Declaration In Support Of Petition To Establish Fact Of Birth
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Declaration In Support Of Petition To Establish Fact Of Birth Form. This is a California form and can be use in San Diego Local County.
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Tags: Declaration In Support Of Petition To Establish Fact Of Birth, PR-143, California Local County, San Diego
FOR COURT USE ONLY
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
TELEPHONE NO.:
FAX NO.(Optional):
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO
CENTRAL DIVISION, MADGE BRADLEY, 1409 4TH AVE., SAN DIEGO, CA 92101
NORTH COUNTY DIVISION, 325 S. MELROSE DR., VISTA, CA 92081
IN THE MATTER OF (NAME):
JUDGE/DEPT.
DECLARATION IN SUPPORT OF PETITION TO ESTABLISH FACT OF BIRTH
CASE NUMBER
, makes the statements in this declaration based
1. Declarant (name),
on personal knowledge or on the contents of the documents identified in item 5.
2. a. I am at least 18 years of age.
b. I reside at (street address and city)
, State of
County of
.
3. Subject person’s name
was born on (date)
at approximately (time of birth)
a.m.
p.m.
to (father’s name)
and (mother’s name)
,
in the county of
, State of
.
4. Facts showing how, when, and where the person named in item 3 was born and explaining how I have personal
knowledge of the birth
are stated in the space below
are stated in Attachment 4 to this declaration.
Attached are true and correct copies of the following documents (check each box that applies):
5.
a.
Hospital records dated (date of each):
b.
Ambulance records dated (date of each):
c.
Physician’s report dated ( date of each):
d.
Witness statements dated (date of each):
e.
Other documents dated (Describe and give the date of each document):
6. Number of pages attached: ______
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
Signature of Declarant
SDSC PR-143 (New 8/09)
DECLARATION IN SUPPORT OF PETITION
TO ESTABLISH FACT OF BIRTH
Health & Saf. Code §§ 103450-103490
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