CHAPTER 19 TABLE OF FORMS: ORDER TO SHOW CAUSE (OSC) · changing the beneficiaries of any insurance or other coverage, including life, health, automobile, and disability, Both parties

19 • ORDER TO ShOW CauSE (OSC) — fORMS

January 2011 745

sample form 3a: Name of Form

CHAPTER 19 TABLE OF FORMS: ORDER TO SHOW CAUSE (OSC)Sample Form No. Name and Brief Description Page

19A Order to Show Cause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 749

19B Application for Order and Supporting Declaration . . . . . . . . . . . . . . . . . 751

19C Joint Legal Custody Attachment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .753

19D-1 Child Custody and Visitation Application Attachment . . . . . . . . . . . . . . 755

19D-2 Additional Visitation Provisions Attachment 2e(4) for Custodial Parent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 757

19D-3 Additional Visitation Provisions Attachment 2e(4) for Non-Custodial Parent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 758

19D-4 Children’s Holiday Schedule Attachment . . . . . . . . . . . . . . . . . . . . . . . . 759

19E Request for Child Abduction Prevention Orders. . . . . . . . . . . . . . . . . . . 761

19F Sample 1 of a Supporting Declaration . . . . . . . . . . . . . . . . . . . . . . . . . .763

19G Sample 2 of a Supporting Declaration . . . . . . . . . . . . . . . . . . . . . . . . . .769

19H Order to Show Cause (Ex Parte Requests). . . . . . . . . . . . . . . . . . . . . . .777

19I Temporary Orders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .779

19J Application for Order and Supporting Declaration (Ex Parte Requests) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 781

19K Sample Declaration for Ex Parte Requests. . . . . . . . . . . . . . . . . . . . . . .783

19L Declaration Regarding Notice of Ex Parte Request (Notice Given). . . . .789

19M Declaration Regarding Notice of Ex Parte Request (No Notice Given) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .790

19N Sample Witness List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 791

19O Order to Show Cause for Modification; Application for Order and Supporting Declaration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .793


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Sample Form No. Name and Brief Description Page

19P Sample of a Supporting Declaration for OSC-Modification . . . . . . . . . .796

19Q Proof of Service of Summons (Family Law—Uniform Parentage—Custody and Support) (OSC served with Dissolution Petition and Summons) . . . . . . . . . . . . . .799

19R Proof of Service of Summons (Family Law—Uniform Parentage—Custody and Support) (OSC served with Paternity Petition and Summons). . . . . . . . . . . . . . . .801

19S Proof of Personal Service (OSC served separately) . . . . . . . . . . . . . . . .803

19T Blank Responsive Declaration to OSC or Notice of Motion . . . . . . . . . .805

19U Application and Order for Reissuance of Order to Show Cause . . . . . .807

19V Income Withholding Order/Notice for Support . . . . . . . . . . . . . . . . . . . .809

19W Earnings Assignment Order for Spousal Support. . . . . . . . . . . . . . . . . . 813

19X Proof of Service by Mail to Child Support Services Department . . . . . . 815

19Y Findings and Order After Hearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 817

19Y-1 Child Custody and Visitation Order Attachment . . . . . . . . . . . . . . . . . . . 819

19Y-2 Child Custody and Visitation Order Attachment 2e(4) . . . . . . . . . . . . . . 821

19Y-3 Child Abduction Prevention Order Attachment. . . . . . . . . . . . . . . . . . . .823

19Y-4 Child Support Information and Order Attachment . . . . . . . . . . . . . . . . .825

19Y-5 Notice of Rights and Responsibilities and Information Sheet on Changing a Child Support Order . . . . . . . . . . . . . . . . . . . . . . . . . . . .827

19Y-6 Spousal or Family Support Order Attachment . . . . . . . . . . . . . . . . . . . .829

19Y-7 Property Order Attachment to Findings and Order After Hearing . . . . . 831

19z Sample of Supporting Declaration Re: Concealment of Minor Children and Need for DA Assistance in Locating Children . . . . .833


January 2011 747


Sample Form No. Name and Brief Description Page

19AA Attorney General’s Pamphlet on Child Abduction . . . . . . . . . . . . . . . . .835

19BB 3130 FOAH Attachment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .837

