ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address) FOR COURT USE ONLY TELEPHONE NO: ATTORNEY FOR (NAME): FAX NO: SUPERIOR COURT OF CALIFORNIA COUNTY OF YUBA 215 FIFTH STREET, SUITE 200 MARYSVILLE, CA 95901 (530) 749-7600 PETITIONER: vs. RESPONDENT: EX PARTE APPLICATION AND DECLARATION RE APPOINTMENT OF ATTORNEY FOR MILITARY [50 U.S.C. App. § 520(1)] CASE NUMBER: APPLICATION The undersigned hereby applies for appointment of an attorney for respondent in the above-entitled matter pursuant to Title 50 of the United States Code, Appendix Section 520(1). Dated: __________________ ____________________________________________ Petitioner or Attorney for Plaintiff/Petitioner DECLARATION The undersigned hereby declares: 1. 2. I am the petitioner attorney for petitioner in the above-entitled action. Respondent in this action is a member of the United States Military, Branch: _________________. His/her service mailing address is _______________________________________________________________ ____________________________________________. Respondent was served with the summons and complaint/petition in the above-entitled action by ________________________________________ on _____________________________________. The time for respondent to plead expired on ___________________, and respondent has not made any appearance, nor has any pleading been filed on his/her behalf. I declare under penalty of perjury under the law of the State of California that the foregoing is true and correct. Dated: __________________ ____________________________________________ Petitioner or Attorney for Petitioner Form Adopted for Mandatory Use Yuba County Superior Court Effective 7/1/03; Rev. 4/25/12 EX PARTE APPLICATION AND DECLARATION RE APPOINTMENT OF ATTORNEY FOR MILITARY [50 U.S.C. App. § 520(1)] FL03004 American LegalNet, Inc. www.FormsWorkFlow.com