STATE OF CALIFORNIA, COUNTY OF LOS ANGELES I, say: (AFFIANTS NAME) I am (not)* a party to this proceeding. I reside at . My occupation is . I personally (know) (do not know)* the citee . (NAME OF CITTEE 226 INCLUDING ALIASES) The present know address of said cite is . . The occupation of said cite is . The name of said citee222s employer is . I last saw cite on day of , 20 . The approximate age of said cite is . The known physical incapacity of said citee is . . * (Strike out inappropriate words) Other known facts tending to show said cite is not in military service are: (SEE REVERSE SIDE) CERTIFICATE / DECLARATION RE MILITARY SERVICE In adoption and related matters LASC ADPT 002 Rev. 03/19 For Mandatory Use NAME, ADDRESS AND TELEPHONE NUMBER OF ATTORNEY(S) : \ ATTORNEY(S) FOR: SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES In the Matter of the Adoption Petition of: \ Adopting Parent(s) Case Number: FILE STAMP . CERTIFICATE / DECLARATION RE MILITARY SERVICE In adoption and related matters American LegalNet, Inc. www.FormsWorkFlow.com I (know) (Have been unable to determine whether)* said cite (is) (is not)* in military service on active duty as a member of the Army of the United States, or of the United States Navy, or of the United States Marine Corps, or of the United States Coast Guard, or of any Department of the United States Air Force. * (Strike out inappropriate words) . DECLARATION I certify (or declare) under penalty of perjury under the laws of the State of California that the forgoing is true and correct. Executed at , California Dated: , 20 . . (SIGNATURE OF DECLARANT) Note 1: 223Any person who shall make use of a declaration required under this section knowing it to be false shall be guilty of misdemeanor and shall be punishable by imprisonment not to exceed one year or by a fine not to exceed $1,000.00 or both.224 Soldiers222 and Sailors222 Civil Relief Act of 1940 as amended. Note 2: You may obtain a Certificate from each of the Armed Services for a fee by writing the following branches: Department of the Army, United States Navy, United States Marine Corps, United States Coast Guard and the United States Air Force. Obtain the correct address for inquiry, from the local offices of these branches. If you receive five (5) reports from the Military Services, attach copies of each to this declaration. LASC ADPT 002 Rev. 03/19 For Mandatory Use American LegalNet, Inc. www.FormsWorkFlow.com