19CC Letter to Watch Commander . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .838

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19EE Visitation Percentage Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .839


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January 2011 749

sample form 19a: Order to Show Cause

Only check if Ex Parte relief is requested

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):

TELEPHONE NO.:

FOR COURT USE ONLY

ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OFSTREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

CASE NUMBER:ORDER TO SHOW CAUSE MODIFICATIONChild CustodyChild SupportAttorney Fees and Costs

VisitationSpousal Support

Injunctive OrderOther (specify):

1. TO (name):2. YOU ARE ORDERED TO APPEAR IN THIS COURT AS FOLLOWS TO GIVE ANY LEGAL REASON WHY THE RELIEF SOUGHT

IN THE ATTACHED APPLICATION SHOULD NOT BE GRANTED. If child custody or visitation is an issue in this proceeding,Family Code section 3170 requires mediation before or concurrently with the hearing listed below.

a. Date: Time: Dept.: Room:b. The address of the court is same as noted above other (specify):

3. THE COURT FURTHER ORDERS that a completed Application for Order and Supporting Declaration (form FL-310), a blankResponsive Declaration (form FL-320), and the following documents be served with this order:

(1) Completed Income and Expense Declaration (form FL-150) and a blank Income and Expense Declaration(2)

Completed Property Declaration (form FL-160) and a blank Property Declaration(3)Points and authorities

(5) Other (specify):

a.

Time for service hearing is shortened. Service must be on or before (date):Any responsive declaration must be served on or before (date):

b.

You are ordered to comply with the temporary orders attached.c.Other (specify):

Date:JUDICIAL OFFICER

NOTICE: If you have children from this relationship, the court is required to order payment of child support based on theincomes of both parents. The amount of child support can be large. It normally continues until the child is 18. You shouldsupply the court with information about your finances. Otherwise, the child support order will be based on theinformation supplied by the other parent.

Form Adopted for Mandatory UseJudicial Council of California

FL-300 [Rev. January 1, 2007]

ORDER TO SHOW CAUSE Family Code, §§ 215, 270 et seq., 3000 etseq., 3500 et seq., 4300

FL-300

(4)

Completed Financial Statement (Simplified) (form FL-155) and a blank Financial Statement (Simplified)

FAX NO. (Optional):

d.

Page 1 of 1

c. The parties are ordered to attend custody mediation services as follows:

E-MAIL ADDRESS (Optional):

Mary Smith

433 1st StreetLos Angeles, CA 90008

213-222-5555

Petitioner in Pro PerLos Angeles

111 N. Hill Street111 N. Hill StreetLos Angeles, CA 90012Central District HBCFL

Mary Smith

Jose Smith

xxx

x BD123987

Jose Smith

x 63 x 604x

x

You do not have to pay any fee to file declarations in response to this order to show cause (including a completed Income and ExpenseDeclaration (form FL-150) or Financial Statement (Simplified) (form FL-155) that will show your finances). In the absence of an ordershortening time, the original of the responsive declaration must be filed with the court and a copy served on the other party at least ninecourt days before the hearing date. Add five calendar days if you serve by mail within California. (See Code of Civil Procedure 1005 forother situations.) To determine court and calendar days, go to www.courtinfo.ca.gov/selfhelp/courtcalendars/.

Request for AccommodationsAssistive listening systems, computer-assisted real-time captioning, or sign language interpreter services are available if you ask atleast five days before the proceeding. Contact the clerk s office or go to www.courtinfo.ca.gov/forms for Request for Accommodationsby Persons With Disabilities and Response (Form MC-410). (Civil Code, § 54.8.)

x

HbCfl

X

Property Control


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CASE NUMBER:

THIS IS NOT AN ORDERPetitioner Respondent Claimant

1. CHILD CUSTODY To be ordered pending the hearinga. Child (name, age) b. Legal custody to

Modify existing order(1) filed on (date):

2. CHILD VISITATION To be ordered pending the hearinga. Attachment 2a

b.

Other (specify):

c.

