Madera — Confidential Declaration (MAD-CIV-010)

Source: https://www.madera.courts.ca.gov/system/files/forms-and-filings/mad-civ-010-confidential-declaration-rev-09-25-2025.pdf

MAD-CIV-010 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address): FOR COURT USE ONLY CONFIDENTIAL Place in confidential part of the court file.

TELEPHONE NO: FAX NO.: E-MAIL ADDRESS (optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF MADERA 200 South G Street Madera, California 93637 Civil Division PETITIONER:

RESPONDENT: CASE NUMBER: CONFIDENTIAL DECLARATION

You are required to complete this Confidential Declaration when you file any petition in any family law case type. If filing a response in any family law case type, this declaration is optional but encouraged. 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.

1. Petitioner (name): ___________________________________________________________________ Address: ____________________________________________________________________________ Alia (if any): ____________________ Social Security Number: ____________________________ Date of Birth: ____________________ Driver’s License: ____________________________

   Female Male Need Interpreter If so, what language? ___________________________________

2. Respondent (name): _________________________________________________________________ Address: ____________________________________________________________________________ Alia (if any): ____________________ Social Security Number: ____________________________ Date of Birth: ____________________ Driver’s License: ____________________________ Female Male NNeed Interpreter If so, what language? ___________________________________

3. If self-represented, someone did not did assist me in completing my forms for compensation. (if you paid someone for assistance, state below):

4. Name of Document Preparer: ______________________________________________________________ Address, city, and zip: ______________________________________________________________________ County of registration number (if LDA): ________________________________________________________ If prepared by an LDA, must complete local form MAD-CIV-019 Authorization for Non-Attorney Court Document Preparer.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date: ___________________

SIGN

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(TYPE OR PRINT NAME) (SIGNATURE)

Form Adopted for Mandatory Use CONFIDENTIAL DECLARATION Page 1 of 1 Madera Superior Court Form Local Form MAD-CIV-010 [Rev. 09/25/2025]