ATTORNEY (Name & Address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): BAR NO.: SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE JUSTICE CENTER: Lamoreaux ­ 341 The City Drive, Orange, CA 92868-3205 Central ­ 700 Civic Center Drive West, Santa Ana, CA 92701 PETITIONER: RESPONDENT: CASE NUMBER: PETITION FOR GRANDPARENT VISITATION 1. Petitioner's relationship to minor child(ren) listed below: grandmother my son (name) my daughter (name) grandfather is the parent of the child(ren). is the parent of the child(ren). Currently living with (relationship) / in (county) Child's name Birthdate Other Parent's Name 2. The parents of the child(ren) (mark all boxes and complete all spaces which apply): a. b. are currently married or have a domestic partnership and living together. are divorced. A Judgment for Dissolution of Marriage or Domestic Partnership was entered on: (specify date) Case No. c. d. e. f. g. h. i. , in . County, Case No. . County, (state) are currently involved in a divorce proceeding in 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 the absent parent. have never been married or in a domestic partnership. are currently living separate and apart on a permanent or indefinite basis. The mother father of the minor child(ren) is deceased. The child(ren) is/are not residing with either parent. The child(ren) has/have been adopted by a and name): Page 1 of 2 Family Code §§ 3102, 3103, 3104 Cal. Rules of Court 5.150, 5.154(b), 5.156, 5.158 American LegalNet, Inc. www.FormsWorkFlow.com stepparent grandparent other (specify relationship . Approved for Optional Use L-0373 [New September 14, 2009] PETITION FOR GRANDPARENT VISITATION 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 PETITIONER'S 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)) Approved for Optional Use L-0373 [New September 14, 2009] PETITION FOR GRANDPARENT VISITATION Page 2 of 2 Family Code §§ 3102, 3103, 3104 Cal. Rules of Court 5.150, 5.154(b), 5.156, 5.158 American LegalNet, Inc. www.FormsWorkFlow.com