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California Declaration for Default Form

Declaration of Default.pdf This form asks the court to finalize the divorce without a hearing.Download

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FL-170	
FOR COURT USE ONLY	
PETITIONER:
RESPONDENT:	
CASE NUMBER:	DECLARATION FOR DEF	AULT OR UNCONTESTED	
DISSOLUTION    LEGAL SEPARATION	
(NOTE: Items 1 through 12 apply to both 	dissolution and legal separation proceedings.)	
I declare that if I appeared in court and were sworn, I woul	d testify to the truth of the facts in this declaration.	
I agree that my case will be proven by this declaration and t	hat I will not appear before the c	ourt unless I am ordered by the 	court to	
do so.	
Petition Response       	is true and correct.	All the information in the	
Default without agreement	
No response has been filed and there is no written agreement or stipul	ated judgment between the parties; 	
a.	
No response has been filed and the parties have agreed t	hat the matter may proceed as	 a default matter without 	
notice; and  	
(2)
Default with agreement	
The parties have entered into a written 	agreement regarding their property and 	their marriage or domestic partnership	
rights, including support, the original 	of which is being or has been submitted 	to the court. I request that the court 	
approve the agreement.      
 The following statement is true 	(check one):	
Page 1 of 3	
DECLARATION FOR DEFAULT OR UNCONTESTED 	DISSOLUTION OR LEGAL SEPARATION 	(Family Law)	
Form Adopted for Mandatory Use Judicial Council of California FL-170 [Rev. July 1, 2012]	
Family Code, § 2336	
1.
2.
3.	
b.
ATTORNEY OR PARTY WITHOUT ATTORNEY 	(Name, State Bar number, and address):	
SUPERIOR COURT OF CALIFORNIA, COUNTY OF	
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:	
BRANCH NAME:
TELEPHONE NO.:	
ATTORNEY FOR	 (Name):	
FAX NO. 	(Optional):	
E-MAIL ADDRESS	 (Optional):	
The default of the respondent was entered 	or is being requested, and I am not s	eeking any relief not requested in the 	
petition; and       	
Type of case 	(check a, b, or c):	4.	
(1)	
The community and quasi-community a	ssets and debts are listed on the 	completed 	current 	Property	
Declaration 	(form FL-160), which includes an estimate of th	e value of the assets and debts that I propose	
to be distributed to each party. The division in the proposed 	Judgment 	(form FL-180) is a fair and equal	
(B)	
division of the property and debts, or	 if there is a negative estate, the 	debts are assigned fairly and equitably.	
There are no assets or debts to	 be disposed of by the court. 	
(3)	
(A)	
(2)
(1)	
Both parties have appeared in the case; and   	
Uncontested	c.	
(2)
(1)	
Declaration of disclosure	 (check a, b, or c):	
Both the petitioner and respondent have	 filed, or are filing concurrently, a 	Declaration Regarding Service of Declaration	a.	of Disclosure 	(form FL-141) and an 	Income and Expense Declaration 	(form FL-150).	
This matter is proceeding by default. I am the petitioner in 	this action and have filed a proof 	of service of the preliminary 	
Declaration of Disclosure 	(form FL-140) with the court. I hereby waive receipt of the final 	Declaration of Disclosure 	(form	
b.	
FL-140) from the respondent.
This matter is proceeding as an unco	ntested action. Serv	ice of the final 	Declaration of Disclosure 	(form FL-140) is mutually 	
waived by both parties. A waiver prov	ision executed by both parties under 	penalty of perjury is contained on the 	Stipulation 	
and Waiver of Final Declaration of Disclosure 	(form FL-144), in the settlement ag	reement or proposed judgment or 	
another, separate stipulation.	
c.	
5.	
The parties have entered into a writt	en agreement regarding their property and t	heir marriage or domestic partnership	
rights, including support, the original of	 which is being or has been submitted to the court. I request that the court 	
approve the agreement.      	
amended

