PALM SPRINGS 3255 E Tahquitz Canyon Way, Palm Springs CA 92262 RIVERSIDE 4050 Main St., Riverside CA 92501 FOR COURT USE ONLY ATTORNEY OR PARTY WITHOUT ATTORNEY TELEPHONE NO: EMAIL ADDRESS (Optional) ATTORNEY FOR (Name): PETITIONER IN PROPR PERSONA: (Yes/No) IN THE MATTER OF: CASE NUMBER: Hearing Date: Time: Department: DECLARATION IN SUPPORT OF PETITION TO ESTABLISH FACT OF MARRIAGE 1. Declarant (name): makes the statements in this declaration based on personal knowledge or on the contents of the documents identified in item 5. 2. a. I am at least 18 years of age. b. I reside at STREET ADDRESS City: 3. County of: Subject Person’s name: Were married on (date) in the County of at approximately (time of marriage) AM PM State of Page 1 of 2 Form Adopted for Use Riverside Superior Court Form #RI-PR004 [Rev. 1/24/11] DECLARATION IN SUPPORT OF PETITION TO ESTABLISH FACT OF MARRIAGE H&S § 103450 - 103490 American LegalNet, Inc. www.FormsWorkFlow.com PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: CASE NUMBER: 4. Facts showing how, when, and where the persons named in 3 were married and explaining how I have personal knowledge of the marriage are stated below stated in attachment 4 to this declaration. 5. Attached are true and correct copies of the following documents (check each box that applies): a. b. Officiating person’s statement dated (date of each): c. Witness statement dated (date of each): d. 6. Marriage license dated (date of each): Other documents dated (Describe and give the date of each document): Number of pages attached: I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date: (TYPE OR PRINT NAME OF ATTORNEY PARTY MAKING DECLARATION) (SIGNATURE) Page 2 of 2 Form Adopted for Use Riverside Superior Court Form #RI-PR004 [Rev. 1/24/11] DECLARATION IN SUPPORT OF PETITION TO ESTABLISH FACT OF MARRIAGE H&S § 103450 - 103490 American LegalNet, Inc. www.FormsWorkFlow.com