changed.
c.
Witness, Honorable
, one of the Justices of the
Important!
16 Court in
County,
day of
, 20
You must tell the court if you find out any other information about a custody case in any court for the children
listed on this form.
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Rev. January 1, 2004
Telephone No.:
Facsimile
This is not a Court Order. No.:
E-Mail Address:
Mobile Tel. No.:
Child Custody, Visitation, and Support Request
(Domestic Violence Prevention)
DV-105, Page 3 of 3
American LegalNet, Inc.
www.USCourtForms.com