Modify existing order(1) filed on (date):(2) ordering (specify):

3. CHILD SUPPORT (An earnings assignment order may be issued.)a. Child (name, age) b. Monthly amount (if not by guideline)

$

c. Modify existing order(1) filed on (date):(2) ordering (specify):

4. SPOUSAL OR PARTNER SUPPORT (An earnings assignment order may be issued.)

a. Amount requested (monthly): $ c.Terminate existing order(1) filed on (date):(2) ordering (specify):

b.Modify existing order(1) filed on (date):(2) ordering (specify):

5. ATTORNEY FEES AND COSTS a. Fees: $ b. Costs: $

Form Adopted for Mandatory UseJudicial Council of California

FL-310 [Rev. January 1, 2007]

APPLICATION FOR ORDER AND SUPPORTING DECLARATION Family Code, §§ 2045, 6224, 6226,6320 6326, 6380 6383

(2) ordering (specify):

FL-310PETITIONER:

RESPONDENT:

NOTE: To obtain domestic violence restraining orders, you must use the forms Request for Order(Domestic Violence Prevention) (form DV-100) and Temporary Restraining Order and Notice of Hearing(Domestic Violence Prevention) (form DV-110).

Page 1 of 2

APPLICATION FOR ORDER AND SUPPORTING DECLARATION

c.(person who makes decisionsabout health, education, etc.) (name)

Form FL-311

Physical custody to(person with whom child lives.)(name)

As requested in form FL-311 FL-312 FL-341(C) FL-341(D) FL-341(E)

As requested in: (1) (2) (3)

(4)

One or more domestic violence restraining/protective orders are now in effect. (Attach a copy of the orders if you

Criminal: County/state:

Family: County/state:

Juvenile: County/state:

Other: County/state:

(1)

(2)

(3)

have one.) The orders are from the following court or courts (specify county and state):

Case No. (if known): Case No. (if known):

Case No. (if known): Case No. (if known):

Mary Smith

Jose SmithBD123987

xx

Ana Smith 5 Mary Smith Mary SmithBrian Smith 3 Mary Smith Mary Smith

x x

xx

x11/23/05Mondays (4 pm to 7 pm)

x

Ana Smith 5 300 (CA guideline)Brian Smith 3 550 (CA guideline)

x11/23/05

$641 per month for Child Support

requests the following orders:

sample form 19b: Application for Order and Supporting Declaration

Only check if Ex Parte relief is requested


January 2011752

sample form 19b: Application for Order and Supporting Declaration

CASE NUMBER:

7. PROPERTY CONTROL To be ordered pending the hearinga. The petitioner

property that we own or are buying (specify):

b. The petitionerdue while the order is in effect:Debt Amount of payment Pay to

8. I request that time for service of the Order to Show Cause and accompanying papers be shortened so that these documentsmay be served no less than (specify number): days before the time set for the hearing. I need to have the ordershortening time because of the facts specified in the attached declaration.

9. OTHER RELIEF (specify):

10. FACTS IN SUPPORT of relief requested and change of circumstances for any modification are (specify):contained in the attached declaration.

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 NAME) (SIGNATURE OF APPLICANT)

FL-310 [Rev. January 1, 2007] APPLICATION FOR ORDER AND SUPPORTING DECLARATION Page 2 of 2

respondent

respondent

PETITIONER:

RESPONDENT:6. PROPERTY RESTRAINT To be ordered pending the hearing

a. The petitioner respondentconcealing, or in any way disposing of any property, real or personal, whether community, quasi-community, or

claimant is restrained from transferring, encumbering, hypothecating,

separate, except in the usual course of business or for the necessities of life.The applicant will be notified at least five business days before any proposed extraordinary expenditures,and an accounting of such will be made to the court.

b.

c. Neither party may incur any debts or liabilities for which the other may be held responsible, other than in theordinary course of business or for the necessities of life.

changing the beneficiaries of any insurance or other coverage, including life, health, automobile, and disability,Both parties are restrained and enjoined from cashing, borrowing against, canceling, transferring, disposing of, or

held for the benefit of the parties or their minor children.

is given the exclusive temporary use, possession, and control of the following

is ordered to make the following payments on liens and encumbrances coming

FL-310Mary Smith

Jose SmithBD123987

4/1/07Mary Smith

X

X

XI request that child support be made retroactive to the date of filingof the petition under Family Code Section 4009.

