GC-120 Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA)

Source: https://www.courts.ca.gov/documents/gc120.pdf

FL-105/GC-120 ATTORNEY OR PARTY WITHOUT ATTORNEY STATE BAR NUMBER: FOR COURT USE ONLY NAME: FIRM NAME: STREET ADDRESS: CITY: STATE: ZIP CODE: TELEPHONE NO.: FAX NO.: EMAIL ADDRESS: ATTORNEY FOR (name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: (This section applies to cases other than probate guardianships.) PETITIONER: RESPONDENT:

OTHER PARTY: CHILD'S NAME (Juvenile cases only): (This section applies only to probate guardianship cases.) CASE NUMBER: GUARDIANSHIP OF (name): Minor DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA)

1. I am (check one): a party to this proceeding to determine custody of a child the authorized representative of the agency, which is a party to this proceeding to determine custody of a child.
2. There are (specify number): minor children who are subject to this proceeding, as follows (list oldest child first): Full Name Date of birth Place of birth (city and state) a. b. c. d. Check this box if you need to list more children. (On form MC-020 or a separate piece of paper, write "FL-105, Attachment 2, Additional Children" at the top, provide all requested information for each additional child, and attach to this form.)
3. a. Check this box if there is only one child or if all of the children listed in item 2 have lived together for the past five years. (Provide the current address of the child listed in item 2a and their residence history for the past five years. If the current address is confidential under Family Code section 3429, check the box and provide only the state of residence.) Dates of residence Residence Person child lived with and Relationship (Month/Year) (City, State) complete current address From: To present Confidential (list state only) Confidential (list state only) From: To: From: To: From: To: From: To:

Additional addresses are listed on Attachment 3a. (Form MC-020 may be used for this purpose.) b. Check this box if there is more than one child and all the children have not lived together for the past five years. (Attach form FL-105(A)/GC-120(A) and list each other child's current address and their residence history for the past five years.)

Form Adopted for Mandatory Judicial Council of California Use DECLARATION UNDER UNIFORM CHILD CUSTODY ProbateFamilyCode,Code,§§§ 1510(f),3400 et 1512seq.; FL-105/GC-120 [Rev. January 1, 2025] JURISDICTION AND ENFORCEMENT ACT (UCCJEA) www.courts.ca.gov

FL-105/GC-120 CASE NAME: CASE NUMBER:

4. Do you have information about, or have you participated as a party or as a witness or in some other capacity in, another court case or custody or visitation proceeding, in California or elsewhere, concerning a child subject to this proceeding? Yes No (If yes, attach a copy of the orders if you have one and provide the following information): Court Court order Your Proceeding Case number (name, state or tribe, or judgment Name of each child connection to Case status location) (date) the case

   a. Family

   Probate b. Guardianship

   c. Other

   Proceeding Case Number Court (name, state or tribe, location)

   d. Juvenile

   e. Adoption

5. One or more domestic violence restraining/protective orders are now in effect. (Attach a copy of the orders if you have one
   and provide the following information):

   Court County State or Tribe Case Number (if known) Orders expire (date)

   a. Criminal

   b. Family

   c. Juvenile

   d. Other

6. Do you know of any person who is not a party to this proceeding who has physical custody of or claims to have rights to custody of or visitation with any child in this case? Yes No (If yes, provide the following information): a. Name and address of person: b. Name and address of person: c. Name and address of person:

   Has physical custody Has physical custody Has physical custody
   Claims custody rights Claims custody rights Claims custody rights
   Claims visitation rights Claims visitation rights Claims visitation rights

Name of each child: Name of each child: Name of each child:

7. Number of pages attached:

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

(NAME OF DECLARANT) (SIGNATURE OF DECLARANT)

NOTICE TO DECLARANT: You have a continuing duty to inform this court if you obtain any information about a custody proceeding in a California court or any other court concerning a child subject to this proceeding. FL-105/GC-120 [Rev. January 1, 2025] DECLARATION UNDER UNIFORM CHILD CUSTODY Page 2 of 2 JURISDICTION AND ENFORCEMENT ACT (UCCJEA) For your protection and privacy, please press the Clear This Form button after you have printed the form. Print this form Save this form Clear this form