Monterey — CI-130

Source: https://www.monterey.courts.ca.gov/system/files/ci-130.pdf

CI-130   ATTORNEY OR PARTY WITHOUT ATTORNEY FOR COURT USE ONLY

NAME: STATE BAR NO:

FIRM NAME:

ADDRESS:

CITY: STATE: ZIP CODE:

E-MAIL ADDRESS (OPTIONAL): TELEPHONE NO:

ATTORNEY FOR (NAME): FAX NO. (OPTIONAL): SUPERIOR COURT OF CALIFORNIA, COUNTY OF MONTEREY Monterey Division -1200 Aguajito Road, Monterey, California 93940

PLAINTIFF/PETITIONER:

DEFENDANT/RESPONDENT: CASE NUMBER: CONFIDENTIAL DECLARATION REGARDING HOUSEHOLD MEMBERS

I, , declare:

I am the Petitioner and proposed guardian in this proceeding. The members of my household who are sixteen years of age or older are as follows:

Name of Person Date of Birth Social Security Number Driver License Number

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on (date) at (city) , California.

Type or Print Name Signature of Declarant

Form Approved for Mandatory Use CONFIDENTIAL DECLARATION REGARDING Monterey County Superior Court CI-130 New. September, 2013 HOUSEHOLD MEMBERS (CIVIL)