VN151 ATTORNEY OF PARTY WITHOUT ATTORNEY (Name and Address) Telephone Number FOR COURT USE ONLY E-MAIL ADDRESS ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF VENTURA 800 SOUTH VICTORIA AVE. VENTURA, CA 93009 IN THE MATTER OF : CASE NUMBER: PETITION TO ESTABLISH RECORD OF Birth Marriage HEARING DATE: _______________ TIME: _______________ COURTROOM: ________________ 1. Petitioner is A beneficially interested person, entitled under Section 103450 of the California Health and Safety Code, time and place of the marriage of: ______________________________ to judicial establishment of the fact, time and place of the birth of: __________________________________ Petitioner’s beneficial interest in the matter herein is based on the following facts and circumstances: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 2. Check one of the following: The fact, time and place of the marriage or birth of ___________________________________ is not registered. A certified copy of the record of the marriage or birth of ________________________________ is not obtainable because __________________________________________________________________________________ _________________________________________________________________________________________ 3. On __________________________ the marriage or birth of _____________________________________ occurred in __________________________ County, state of ________________________________ . 4. _______________________________ now resides at ________________________________________, County of (Address) Ventura, State of California. Petitioner requests that the Court make an order determining that the marriage or birth of ______________________ did in fact occur at the time and place shown by the proofs adduced at said hearing. __________________________ _____________________________________________ (Dated) (Type or print name) _____________________________________________ (Signature) VERIFICATION I, ____________________________, the petitioner in this action, certify under penalty of perjury, under the laws of the Sate of California, that the foregoing is true and correct, except as to those matters stated on information and belief, and as to those matters, I am informed and believe them to be true. __________________________________________ (Signature) Optional Form VN151 (Rev. 01/06) PETITION TO ESTABLISH RECORD American LegalNet, Inc. www.FormsWorkFlow.com