XX

Mary Smith


January 2011 753

sample form 19C: Joint Legal Custody Attachment

CASE NUMBER:PETITIONER:

RESPONDENT:

JOINT LEGAL CUSTODY ATTACHMENT Family Code, § 3003, 3083www.courtinfo.ca.gov

Form Approved for Optional UseJudicial Council of California

FL-341(E) [Rev. January 1, 2005]

FL-341(E)

Page 1 of 1

JOINT LEGAL CUSTODY ATTACHMENTPetition or Application for Order Findings and Order After Hearing or Judgment

In exercising joint legal custody, the parents will share in the responsibility and confer in good faith on matters concerning the health, education, and welfare of the children. The parents must confer in making decisions on the following matters:

Enrollment in or leaving a particular private or public school or daycare centerParticipation in particular religious activities or institutionsBeginning or ending of psychiatric, psychological, or other mental health counseling or therapySelection of a doctor, dentist, or other health professional (except in emergency situations) Participation in extracurricular activitiesOut-of-country or out-of-state travel

Other (specify):

If a parent does not obtain the required consent of the other parent to the decisions checked in item 2:

In all other matters in exercising joint legal custody, the parents may act alone, as long as the action does not conflict with any orders concerning the physical custody of the children.

School notification. Each parent will be designated as a person the children's school will contact in the event of an emergency.

Health-care notification5.

a.b.c.d.e.f.

g.

6.

Stipulation and Order for Custody and/or Visitation of Children

The parents will have joint legal custody of the minor children.

Special decision-making designation4.petitioner respondent will be responsible for making decisions regarding the following

Each parent must notify the other of the name and address of each health practitioner who examines or treats the children; such notification must be made within (specify number): days of the commencement of the first such treatment or examination.

a.

Each parent is authorized to take any and all actions necessary to protect the health and welfare of the children, including but not limited to consent to emergency surgical procedures or treatment. The parent authorizing such emergency treatment must notify the other parent as soon as possible of the emergency situation and of all procedures or treatment administered to the children.

b.

Other (specify): 8.

a.

Each parent will have access to the children's school, medical, and dental records and the right to consult with professionals who are providing services to the children.

b.

Both parents are required to administer any prescribed medications for the children.c.

Name. Neither parent will change the last name of the children or have a different name used on the children's medical, school, or other records without the written consent of the other parent.

7.

1.

2.

3.

TO

He or she may be subject to civil or criminal penalties.The court may change the legal and physical custody of the minor children.

Other consequences (specify):

a.b.c.

The issues (specify):

Maria AlvarezRaul Torres

BD345678

✔

✔

✔

✔

✔

✔

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✔

✔

✔

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January 2011 755

sample form 19D-1: Child Custody and Visitation Application Attachment

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

CASE NUMBER:

CHILD CUSTODY AND VISITATION APPLICATION ATTACHMENT

1. Custody. Custody of the minor children of the parties is requested as follows:Child's name Date of Birth Legal Custody to Physical Custody to

2. Visitation.a. Reasonable right of visitation to the party without physical custody (not appropriate in cases involving domestic

c. The parties will go to mediation at (specify location):d. No visitation

TO Petition, Response, Application for Order or Responsive Declaration Other (specify):

b.

FL-311

Visitation for the

Weekends starting (date):

Other (specify days and times as well as any additional restrictions):

(1)

(4)

Weekdays starting (date):(3)

a.m. p.m.

to a.m. p.m.

from at

petitioner will have the children with him or her during the period

e.

(2) Alternate weekends starting (date):will have the children with him or her during the period

at a.m. p.m.

to a.m. p.m.

at a.m. p.m.

to a.m. p.m.

petitioner

See Attachment 2e(4).

at

at

at

respondent

from

respondent

from

CHILD CUSTODY AND VISITATION APPLICATION ATTACHMENT Family Code, § 6200 et seq.Form Approved for Optional UseJudicial Council of CaliforniaFL-311 [Rev. July 1, 2005]

Page 1 of 2

To be ordered now and effective until the hearing

(person who makes decisions abouthealth, education, etc.)

(person with whom the child lives)

See the attached -page document dated (specify date):

petitioner respondent will be as follows:

(The first weekend of the month is the first weekend with a Saturday.)1st 2nd 3rd 4th 5th weekend of the month

(day of week) (time)


The parents will alternate the fifth weekends, with the petitioner respondenthaving the initial fifth weekend, which starts (date):

The petitioner will have fifth weekends in odd even months.




