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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: Petition To Establish Fact Of Birth, PR-142, 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.
CASE NUMBER
PETITION TO ESTABLISH FACT OF BIRTH
1. Petitioner (name):
Is a beneficially interested person, entitled under Health and Saf. Code 103450 to an order establishing the fact and
the date and place of the birth of the person named in item 3.
2. Petitioner’s beneficial interest in this matter is
stated below
stated in attachment 2.
3. Petitioner requests the court to establish the birth of:
Gender:
a. Name:
b. Father’s name:
Time:
d. Place of birth: City:
Female
Mother’s name:
c. Date of birth:
Male
County:
State:
Country:
4. (Check one of the following):
a.
There is no official record of the fact, date, and place of the birth of the person named in item 3.
b.
A certified copy of the official record of the birth of the person named in item 3 cannot be obtained for the
reasons
stated below
stated in attachment 4b.
5. The person named in number 3 now resides at (street address, city, county, and state):
.
SDSC PR-142 (New 8/09)
PETITION TO ESTABLISH FACT OF BIRTH
Health & Saf. Code, § 103450-103490
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IN THE MATTER OF (NAME):
CASE NUMBER
6. Petitioner requests that the court make an order determining that the birth of the person named in item 3 did in fact
occur on the date and at the place stated in item 3 above, as shown by the Declaration in Support of Petition to
Establish Fact of Birth (SDSC Form #PR-143), filed herewith, and by proof offered as evidence to this court.
7. Number of pages attached: ______
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
Attorney’s Signature
Date:
Petitioner’s Signature
SDSC PR-142 (New 8/09)
PETITION TO ESTABLISH FACT OF BIRTH
Health & Saf. Code, § 103450-103490
Page 2 of 2
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