PETITIONER:	CASE NUMBER:	
RESPONDENT:	
Child support should be ordered as set forth in the proposed  Judgment (form FL-180).
7.
b.  am receiving am not receiving intend to apply for      public assistance for the child or children
To the best of my knowledge,  the other party  is is not       receiving public assistance.
The petitioner respondent      is presently receiving public assistance, and all support should be made 
payable to the local child support agency at the address set fo rth in the proposed judgment. A representative of the local 
child support agency has signed the proposed judgment.
If there are minor children, check and complete
 item (1) if applicable and item (2) or (3): 
a.
petitioner’s respondent’s earning ability. The facts in support 
I request that this order be based on the
(3)
of my estimate of earning ability are  (specify):
Continued on Attachment 7a(3).	
FL-170 [Rev. July 1, 2012]	DECLARATION FOR DEFAULT OR UNCONTESTED  DISSOLUTION OR LEGAL SEPARATION 	
(Family Law)	
I 
listed in the proposed order. 	
Page 2 of 3
FL-170	
6. Child custody and visitation (parenting time)  should be ordered as set forth in the proposed Judgment (form FL-180).             
d. Facts in support of  requested judgment ( In a default case, state your reasons below):	
Contained on Attachment 6d.
The information in the child support  calculation attached to the proposed  judgment is correct based on my 
personal knowledge.
(2)	
a.
The information in  Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act  (UCCJEA) (form FL-105)       	
has not     changed since it was last filed with the court. (If changed, attach updated form.)	has
Complete items (1) and (2) regarding public assistance.
(2) (1)
c. 
Spousal, Partner, and Family Support  (If a support order or attomey fees  are requested, submit a completed  Income and 
Expense Declaration  (form FL-150) unless a current form is on file. Inclu de your best estimate of the other party’s income. 
Check at least one of the following.)
a. I knowingly give up forever any right 
to receive spousal or partner support.
b. I ask the court to reserve jurisdiction to awar
d spousal or partner support in the future to (name):
I ask the court to terminate foreve r spousal or partner support for:
c.
d.
8.
Family support should be ordered  as set forth in the proposed Judgment (form FL-180).	
e.	
b.
There is an existing court order for cust ody/parenting time in another case in (county):  	
The case number is (specify):
Child support is being enf orced in another case in (county):
The case number is  (specify):
(1)	
Spousal support or domestic 
partner support should be ordered  as set forth in the proposed Judgment (form FL-180) 
based on the factors described in:            	
petitioner respondent.
Other  (specify):	
f.c.
The current custody and visitation (par enting time) previously ordered in this case, or current schedule is (specify):	
Spousal or Partner Support Declaration  Attachment  (form FL-157)
written agreement
attached declaration  (Attachment 8d.)	
Contained on Attachment 6c.

THIS STATEMENT APPLIES ONLY TO LEGAL SEPARATIONS	
I ask that the court grant the request for a judgment for legal separation  based on irreconcilable differences and that the
court make the orders se t forth in the proposed Judgment (form FL-180) submitted with this declaration.
I understand that a judgment of legal separation does not terminate a marriage or domestic partnership and that I am 
still married or a partner in a domestic partnership.
Other  (specify):
19.
I declare under penalty of perjury under the laws of the St ate of California that the foregoing is true and correct.
Date:	
(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)	
18.	
PETITIONER:	CASE NUMBER:	
RESPONDENT:	
FL-170	
FL-170 [Rev. July 1, 2012]	DECLARATION FOR DEFAULT OR UNCONTESTED 
DISSOLUTION OR LEGAL SEPARATION 	
(Family Law)	
Page 3 of 3	
STATEMENTS IN THIS BOX APPLY ONLY TO DISSOLUTIONS	
If this is a dissolution of marriage or  of a domestic partnership created in another state, the petitioner and/or the responden t 
have been residents of this county for at l east three months and of the state of Calif ornia for at least six months continuously 
and immediately preceding the date of the filing of the petition for dissolution  of marriage or domestic partnership.
I ask that the court grant the request for a judgment for dissol ution of marriage or domestic partnership based on irreconcilab le 
differences and that the court make  the orders set forth in the proposed Judgment (form FL-180) submitted with this declaration.
17. This declaration is for the termination of  marital or domestic partner status only.  I ask the court to reserve jurisdiction 
over all issues whose determination is  not requested in this declaration.
15.
16.
There are irreconcilable differences that 
have led to the irremediable breakdown of  the marriage or domestic partnership, and 
there is no possibility of saving the marriage or dome stic partnership through counseling or other means.
This declaration may be reviewed by a commissioner sitting as  a temporary judge, who may determine whether to grant this 
request or require my appearance und er Family Code section 2336.
13.
14. 12. respondent      requests restoration of his or her former name
 as set forth in the proposed Judgment
  (form FL-180).
The petitioner	
9.
Parentage
 of the children of the petitioner and respondent born  prior to their marriage or domestic partnership should be 
ordered as set forth in the proposed  Judgment (form FL-180). 
10. Attorney fees  should be ordered as set forth in the proposed  Judgment (form FL-180) 	
a.	A Voluntary Declaration of Paternity is attached.
11. The judgment should be entered nunc pr o tunc for the following reasons (specify):	
b.	Parentage was previously established by the court in  (county):
The case number is  (specify):
facts in support in form FL-319	
other  (specify facts below) :	
Written agreement of the parti es attached here or to the Judgment (form FL-180).
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