SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE BLYTHE 265 N. Broadway, Blythe, CA 92225 HEMET 880 N. State St., Hemet, CA 92543 INDIO 46-200 Oasis St., Indio, CA 92201 RIVERSIDE 4175 Main St., Riverside, CA 92501 RI-FL004 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): PETITIONER: RESPONDENT: CASE NUMBER: DECLARATION REGARDING NOTICE OF REQUEST FOR EMERGENCY ORDERS (FAMILY LAW ­ NON-DOMESTIC VIOLENCE) NOTICE: The court cannot consider your request for emergency orders unless you have given notice as required by California Rules of Court, rules 5.151, 5.165 and 5.167. If you or a family member needs domestic violence or child abuse protection, please use the Domestic Violence Protection Act forms (DV-100, DV-109 and DV-110) www.riverside.courts.ca.gov/selfhelp/domesticviolence INSTRUCTIONS: You must give notice to all parties or their attorneys no later than 10:00 a.m. on the court day before the emergency hearing. After providing notice, you must serve your documents requesting emergency orders on all parties or their attorneys at the first reasonable opportunity. Your proof of service should be filed separately from this declaration. You may ask the court to waive notice under Rule 5.165(b)(2) or service under Rule 5.167(a) by filling out Section C of this form. A. NOTICE 1. I informed the other party in this action that a request for emergency orders would be sought by speaking to: on at a.m. p.m. (PARTY'S NAME OR THEIR ATTORNEY OF RECORD) (DATE) (TIME) I spoke to the party in person. I spoke to the party by telephone at the following number: I left a message on voicemail of the party at the following number: 2. At the time the notice was given, I informed the other party that emergency order would be presented to the court on at a.m. p.m. at the courthouse. (DATE) (TIME) (COURTHOUSE LOCATION) I informed the other party that the emergency orders requested were: 3. I informed the other party that he/she should appear at the Family Law Court if he/she wished to be heard a.m. p.m. in department located at: by the court on at (DATE) (TIME) (DEPT.) Riverside 4175 Main St., Riverside, CA 92501 Hemet 880 N. State St., Hemet CA 92543 Approved for Optional Use Riverside Superior Court RI-FL004 [Rev. 02/20/14] Indio 46-200 Oasis St., Indio, CA 92201 Blythe 265 N. Broadway, Blythe, CA 92225 Page 1 of 2 Cal. Rules of Court, rules 5.151, 5.165 Local Rule 5165 riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com DECLARATION REGARDING NOTICE OF REQUEST FOR EMERGENCY ORDERS PETITIONER: RESPONDENT: CASE NUMBER: 4. I asked the other party if they intended to appear at the hearing, and the other party responded: 5. I asked the other party if they would be opposing the request, and the other party responded: 6. I asked if the other party would file a written opposition, and the other party responded: B. SERVICE Service of the documents requesting emergency orders has been completed. Proof of Service has been filed with the court. Service of the documents requesting emergency orders has not been completed because: I am requesting that service of the documents be waived by the court. (Complete Section C) Other: C. REQUEST TO WAIVE NOTICE AND SERVICE I ask the court to waive notice service to all parties and their attorneys of the request for 1. emergency order because: (Choose the option(s) that are applicable) a. Attempted Notice I attempted in good faith to inform the opposing party but was unable to do so because: (Describe efforts made to give notice) b. Waiver of Notice and/or Service Notice Giving notice would frustrate the purpose of the order. Giving notice would result in immediate and irreparable harm to me or the children who may be affected by the requested order. Giving notice would result in immediate and irreparable damage to or loss of property. We agreed in advance that notice was not necessary. Service There are extraordinary circumstances that imminent harm is likely if I serve (deliver) the documents to the other party before the hearing. Provide the reasons why the court should waive notice service: I declare under penalty of perjury under the laws of the State of California that the information in the declaration is true and correct. Date: (TYPE OR PRINT NAME OF ATTORNEY PARTY MAKING DECLARATION) (SIGNATURE) Page 2 of 2 Approved for Optional Use Riverside Superior Court RI-FL004 [Rev. 02/20/14] DECLARATION REGARDING NOTICE OF REQUEST FOR EMERGENCY ORDERS Cal. Rules of Court, rules 5.151, 5.165 Local Rule 5165 riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com