Attorney or Party without Attorney—Name, Address, and Telephone No.: Attorney for: SUPERIOR COURT OF CALIFORNIA, COUNTY OF SHASTA 1500 Court Street, Room 319, Redding, CA 96001 Plaintiff/Petitioner: Defendant/Respondent: Other Party: DECLARATION OF NOTICE FOR EMERGENCY TEMPORARY ORDER Case Number: You must check 1a or 1b. Defendant/Respondent Other Party 1a. I am the Plaintiff/Petitioner 1b. I am the attorney for the Plaintiff/ Petitioner Defendant/Respondent . Other Party . You must complete 2, 3, 4, 5, and 6. 2. The specific relief requested is ______________________________________________________. 3. The request contains a written declaration based upon personal knowledge of immediate danger or irreparable harm that will occur if the request is not immediately granted. 4. The part(ies) to whom notice was given responded as follows: 5. I do do not expect opposition to the ex parte request. 6. I do do not expect the party to whom notice was given to appear at the hearing. . You must complete either 7a or 7b, or you must check 8a or 8b. NOTICE HAS BEEN GIVEN to _______________________________________that the Court is being asked for an emergency temporary order; the specific relief requested; and the date, time, place of the ex parte hearing. 7a. I gave this notice on (date) ______________ at (time)________a.m./p.m. by the following method: (1) telephone text message fax To telephone no.:____________________________. (2) in person at (location):______________________________________________,California. (3) e-mail to e-mail address:_____________________________________________________. (4) other (please describe):_____________________________________________________. 7b. Notice was given by someone other than me, namely ___________________________. Attached is a declaration signed by the person who gave notice describing the time, date, and manner of service. NOTICE HAS NOT BEEN GIVEN to ____________________________________for the following reason: 8a. Reasons are contained in the written declaration in support of the request for an emergency temporary order filed concurrently herewith. 8b. Good-faith efforts to give notice to the opposing party were made, as described in the attached declaration, but those efforts were unsuccessful. I understand that I must appear in person in Department _____ at (time)__________ a.m./p.m. on (date) _______________ (no sooner than the first business day after this document is received by the Court if notice is provided by 10:00 a.m. on the day before the hearing). I declare under penalty of perjury under the laws of the State of California that this declaration is true and correct. Dated: (print name) (signature) (Please note: After the above hearing, the documents will be submitted for signature and processed. The moving party must pick the documents up in Room 319 (with photo identification) and have them personally served upon the other party in a timely manner.) ______________________________________________________________________________________ Form Approved for Optional Use Shasta County Superior Court LF-FAM-101 [rev July 1, 2012] DECLARATION OF NOTICE FOR EMERGENCY TEMPORARY ORDER FC §§3062-3064, §6326; Local Rule 14.03 CRC Rule 3.1200-3.1207 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com