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 Petitioner: Respondent: CASE NUMBER PETITION FOR FAMILY VISITATION 1. Parent ____________________________ of the below-listed minor child(ren) is deceased. Petitioner is related to the deceased parent as follows: child of deceased parent Name of Child sibling of deceased parent Birthdate grandparent of deceased parent Other Parent's Name Identify Person Living With & County of Residence 2. Describe the relationship and the bonding between each child and the petitioner(s). Explain the reason why family visitation is in the best interest of each child: See attachment _______________________________________________________________________ SB-11292 Petition for Family Visitation Page 1 of 2 03/12/13 rev. optional use Family Code, Section 3102 American LegalNet, Inc. www.FormsWorkFlow.com Petitioner: Respondent: Case Number 3. Describe the duration and frequency of visitation that is being requested: See attachment 4. A completed Declaration under the Uniform Child Custody Jurisdiction and Enforcement Act (Form FL-105) is attached, as there is no existing Family Law Case and this Petition shall start a new matter. Petitioner(s) request 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 Section 3102. A Request for Order is being concurrently filed in order to request a hearing date on the request for visitation. 5. 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 Here) ____________________________________ (Sign Name Here) __________________________________________ (Type or Print Name Here) ____________________________________ (Sign Name Here) _______________________________________________________________________ SB-11292 Petition for Family Visitation Page 2 of 2 03/12/13 rev. optional use Family Code, Section 3102 American LegalNet, Inc. www.FormsWorkFlow.com