(time)(day of week)

violence)

(a)

(b)

The

The

Mary Smith

Jose TorresBF123987

X

X

Ana Torres 02/04/97 Mary Smith Mary Smith

X

X X

X 02/01/08

X X

Saturday 10:00 X

Sunday 5:00 X

X

X


January 2011756

sample form 19D-1: Child Custody and Visitation Application Attachment

PETITIONER:

RESPONDENT:

CASE NUMBER:

4. Transportation for visitation and place of exchange

Transportation to the visits will be provided by (name):a.b.

Drop-off of the children will be at (address):c.

g. Other (specify):

5. Travel with children. The

the state of California.a.b. the following counties (specify):

other places (specify):c.

Transportation from the visits will be provided by (name):

CHILD CUSTODY AND VISITATION APPLICATION ATTACHMENTFL-311 [Rev. July 1, 2005] Page 2 of 2

6. Child abduction prevention. There is a risk that one of the parents will take the children out of California without the other

e. The children will be driven only by a licensed and insured driver. The car or truck must have legal child restraint

f. During the exchanges, the parent driving the children will wait in the car and the other parent will wait in his or herhome while the children go between the car and the home.

petitioner respondent other (name):must have written permission from the other parent or a court order to take the children out of

parent's permission. I request the orders set out on attached form FL-312.

7. Children's holiday schedule. I request the holiday and visitation schedule set out on the attached form FL-341(C)other (specify):

8. Additional custody provisions. I request the additional orders regarding custody set out on the attachedform FL-341(D) other (specify):

9. Joint legal custody provisions. I request joint legal custody and want the additional orders set out on the attached

form FL-341(E) other (specify):

10. Other. I request the following additional orders (specify):

3. Supervised visitation.I request that (name):schedule set out on page 1 and that the visits be supervised by (name):who is a professional nonprofessional supervisor. The supervisor's phone number is (specify):

I request that the costs for supervision be paid as follows: petitioner: percent; respondent: percent.

have supervised visitation with the minor children according to the

If item 3 is checked, you must attach a declaration that shows why unsupervised visitation would be bad for yourchildren. The judge is required to consider supervised visitation if one parent is alleging domestic violence and isprotected by a restraining order.

d. Pick-up of the children will be at (address):

devices.

Mary Smith

Jose TorresBF123987

XJose Torres

Angela Torres or any other person of pettitioner’s choiceX (562)722-3200

X

X 350 Lake St. Los Angeles, CA or Petitioner's future home.

X 350 Lake St. Los Angeles, CA or Petitioner's future home.

X X

XX Los Angeles


January 2011 757

sample form 19D-2: Additional Visitation Provisions Attachment 2e(4) for Custodial Parent

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28

SHORT TITLE: Smith and Smith CASE NUMBER: BD123456

Attachment 2e(4) :

VISITATION ATTACHMENTF:\Document\Publications\Volunteer Manual\2009\2009 Forms\New forms Chapter 9\C&V Attachment to Petition CP & OSC No RO.wpd Page

Additional Visitation Provisions

1. Visitation shall be forfeited if Respondent does not show up to pick up minor(s) within

the first 30 minutes that visitation period is to start.

2. Respondent shall not consume any alcoholic beverage, narcotic or non-prescription drugs

24 hours prior to or during any visit. Respondent shall forfeit all or any portion of a visit

if it appears at said visit that Respondent is under the influence of alcohol or any narcotic or

non-prescription drugs.

3. Respondent shall notify Petitioner of his/her current address and telephone number within

7 days of any change in address or telephone number.

4. In emergency situations, each parent is authorized to take any and all actions necessary

to protect the health and welfare of the child(ren), including but not limited to the consent

to emergency surgical procedures or treatment and must notify the other parent within 3

hours of such emergency and of all procedures or treatment administered to the child(ren).

