Page 1 of 2 PETITION FOR GRANDPARENT VISITATION-(Rev. 06/20/12)-FCS-081 2 1. Petitioners relationship to minor child(ren) listed below: gran d moth e r grandfat h er my son (name) is the parent of the child(ren). my daughter (name) is the parent of the child(ren). Child s na m e Birthdate Currently living with (relationship)/in(county) Other 2. The parents of the child(ren) (mark all boxes and complete all spaces which apply): a. are currently married or have a domestic partnership and living together. b. are divorced. A Judgment for Dissolution of Marriage or Domestic Partnership was entered on: (specify date) , in County , (state) . Case No. . c. are currently involved in a divorc e proceeding in County , Case No. . d are currently married or have a domestic partnership and one of the parents has been absent for more than one month without the other parent knowing the whereabouts of absent parent. e. have never been married or in a domestic partnership. f. are currently living separate and apart on a perma nent or indefinite basis. g. The mother father of the minor child(re n) is deceased. h. The child(ren) is/are not residing with either parent. i. The child(ren) has/have been adopted by a stepparent grandparent other (specify r elationship and name): . FOR COURT USE ONLY PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: PETITION FOR G R AN DPAR E NT VISITATI O N CASE NUMBER: AMADOR COUNTY SUPERIOR COURT 500 ARGONAUT LANE JACKSON, CA 95642 (209) 257 - 2603 American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 PETITION FOR GRANDPARENT VISITATION-(Rev. 06/20/12)-FCS-081 CASE NAME: CASE NUMBER: 3. Describe the relationship between each child and the petitioner(s). Explain the reason why grandparent visitation is in the best interest of each child: continued in attached declaration. 4. Describe the duration and frequency of visitation that is being requested: continued in attached declaration. 5. A completed declaration under the Uniform child Custody Jurisdiction and Enforcement Act, form FL-105, is attached. (Not required if the Petition is filed within an open Family Law Case.) 6. Petitioner(s) requests that the court grant reasonable visitation with the above named child(ren), and such other relief as the court may deem appropriate, pursuant to Family Code sections 3100, 3102, 3103 and 3104. 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 PETITIONER) (TYPE OR PRINT NAME) (SIGNATURE OF PETITIONER) PARENT CONSENT TO PETITIONERS REQUEST FOR GRANDPARENT VISITATION Mother Father hereby consents to and joins in this petition for Grandparent Visitation. Date: (TYPE OR PRINT NAME) (SIGNATURE OF PARENT OF MINOR CHILD(REN)) American LegalNet, Inc. www.FormsWorkFlow.com