ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME AND ADDRESS): TELEPHONE NO.: FOR COURT USE ONLY ATTORNEY(S) FOR (NAME): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO Central District, 351 North Arrowhead Avenue, San Bernardino, CA 92415-0210 West District, 8303 Haven Avenue, Rancho Cucamonga, CA 91730 Desert District, 14455 Civic Drive, Victorville, CA 92392 North Desert District, 235 East Mountain View, Barstow, CA 92311 TITLE OF CASE (ABBREVIATED) IN THE MATTER OF , A Minor (A) Person(s) who should be declared free from the custody and control of (h ) (their) parents CASE NUMBER: APPLICATION FOR ORDER FOR PUBLICATION OF CITATION (ABANDONMENT RE: ADOPTION) Companion Adoption No. STATE OF CALIFORNIA, COUNTY OF SAN BERNARDINO Application is hereby made for an order directing service of the foregoing citation on Name of Citee - Including Aliases by publication of said citation in the which newspaper is most likely to give notice to said parent or alleged parent because GROUND 1: Resides out of State at specific address. See Rule 20 Sec. 1(a) GROUND 2: Has departed from the State. See Rule 20 Sec. 1(b) Said parent or alleged parent resides out of the State of California, at , Street Address in , City . Such place of residence was corroborated on State day of , , by the attached documentary evidence* Within Past 90 Days Said parent or alleged parent departed from the State of California on or about the day of , , under the following circumstances: . Until such departure, said parent or alleged parent resided in California, at , Street Address . The attached documentary evidence* received on City day of Within 90 Days , , show that said parent or alleged parent is (are) now outside the State of California. Said parent or alleged parent conceals himself to avoid service. The attached affidavit of shows repeated efforts to serve said parent or alleged parent on GROUND 3: Conceals himself to avoid service. See Rule 20 Sec. 1(d) day of , , and on day of , , and also alleges facts tending to show concealment to avoid such service. Said parent or alleged parent knew of the pendency of this action at the time such service was first attempted because on , day of , Facts Showing Knowledge of Action *Where evidence has been lost or destroyed or is unavailable, explain. NOTE: Where information obtained from another person is alleged, there must be compliance with Section 3 of Rule 20. ACIS Code 37108 13-9005-301 Rev. 1/99 APPLICATION FOR PUBLICATION OF CITATION ABANDONMENT SB-9005 American LegalNet, Inc. www.FormsWorkflow.com Said parent or alleged parent cannot, after due diligence, be found within the State of California. The last known address of said parent or alleged parent is GROUND 4: Cannot after due diligence be found. See Rule 20 Sec. 1(c) , Street Address as shown by the attached documentary evidence. To the best of my knowledge, the names and addresses of every relative, friend, and other person likely to know the present whereabouts of said citee are as follows: NOTE: If parents not contacted, state why. Dates and results of inquiries to each of them as to whereabouts of said parent or alleged parent are as follows: (If the place of residence of the parent or alleged parent is unknown, then give name, relationship and address of some relative residing in the State of California. If no relatives are known, so state.) Additional facts relating to Grounds 1, 2, 3 or 4. This application is made only under Ground above. All printed statements for the other three Grounds are deemed deleted. (Strike out Grounds not used.) DECLARATION AFFIDAVIT Dated , I certify (or declare) under penalty of perjury that the foregoing is true and correct. Petitioner Executed at Subscribed and sworn to before me , this day of , Petitioner Notary Public in and for the County of San Bernardino, State of California , *NOTE: This form is designed for use either as an affidavit (2003 C.C.P.) or an unsworn statement (2015.5 C.C.P.). If an affidavit, affiant should sign where indicated at the left. If an unsworn statement, he should sign where indicated at the right. American LegalNet, Inc. www.FormsWorkflow.com