5. Other:

✔

✔

✔

✔


January 2011758

sample form 3a: Name of Formsample form 19D-3: Additional Visitation Provisions Attachment 2e(4) for Non-Custodial Parent

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15

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19

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28

SHORT TITLE: CASE NUMBER:

Attachment :

VISITATION ATTACHMENT

F :\D ocum en t\M aste r F o rm s - L ega l P rogram \A ttachm en ts\C & V A ttachm en t to P e tition N C P & O S C N o R O .w pd . Rev. 4/7/04 Page

Additional Visitation Provisions

G 1. Respondent shall notify Petitioner of his/her current address and telephone number within

days of any change in address or telephone number.

G 2. Respondent shall notify Petitioner 45 days prior to any contemplated change in residence

of the child. The notification shall state, to the extent known, the contemplated address of

the child, but shall include the county and state of the new residence. The notification shall

be sent by certified mail, return receipt requested.

G 3. In emergency situations, each parent is authorized to take any and all actions necessary

to protect the health and welfare of the child(ren), including but not limited to the consent

to emergency surgical procedures or treatment and must notify the other parent within 3

hours of such emergency and of all procedures or treatment administered to the child(ren).

G 4. Other:

///

///

///

///

///

///

///

///

///

Alvarez and Torres BD345678

2e(4)

7

✔

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January 2011 759

sample form 19D-4: Children’s Holiday Schedule Attachment

that includes dates of leaving and returning, destinations, flight information, and telephone numbers for emergency purposes. The other parent has (specify number): days to respond if there is a problem with the schedule.

may take a vacation of up to (specify number): days

CASE NUMBER:PETITIONER:

RESPONDENT:

CHILDREN'S HOLIDAY SCHEDULE ATTACHMENT Family Code, §§ 3003, 3083 www.courtinfo.ca.gov

Form Approved for Optional UseJudicial Council of California

FL-341(C) [Rev. January 1, 2005]

FL-341(C)

Page 1 of 1

CHILDREN'S HOLIDAY SCHEDULE ATTACHMENTPetition or Application for Order Findings and Order After Hearing or Judgment

1. Holiday parenting. The following table shows the holiday parenting schedules. Write "Pet" or "Resp" to specify each parent's years—odd, even, or both ("every year")—and under "Time" specify the starting and ending days and times.

Holiday

Time (from when to when) (Unless otherwise noted, all single- day holidays start at a.m. and end at p.m.)

Even Years Odd Years

Any three-day weekend not specified above will be spent with the parent who would normally have that weekend.

Stipulation and Order for Custody and/or Visitation of Children

Every Year Petitioner/

Respondent

Other (specify):

Other (specify):

January 1 (New Year's Day)Martin Luther King's Birthday (weekend)Lincoln's BirthdayPresident's Day (weekend)Spring Break, first halfSpring Break, second halfMother's DayMemorial Day (weekend)Father's DayJuly 4thLabor Day (weekend)Columbus Day (weekend)HalloweenVeteran's Day (weekend)Thanksgiving DayThanksgiving weekendWinter Break, first halfWinter Break, second halfNew Year's EveChild's birthdayMother's birthdayFather's birthdayBreaks for year-round schoolsSummer Break, first half

Other (specify):

2. Vacations.

This vacation may be outside California.

Summer Break, second half

TO

Petitioner/Respondent

Petitioner/Respondent

petitioner respondent

Any vacation outside a court order.

California the United States requires prior written consent of the other parent or

The weeks with the children the following number of times per year (specify): . They must notify the other parent in writingof their vacation plans a minimum of (specify number): days in advance and provide the other parent with a basic itinerary

a.b.

c.

Maria Alvarez

Raul TorresBD3345678

✔

88

Petitioner

RespondentPetitioner Respondent

Respondent Petitioner

Petitioner RespondentPetitionerRespondent


January 2011760



January 2011 761

sample form 19e: Request For Child Abduction Prevention Orders

CASE NUMBER:PETITIONER / PLAINTIFF:

RESPONDENT / DEFENDANT:

REQUEST FOR CHILD ABDUCTION PREVENTION ORDERS

Attachment to Petition Response Application for Order andSupporting Declaration

Responsive DeclarationOther (specify):

FL-312

Your name:1.

another county in California?a.

