Santa Barbara — SC-4037

Santa Barbara — SC-4037¶

Source: https://www.santabarbara.courts.ca.gov/system/files/sc-4037.pdf

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ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME AND ADDRESS): TELEPHONE NO.: FOR COURT USE ONLY

EMAIL ADDRESS (Optional) ATTORNEY FOR (NAME):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA BARBARA

Santa Barbara–Anacapa Santa Maria-Cook Lompoc Division
1100 Anacapa Street 312-C East Cook Street 115 Civic Center Plaza

Santa Barbara, CA 93101 Santa Maria, CA 93454 Lompoc, CA 93436

MATTER OF:

CASE NUMBER:
PETITION FOR FREEDOM
FROM PARENTAL CUSTODY AND CONTROL HEARING DATE TIME: DEPT:

Petitioner(s) Name(s):

a. ____________________________________________________________

b. ____________________________________________________________

Relationship to child named below: _______________________________________________________

Street Address: ______________________________________________________________________

City: _________________________________ State: ____________ Zip: ________________

Telephone number: ______________________ Email address: _________________________

Information about the child

a. Birth name of Child _________________________________________

b. Birth Date: ______________________________

c. Place of Birth:

City: ______________________________ State: ________________
Name of child’s birth parents:

Parent: ______________________________________________________

Parent: ______________________________________________________

Attachment 3
I filed this request in this county because (Check all that apply):

the child resides here.

an Adoption Request has been filed here and was assigned the following case number: ____________________.

Optional Form PETITION FOR FREEDOM Fam. Code §7800 et seq. SC-4037 [New July 1, 2020] FROM PARENTAL CUSTODY AND CONTROL Page 1 of 4

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Matter of: Case Number:

Petitioner(s) is the child’s court-appointed guardian. (Attach the Letters of Guardianship as Attachment 5.) a. County in which the guardian was appointed: __________________________. b. Case Number of guardianship proceeding: ____________________. c. One or both parents do not have the legal custody of the child. d. The child has been in the physical custody of the guardian for a period of not less than two years. e. The child would benefit from being adopted by the guardian. (Must complete Attachment 5e.)

(Skip to paragraph 10.)
Petitioner(s) request(s) an order declaring the child free from the custody and control of _______________________________________ (name of parent(s)) for the following reason(s) (check all that apply):

a. Abandonment (check at least one box below): The child has been left without provision for the child’s identification by the child’s parent(s). The child has been left by the parent(s) named above in the care and custody of a non-parent for a period of six months: without any provision for the child’s support, or without communication from the parent(s), with the intent on the part of the parent(s) to abandon the child. (Use Attachment 6a to tell the court about the nature of the communication between the child and abandoning parent and whether any child support has been paid.) The parent named above has left the child in the care and custody of the other parent for a period of one year: without any provision for the child’s support, or without communication from the parent, with the intent on the part of the parent to abandon the child. (Use Attachment 6a to tell the court about the nature of the communication between the child and abandoning parent and whether any child support has been paid.)

b. The child has been a dependent of the juvenile court, AND the parent(s) have been deprived of the child’s custody for one year before the filing of this petition AND (Check at least one): The child has been neglected or cruelly treated by the parent(s) named above. The parent(s) named above suffer a disability because of the habitual use of alcohol or drugs. Juvenile Court Case Number: ________________________.

c. The parent(s) named above are convicted of a felony, the facts of which are of such a nature so as to prove the unfitness of the parent(s) to have the future custody and control of the child. (Use Attachment 6c to specify the felony and facts connecting the felony to parental unfitness.)

Optional Form PETITION FOR FREEDOM Fam. Code §7800 et seq. SC-4037 [New July 1, 2020] FROM PARENTAL CUSTODY AND CONTROL Page 2 of 4

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Matter of: Case Number:

d. The parent(s) named above have been declared by a court of competent jurisdiction to be
developmentally disabled or mentally ill and have been certified to be incapable of supporting or
controlling the child in a proper manner.
A copy of the court order is attached as Attachment 6d (required).

e. The parent(s) named above is/are mentally disabled and is/are likely to remain so in the foreseeable
future.
The evidence of two qualified experts (as defined by Fam. Code, § 7827, subd. (c)) is attached
at Attachment 6e (required).

Child may have Indian ancestry: Yes No

a. Whether you answered “Yes” or “No,” you must fill out and attach as Attachment 7 Indian Child Inquiry
Attachment (Judicial Council Form ICWA-010(A)) and Parental Notification of Indian Status (Judicial
Council form ICWA-020) or other proof that ICWA inquiry has been completed in accordance with rule
5.481(a).
b. If you answered “Yes,” you must also fill out and attach as Attachment 7 Adoption of Indian Child
(Judicial Council form ADOPT-220) if, after notice, it is determined that ICWA does apply to the child.
The parent retaining custody (if any) has completed a consent to the relief requested in this petition and the

consent is attached as Attachment 8. (Use Attachment 8 only if the parent retaining custody is not a petitioner.)
It is in the best interests that the child be declared free from the custody and control of the parent(s) named in

paragraph 3 because:

Optional Form PETITION FOR FREEDOM Fam. Code §7800 et seq. SC-4037 [New July 1, 2020] FROM PARENTAL CUSTODY AND CONTROL Page 3 of 4

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Matter of: Case Number:

I/We ask the court for an order and judgment from the court declaring

________________________________________________ (child’s name) free from the custody and control of

________________________________________________ (name of parent(s)) and for such other relief as the

court may deem proper.

If a lawyer is representing you in this case, he or she must sign here:

SIGN

Date: (Type or print attorney name) (Signature of Attorney for Petitioner)

I declare under penalty of perjury under the laws of the State of California that the information on this form and all the attachments is true and correct to my knowledge. That means that if I lie on this form, I am guilty of a crime. SIGN

Date: (Signature of Petitioner)

SIGN

Date: (Signature of Petitioner)

Optional Form PETITION FOR FREEDOM Fam. Code §7800 et seq. SC-4037 [New July 1, 2020] FROM PARENTAL CUSTODY AND CONTROL Page 4 of 4

Exceptions & meaning →

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Matter of: Case Number:

ATTACHMENT 5e

Tell the court about the nature and extent of the relationship between (1) the child and the birth parent; (2) the child and the guardian, including family members of the guardian; and (3) the child and any siblings or half-siblings.