Attorney or Party Without An Attorney (Name, State Bar No. & Address) For Court Use Only Telephone No. Attorney for: SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO Joshua Tree District, 6527 White Feather Road, Joshua Tree, CA 92252 Rancho Cucamonga District, 8303 Haven Avenue, Rancho Cucamonga, CA 91730 San Bernardino District, 351 N. Arrowhead Avenue, San Bernardino, CA 92415 Victorville District, 14455 Civic Drive, Suite 100, Victorville, CA 92392 Petitioner: Respondent: DECLARATION RE: COMPLIANCE WITH CUSTODY ORDERS (CUSTODY/VISITATION) The undersigned hereby declares that: CASE NUMBER: I am the Petitioner Respondent Other Parent in this case. I have filed a Request for Order for Modification of a Custody and/or Visitation Order previously made in this case. 1. The previous court order DID NOT direct one of the parties to take follow-up actions, such as parenting classes, anger management, counseling, etc. If this box is checked proceed to item 6. -ORThe previous court order DID direct one of the parties enroll in, attend, arrange for and/or complete the following programs/classes/sessions: Parenting or Co-Parenting Classes or Programs Evidence Code 730 evaluation Anger management classes or programs Family Code 3190 counseling Batterer's treatment program Conjoint or family counseling/therapy Alcohol and/or Drug Assessment Alcoholic/Narcotic Anonymous (AA/NA) Alcohol or Drug Treatment Program or Classes Other:___________________________ 2. 3. I was ordered to complete the services identified above by the court. I am am not currently in compliance with the existing orders and directives of the court as set forth above. -OR4. The other party was ordered to comply with the above court orders. The other party is is not in compliance with the orders. 5. Additional information about compliance:______________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 6. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: _________________________ Printed Name ____________________________________ Signature____________________________________ Form No. 13-11300-360 (optional) Rev. 08-21-13 DRCO DECLARATION RE: COMPLIANCE WITH CUSTODY ORDERS American LegalNet, Inc. www.FormsWorkFlow.com