Choose a location ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME AND ADDRESS): TELEPHONE NO.: FOR COURT USE ONLY ATTORNEY FOR (NAME): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA BARBARA STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: CASE NUMBER: DECLARATION RE: EX PARTE NOTICE I, the undersigned, declare under penalty of perjury that 1. I am: (1) (2) (3) counsel for: Plaintiff/Petitioner Defendant/Respondent unrepresented Plaintiff/Petitioner other (explain): unrepresented Defendant/Respondent 2. The opposing party is represented by counsel: YES NO If you checked "Yes", fill in attorney's name, address and phone: 3. The parties to this action have been involved in another Family Law, Domestic Violence, Family Support Division, Paternity, Criminal, Guardianship or Juvenile Court case. YES NO If there has been another case, fill in the County in which the case is pending 4. I have given notice of this ex parte application Date and time I gave notice (Date) and the Case number YES NO (If you answered "No", skip #5-#9 and complete the rest of the form.) (Time) 5. 6. The notice included the information contained in attachment 1 of this declaration. I gave notice that I would present this application for these orders at in Department of the SUPERIOR COURT. AM/PM on 7. A copy of these pleadings were given to : by Personal delivery Other (explain): Overnight letter or other overnight carrier Fax transmission 8. I have received the following response: 9. I anticipate the other party will oppose this application. I do not anticipate the other party will oppose this application. Page 1 of 2 SC-4012 [Rev. April 15, 2003] DECLARATION RE: EX PARTE NOTICE Local Rule 1407 American LegalNet, Inc. www.FormsWorkFlow.com Insert Case Name: CASE NUMBER: 10. I have not given notice of the present application for ex parte orders because: Notice would frustrate the purpose of the orders sought. Applicant would suffer immediate and irreparable harm before the orders could issue. No significant burden or inconvenience to the responding will result. The orders requested are those permitted without notice by local rule. I made reasonable, good faith efforts to give notice, described as follows: Other: EXPLAIN WHY YOU CHECKED ANY BOX IN ITEM 10: 11. I believe that alcohol drug abuse is a major factor in the party's abusive behavior. 12. If I am asking that anyone else be protected, their names, relationships and need for protection are set forth below: Name a. b. c. Relationship Why protection needed This person lives in my residence (CIRCLE YES OR NO) YES YES YES NO NO NO 13. Are you in mediation? YES NO If so, have you notified the mediator of this application? YES NO I declare under penalty of perjury, under the laws of the State of California, that the foregoing is true and correct, and that this declaration was signed at , California, this ____ day of , 20 __, at (AM) (PM) Signature of Declarant This form may be used to satisfy the requirements of ex parte notice pursuant to Rule 1407 et. Seq., Unified Rules, Santa Barbara County Superior Court. Page 2 of 2 SC-4012 [Rev. April 15, 2003] DECLARATION RE: EX PARTE NOTICE Local Rule 1407 American LegalNet, Inc. www.FormsWorkFlow.com