REQUEST FOR CHILD ABDUCTION PREVENTION ORDERSForm Adopted for Mandatory UseJudicial Council of California

Page 1 of 2

Family Code, § 3048

Do you think the other parent might take the children without your permission to2.Yes No If "Yes," what county? (specify):

another state?b. Yes No If "Yes," what state? (specify):a foreign country?c. Yes No If "Yes," what country? (specify):

Yes NoIf "Yes," is the other parent a citizen of that country?Yes NoIf "Yes," does the other parent have family or emotional ties to that country?

Why do you think the other parent might take the children without your permission?The other parent (check all that apply):

3.

has violated - or threatened to violate - a custody or visitation order in the past.a.

Explain:

Explain:

does not have strong ties to California.b.Explain any work, financial, social, or family situation that makes it easy for the other parent to leave California.

has recently done things that make it easy for him or her to take the children away without permission. He or shehas (check all that apply)

c.

quit his or her job.closed a bank account.sold or gotten rid of assets.

sold his or her home.ended a lease.hidden or destroyed documents.

applied for a passport, birth certificate, or school or medical records.

has a history of (check all that apply)d.domestic violence.child abuse.not cooperating with me in parenting.

has a criminal record. Explain:e.

Other (specify):

taking the children without my permission.Explain:

FL-312 [New July 1, 2003]

Mary Smith

Jose Smith BD123987

X

Mary Smith

X X

XX

The Respondent's mother, father, 4 brothers, 2 sisters and numerousaunts, uncles, and cousins live in Mexico.

X

The Respondent's family owns a successful hotel business in Mexico and he can easily find a job

there. The Respondent also always talks about how much he misses Mexico and his family.

X

XX X

XX

XX

XX

The Respondent on many occassions has threatened to take our childrenaway from me so that I will never see them again if I were to leave him. Onor about 01/01/04, I tried to separate from Respondent, but he took the kidsto Mexico and did not return until I agreed to take him back.

X On or about February 2004, Respondent was arrestedand convicted for spousal battery against me.

Mexico


January 2011762

sample form 19e: Request For Child Abduction Prevention Orders

CASE NUMBER:PETITIONER / PLAINTIFF:

RESPONDENT / DEFENDANT:

Date:SIGN HERE

REQUEST FOR CHILD ABDUCTION PREVENTION ORDERS Page 2 of 2

Notify Other State of Travel Restrictions8.I ask the court to order the other parent to register this order in the state of before thechildren can travel to that state for visits.

Turn In and Do Not Apply for Passports or Other Vital Documents9.I ask the court to order the other parent to turn in and NOT apply for passports or other documents (such as visas or birthcertificates) that can be used for travel.

Provide Itinerary and Other Travel Documents10.If the other parent is allowed to travel with the children, I ask the court to order the other parent to give me before leaving

the children's travel itinerary.copies of round-trip airline tickets.addresses and telephone numbers where the children can be reached.an open airline ticket for me in case the children are not returned.other (specify):

Notify Foreign Embassy or Consulate of Passport Restrictions11.I ask the court to order the other parent to notify the embassy or consulate of of thisorder and to provide the court with proof of that notification within calendar days.

Foreign Custody and Visitation Order12.I ask the court to order the other parent to get a custody and visitation order in a foreign country equal to the most recentU.S. order before the children can travel to that country for visits. I understand that foreign orders may be changed orenforced depending on the laws of that country.

Other (specify):13.

I declare under penalty of perjury under the laws of the State of California that the information on this form is true and correct.

Supervised Visitation4.I ask the court to order supervised visitation.

form FL-341(A) as follows:Terms of visitation are attached (check one):

Post a Bond5.I ask the court to order the other parent to post a bond for $ . If the other parent takes the children withoutmy permission, I can use this money to bring the children back.

Do Not Move Without My Permission or Court Order6.I ask the court to order the other parent NOT to move with the children, without my written permission or a court order.

No Travel Without My Permission or Court Order7.I ask the court to order the other parent NOT to travel with the children outside (check all that apply)

this countyCalifornia

the United Statesother (specify):

I REQUEST THE FOLLOWING ORDERS:

without my written permission or a court order.

FL-312 [New July 1, 2003]

Mary Smith

Jose Smith BD123987

X

X FL-311

X10,000

X

X

XX

X

X

XXXX

XMexico

15

X

01/01/08 Mary Smith