San Bernardino — SB-9007

Source: https://sanbernardino.courts.ca.gov/system/files/sb-9007.pdf

PARTY WITHOUT ATTORNEY OR ATTORNEY STATE BAR NUMBER: FOR COURT USE ONLY

NAME:

FIRM NAME:

STREET ADDRESS:

CITY: STATE: ZIP CODE:

TELEPHONE NO: FAX NO:

E-MAIL ADDRESS:

ATTONREY FOR (name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

IN THE MATTER OF ADOPTION PETITION OF:

CASE NUMBER:

Affidavit / Certificate / Declaration

Re: Military Service in an Adoption and Related Matters

Name of Citee: _____________________________________________ Aliases of Citee: ____________________________________________ ____________________________________________

Please complete the following questions regarding the above named Citee.

State of California, County of San Bernardino

I, ________________________________________________ say: (Your Name) I am a party to this proceeding I am not a party to this proceeding. I reside at: ___________________________________________________________________ My occupation is: ______________________________________________________________

1. I personally know the citee Do not know the citee.
2. I have known said citee: ______ years months.
3. The last known address of said citee is:__________________________________
_________________________________________
4. The approximate age of the said citee is: .
5. The last date I saw the said citee was: .
6. The occupation of said citee is: __________________________________________________
7. The name of said citee’s employer is: _____________________________________________
8. The last know physical incapacity of said citee is:______________
___________________________________________________________________________

SB-9007 Rev. 10-2019 Optional

9. I know the citee is or is not (check below) an active duty member of the following military service branch: a. is or is not --- Army of the United States b. is or is not --- United States Navy c. is or is not --- United States Marine Corps d. is or is not --- United States Coast Guard e. is or is not --- United States Air Force f. Other: _________________________________
10. Known facts tending to show that said citee is not in the Military service: _________________ ___________________________________________________________________________ ------------------------------------------------------------------

This form is designed for use either as an affidavit or an unsworn statement made under penalty of perjury. a. If an affidavit, should sign where indicated below. b. If an unsworn statement, they should sign where indicated below.

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AFFIDAVIT Declaration is to be signed only if declarant is within the State of California.

Signature of Affiant: ___________________________________SIGN Dated: _________________ Subscribed and sworn to before me on ____________________________________

____________________________________SIGN Signature of Notary Public in and for the Notary Seal County of ______________, State of California

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UNSWORN STATEMENT Declaration I certify or declare under penalty of perjury that the foregoing it true and correct.

Signature of Declarant: __________________________________SIGN Executed at _______________________ on: _________________

Disclaimer: “Any person who shall make or use an affidavit or declaration required under this section knowing it to be false shall be guilty of a misdemeanor and shall be punishable by imprisonment not to exceed one year or by fine not to exceed $1,000 or both.” Soldiers’ and Sailors’ Civil Relief Act of 1940, as amended

SB-9007 Rev. 10-2019 Optional