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 GRANDPARENT VISITATION 1. 2. Petitioner is the grandparent of the minor child(ren) listed below. My son ________________________________ is the parent of the child(ren) I wish to visit. My daughter ____________________________ is the parent of the child(ren)I wish to visit. Name of Child Birthdate Identify Person Living With & County of Residence Other Parent's Name 3. The parents of the child(ren): (mark all boxes/complete spaces for all which apply) are divorced. A Judgment for Dissolution of Marriage or Domestic Partnership was entered on the following date ___________, in ________________________________County, _________________ (State). Case No. _______________________. The child(ren) have resided in San Bernardino County for the last 6 months or more. are currently involved in a divorce proceeding in San Bernardino County, Case No.___________________. have never been married nor in a registered domestic partnership. my daughter son who is the parent is deceased and the child(ren) have not been adopted (or if adopted, adoption was by stepparent or grandparent of the child(ren)). are currently married or have a registered domestic partnership and one of the parents has been absent for more than one month without the other parent knowing the whereabouts of the absent parent. are currently married or have a registered domestic partnership and the parents are currently living separately and apart on a permanent or indefinite basis. _______________________________________________________________________ SB-11290 03/12/13 rev. optional use Petition for Grandparent Visitation Family Code, Sections 3100 through 3104 Page 1 of 2 Personal Service is required except when this Petition is filed in a dissolution, nullity, legal separation or exclusive custody case. That type of filing requires service by certified mail, return receipt to the last known address of the parents, stepparent, or person with physical custody of the child. (See Family Code §3104subsection (c), §3103subsection (c).) American LegalNet, Inc. www.FormsWorkFlow.com Petitioner: Respondent: Case Number are currently married or have a registered domestic partnership and one of the parents joins in this petition with the grandparent, as shown by the signature of the parent below. are currently married or have a registered domestic partnership and the child(ren) is not residing with either parent. are currently married or have a registered domestic partnership and the child(ren) has been adopted by a stepparent. 4. Describe the relationship and the bonding between each child and the petitioner(s). Explain the reason why grandparent visitation is in the best interest of each child: See attachment 5. Describe the duration and frequency of visitation that is being requested: See attachment 6. 7. 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) requests 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 3100 through 3104. A Request for Order is concurrently filed with this Petition in order to request a hearing date. 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) __________________________________________ (Type or Print Name Here) ____________________________________ (Sign Name Here) ____________________________________ (Sign Name Here) PARENT'S CONSENT to Petition for Grandparent Visitation Mother Father hereby consents to and joins in this Petition for Grandparent Visitation. Date: __________________________________________ (Type or Print Name Here) ____________________________________ (Sign Name Here) NOTICE: The Court shall balance the interests of the child in having grandparent visits against the rights of the parents. In the following circumstances, a rebuttable presumption against best interests/visitation is created: 1. If the parents agree that visitation is not in the best interests of the child. 2. If the parent awarded sole legal and physical custody (or the parent with whom the child resides if no custody order) objects. _______________________________________________________________________ SB-11290 03/12/13 rev. optional use Petition for Grandparent Visitation Family Code, Sections 3100 through 3104 Page 2 of 2 Personal Service is required except when this Petition is filed in a dissolution, nullity, legal separation or exclusive custody case. That type of filing requires service by certified mail, return receipt to the last known address of the parents, stepparent, or person with physical custody of the child. (See Family Code §3104subsection (c), §3103subsection (c).) American LegalNet, Inc. www.FormsWorkFlow.com