ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF IMPERIAL Juvenile Division 324 Applestill Rd. El Centro, CA 92243 Name of Dependant Child: CASE NUMBER: DECLARATION RE NOTICE EX PARTE APPLICATION I, the undersigned, declare: 1. I am [ ] counsel [ ] social worker [ ] mother [ ] father [ ] minor [ ] Department of Family and Children's Services or [ ] other (explain) __________________________________________________________ in this dependency action. 2. Pursuant to Juvenile Court Local Rules, I have given notice of, and a copy of this application for ex parte orders to, the following persons: ______________________________________________ _______________________________________________________________________________ Notice to the above named persons was given in the following manner: [ ] telephone at ________ [ ] a.m. [ ] p.m. [ ] letter [ ] mailed [ ] hand delivered to (insert name and address): _______________________________________________________________________________ ______________________________________, on _______________________________, ______ 3. I have received the following response: _____________________________________________ _______________________________________________________________________________ 4. I have not given notice of this application for ex parte orders for the following reason(s): [ ] a. Would frustrate the purpose of the orders requested. [ ] b. Minor child would suffer immediate and irreparable harm before the orders could issue. [ ] c. No significant burden or inconvenience to responding party will result from the orders requested. [ ] d. I made reasonable, good faith efforts to give notice, as follows: ___________________________________________________________________________ ___________________________________________________________________________ [ ] e. Other:___________________________________________________________________ I declare under penalty of perjury under the laws of the State of California the foregoing is true and correct. Executed at __________________, California, on ___________________ (DATE) ______________________________ Declarant Form Approved for Mandatory Use JV-02 (Adopted 07/01/07, Revised 01/01/13) DECLARATION RE NOTICE OF EX PARTE APPLICATION American LegalNet, Inc. www.FormsWorkFlow.com