FL-511 GOVERNMENTAL AGENCY (under Family Code, §§ 17400, 17406) or ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address): (Party appearing without an attorney should enter in this space the same address listed in item 3, below.) FOR COURT USE ONLY FAX NO.: TELEPHONE NO.: ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PETITIONER: RESPONDENT: OTHER: EX PARTE APPLICATION FOR ORDER FOR NONDISCLOSURE OF ADDRESS AND ORDER 1. (Name): address or other identifying information of (name): in the pleadings and other documents to be filed in this action. 2. CASE NUMBER: The local child support agency acting on behalf of (name): for nondisclosure of the address or other identifying information of (name): in the pleadings and other documents to be filed in the UIFSA action. applies for an order for nondisclosure of the applies for an order 3. The following is the mailing address for service of process on (name): 4. Facts in support of this application (state facts that demonstrate that the health, safety, freedom of movement, or physical or emotional well-being of the applicant or the applicant's child may be unreasonably put at risk by the disclosure of the applicant's address or other identifying information): contained in the attached declaration I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: (TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT) Page 1 of 2 Form Adopted for Mandatory Use Judicial Council of California FL-511 [Rev. January 1, 2003] EX PARTE APPLICATION FOR ORDER FOR NONDISCLOSURE OF ADDRESS AND ORDER Family Code, § 4977 www.courtinfo.ca.gov (UIFSA) 2002 © American LegalNet, Inc. PETITIONER: CASE NUMBER: RESPONDENT: OTHER: THE COURT FINDS: 5. The health, safety, or liberty of (name): would be unreasonably put at risk by the disclosure of his or her address or other identifying information that may lead to his or her whereabouts. 6. The application is not sufficient to grant the requested relief. THE COURT ORDERS: 7. The address or other identifying information that may lead to the whereabouts of (name): shall not be disclosed in the pleadings or documents filed in this action. 8. The application is denied. 9. Other (specify): Date: JUDICIAL OFFICER NOTE: Use of this ex parte application and order will require that the UIFSA petition in this matter be initiated in the California court in which this application is submitted pursuant to Family Code sections 4907 and 4918. FL-511 [Rev. January 1, 2003] EX PARTE APPLICATION FOR ORDER FOR NONDISCLOSURE OF ADDRESS AND ORDER Page 2 of 2 (UIFSA) 2002 © American LegalNet, Inc.