State statute
Placer — Non-Professional Visitation Monitor Declaration of Qualifications
California foreclosure, tax-defaulted, court-ordered and probate-sale law and official procedures — verbatim and citable.
- Edition
- 2026-09-26
- Last updated
- 2026-09-27
- Jurisdiction
- Placer County
Placer — Non-Professional Visitation Monitor Declaration of Qualifications¶
Page 1¶
SUPERIOR COURT OF THE STATE OF CALIFORNIA, COUNTY OF PLACER ATTORNEY OR UNREPRESENTED PARTY FOR COURT USE ONLY (Name, State Bar Number, and Address):
TELEPHONE NO.:
EMAIL ADDRESS (Optional):
ATTORNEY FOR (Name): Superior Court of California, County of Placer 10820 Justice Center Drive 2501 N. Lake Blvd. P. O. Box 619072 P.O. Box 5669 Roseville, CA 95661-9072 Tahoe City, CA 96145 Petitioner/Plaintiff:
Respondent/Defendant: NON-PROFESSIONAL VISITATION MONITOR DECLARATION OF CASE NUMBER: QUALIFICATIONS
In accordance with section 5.20(c)(1) and (g) of the California Standards of Judicial Administration, I hereby personally acknowledge and declare:
Initials
_______ 1. I am 21 years of age or older.
_______ 2. I have no convictions for driving under the influence (DUI) within the last 5 years.
_______ 3. I have not been on probation or parole for the last 10 years.
_______ 4. I have no record of a conviction for child molestation, child abuse, or other crimes against a person.
_______ 5. I have a current valid driver’s license and proof of automobile insurance (if transporting children).
_______ 6. I have no civil, criminal, or juvenile restraining orders issued within the last 10 years.
_______ 7. I have no current or past court order in which I am the person being supervised.
_______ 8. I am not financially dependent on the person being supervised.
_______ 9. I am not an employee of the person being supervised.
_______ 10. I am not an employee of or affiliated with the Placer Superior Court, unless my employment contract specifically permits me to be a non-professional monitor.
_______ 11. I am not in an intimate relationship with the person being supervised.
_______ 12. I agree to adhere to and enforce the court order regarding supervised visitation.
_______ 13. I have read and understand the handbook entitled “A Guide for the Non-Professional Provider of Supervised Visitation” and agree to abide by it when supervising visits.
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
Form Adopted for Optional Use www.placer.courts.ca.gov Superior Court of California, County of Placer Form No. PL-FCS005 Effective 08-12-2013