SUPERIOR COURT OF CALIFORNIA, COUNTY OF BUTTE RULES ATTORNEY OR PARTY WITHOUT ATTORNEY (Name & Address): TELEPHONE NO: FOR COURT USE ONLY ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF BUTTE Butte County Courthouse One Court Street Oroville, CA 95965 (530) 532-7002 Chico Courthouse 655 Oleander Chico, CA 95926 (530) 532-7009 PETITIONER/PLAINTIFF(S): RESPONDENT/DEFENDANT(S): DECLARATION FOR DEFAULT CUSTODY AND VISITATION ORDERS CASE NUMBER: Notice to the Respondent Please read both sides of this form The other parent in your case (the "Petitioner") has described the custody and/or visitation order s/he is asking the Court to make in your case. If you do not agree with the order, you must take legal action. If you do not take legal action, the Court may order what the Petitioner requested. Talk with an attorney or visit the Self-Help and Referral Program (SHARP) for more information about your legal rights and the legal process. Petitioner - You must fill this form out if:     You are asking for a default Judgment in this case, and You have children with the other parent in this case, and You do not already have a custody and visitation Court order that will be part of your Judgment, and You do not already have a Marital Settlement Agreement/Stipulated Judgment that will be part of your Judgment. IMPORTANT: This form cannot help you ask for different custody and visitation orders than what you asked for in your Petition. I, _________________________________ (your name), am the Petitioner in this case. 1. Check one only:  I have attached form FL-311 to describe the custody and visitation schedule I want OR  Form FL-311 was attached to the petition I filed. 2.  I am asking for the custody orders described on form FL-311 because: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ (FL.030) Mandatory Page 1 of 2 (A.D. 7-1-2012) DECLARATION FOR DEFAULT CUSTODY AND VISITATION ORDERS American LegalNet, Inc. www.FormsWorkFlow.com SUPERIOR COURT OF CALIFORNIA, COUNTY OF BUTTE RULES 3.  I am asking for the visitation schedule described on form FL-311 because: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 4. The child(ren) has/have mainly lived with  Mother during the last six months.  Father  Other: __________________ During the last six months the other parent had the following contact with the child(ren). Describe the schedule, number of visits, lengths of visits: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: ___________________ Petitioner's name: ______________________________________ Petitioner's signature: ______________________________________ Instructions for the Petitioner Fill out this form completely. Make 2 copies. File the original and copies with the Family Law Clerk's Office at One Court Street, Oroville, CA 95965. Have someone else, NOT YOU, who is 18 years or older, serve a copy of this form on the other party. This must be done at least 15 court days (whether served by mail or in person) before the Judgment is submitted. The person who serves this form must fill out the appropriate Proof of Service (form FL-330/FL335). 5. You must file the Proof of Service form with the Court. Keep a file-stamped copy for yourself. 1. 2. 3. 4. (FL.030) Mandatory Page 2 of 2 (A.D. 7-1-2012) DECLARATION FOR DEFAULT CUSTODY AND VISITATION ORDERS American LegalNet, Inc. www.FormsWorkFlow.com