CONFIDENTIAL ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME, ADDRESS, PHONE) FOR COURT USE ONLY NOTICE TO CLERK Place in confidential part of the court file. Attorney for: SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS Street Address: 800 11th Street, Modesto, CA 95354 Civil Clerk' Office: 1100 I Street, P.O. Box 1098, Modesto, CA 95353 Petitioner: Respondent: CONFIDENTIAL DECLARATION Case Number: You are required to complete this Confidential Declaration when you file any petition or response in any family law case type. You are required to provide the social security numbers for yourself and your spouse on this form if you know them. This form will be kept in a confidential part of the court file and may not be disclosed without good cause shown to the court. After you have completed this form, you may redact (block or cross out) any social security number listed on this form from any future document or other written material filed with the court. You may not redact or change any previously filed documents without a court order. Petitioner (name):_____________________________________________________________________ Address: ____________________________________________________________________________ Alias (if any): ______________________________Social security number: _____________________ Date of Birth: ________________________ Drivers License: ________________________________ Female Male Respondent (name):___________________________________________________________________ Address: ___________________________________________________________________________ Alias (if any): ______________________________Social security number: ______________________ Date of Birth: ______________________________ Drivers License: ___________________________ Female Male I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: ___________________________ (Type or Print Your Name) ___________________________ (Sign Your Name) FL003 CONFIDENTIAL DECLARATION (FAMILY LAW) Rev 6-10 American LegalNet, Inc. www.FormsWorkFlow.com