ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO.(Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRAL DIVISION, JUVENILE COURT, 2851 MEADOW LARK DR., SAN DIEGO, CA 92123 NORTH COUNTY DIVISION, 325 S. MELROSE DR., SUITE 130,VISTA, CA 92081 IN THE MATTER OF THE PETITION OF JUDGMENT UNDER FAM. CODE § 8604(b) CASE NUMBER The citation for an order to allow the adoption of __________________________________________________, a minor child, to proceed without consent of ___________________________________________________, was heard on __________________________, before ____________________________________, Judge, presiding. Also appearing: _________________________________________________________________________________________________ ________________________________________________________. The citation was called in open court for ____________________________________________ with without response. The report of the Health and Human Services Agency was received into evidence. The court having sworn and examined ______________________________________ and other evidence, both oral and documentary, having been introduced, and good cause appearing, the court makes the following findings and orders: Notice of the hearing on the citation was given to _________________________________________, as required by law. _______________________________________________ has been awarded custody of the child by judicial order or has custody by agreement of both parents. The court finds by clear and convincing evidence that __________________________________________ has willfully failed to communicate with the child and support the child for at least one year. The petition is true. The consent of ________________________________________________ is not necessary for the adoption of this child. IT IS SO ORDERED. Date: Judge of the Superior Court SDSC JUV-242 (New 9/12) JUDGMENT UNDER FAM. CODE § 8604(b) American LegalNet, Inc. www.FormsWorkFlow.com