ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, Address, Telephone No., State Bar Number): ATTORNEY FOR: SUPERIOR COURT OF CALIFORNIA, COUNTY OF SHASTA PETITIONER(S) CASE NUMBER RESPONDENT(S) DECLARATION RE NOTICE OF EX PARTE APPLICATION FOR TEMPORARY ORDER (California Rule of Court 3.1200-3.1207) DO NOT use this form for Family Law, Civil Harassment, Domestic Violence, Elder Abuse, or Workplace Violence ­ use LF-FAM- 101 Declaration For Emergency Temporary Order I am the attorney for the: (circle one) Plaintiff/Petitioner Defendant/Respondent I am the: (circle one Plaintiff/Petitioner Defendant/Respondent I HAVE GIVEN written and/or verbal notice that I am asking the court for a temporary order. I have advised the other person(s) that if he/she/they wish to object to the request he/she/they must immediately do so by filing a responsive declaration with the court at Room 319, 1500 Court Street, Redding, or at 20509 Shasta Street, Burney. I gave this notice in writing by depositing the notice in the U.S. mail on: ____________________________ at ________________ a.m./p.m. to the following address: _________________________________________________________________________________ I gave this notice in writing by personal service upon the other party or attorney on: ____________________________ at ________________ a.m./p.m. I gave this notice by telephone/fax or electronic mail in the following manner (describe how, when and to whom): _______________________________________________________________ I HAVE NOT GIVEN written and/or verbal notice to the other party/attorney for the following reasons: Contained in my written declaration in support of the request for a temporary order filed concurrently herewith OR I have attached a written affidavit based upon personal knowledge of immediate danger or irreparable harm that will occur if my request is not immediately granted. I declare under penalty of perjury under the laws of the State of California that this declaration is true and correct. Dated: ___________________________ _________________________________ Type or Print Name _________________________________________ Signature ________________________________________________________________________________________ Form Approved for Optional Use Shasta County Superior Court LF-MSC-102 [rev July 1, 2012] DECLARATION RE NOTICE OF EX PARTE APPLICATION FOR TEMPORARY ORDER CRC Rule 3.1200-3.1207 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com