LOCAL RULES OF THE SISKIYOU COUNTY SUPERIOR COURT APPENDIX 3: DECLARATION RE EX PARTE NOTICE (SC-CV-1) NAME OF APPLICANT OR ATTORNEY FOR APPLICANT: (FOR COURT USE ONLY) ADDRESS: TELEPHONE: SISKIYOU COUNTY SUPERIOR COURT 311 FOURTH STREET YREKA, CALIFORNIA 96097 IN THE MATTER OF: PETITIONER / PLAINTIFF: CASE NUMBER RESPONDENT / DEFENDANT: DECLARATION RE EX PARTE NOTICE I, the undersigned, declare under penalty of perjury that 1. I am: (1) (2) (3) 2. unrepresented Petitioner/Plaintiff the attorney for: Petitioner/Plaintiff unrepresented Respondent/Defendant Respondent/Defendant other (explain): ______________________________________________________________________________________ No If you checked "yes", fill in attorney's name, address and telephone number: The opposing party is represented by counsel: Yes _________________________________________________________________________________________________________________ 3. The parties to this action have been involved in another Family Law, Domestic Violence, Family Support Div., Paternity, Criminal, Guardianship, or Juvenile Court case. YES NO. If there has been another case, state the County in which it is pending ____________________ , and the case number __________________ 4. 5. 6. 7. I have given notice of this ex parte application YES NO (If you answered "No", skip #5 - #9 and complete the rest of the form.) I gave notice to____________________________________________, on __________________________________ at __________________ (Name) (Date) (Time) The notice included the information contained in Attachment 1 of this declaration. I gave notice to ______________________________ that I would present an application for these orders at ______________ (AM) (PM) on __________________________ at the SUPERIOR COURT CHAMBERS, DEPT. 1. applications to the clerk of the Court.] [Unrepresented parties must deliver their 8. A copy of these pleadings was given to: ________________________________________________________ by the following method: personal delivery overnight letter or other overnight carrier fax transmission other (explain): _____________________ _________________________________________________________________________________________________________________ 9. I have received the following response: _________________________________________________________________________________ _________________________________________________________________________________________________________________ 10. I anticipate that the other party WILL oppose this application. I anticipate that the other party WILL NOT oppose this application. Mandatory Form Rev. 7/1/13 APPENDIX 3 PAGE 1 OF 2 American LegalNet, Inc. www.FormsWorkFlow.com LOCAL RULES OF THE SISKIYOU COUNTY SUPERIOR COURT 11. 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 party 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 11:_______________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ alcohol drugs 12. I believe that the other party's abuse of is a major factor in his/her offensive behavior. 13. If you are asking that anyone else be protected, then his or her name, age, relationship to you, and need for protection must be stated. NAME & AGE RELATIONSHIP WHY PROTECTION NEEDED LIVES IN MY RESIDENCE (CIRCLE YES OR NO) YES NO YES NO YES NO YES NO YES NO a. ___________________________________________________________________________________________________________ b. ___________________________________________________________________________________________________________ c. ___________________________________________________________________________________________________________ d. ___________________________________________________________________________________________________________ e. ___________________________________________________________________________________________________________ 14. Are you in mediation? YES NO If so, have you notified the Court 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, on _____________________, 200_____, Signature of Declarant _______________________________________ Print Name:________________________________________________ This form may be used to satisfy the requirements of ex parte notice pursuant to Rule 3.03.B of the Local Rules of the Siskiyou County Superior Court, if you provide an attachment which includes a statement of the notice you gave and of the exact temporary orders you are requesting from the Court. Mandatory Form Rev. 7/1/13 APPENDIX 3 PAGE 2 OF 2 American LegalNet, Inc. www.FormsWorkFlow.com