Fresno — Entry of Default

Source: https://www.fresno.courts.ca.gov/system/files/forms-and-filings/entry-default.pdf

Sparse pages use OCR; original PDF remains authoritative.

How to Request Entry of Default WHEN TO USE THIS PACKET: These forms can be used to ask the court to enter the default in a Dissolution, Legal Separation, or Nullity case. If this is a Dissolution, Legal Separation or Nullity and you have served the other party with a: Summons, Petition, Declaration of Disclosure, Schedule of Assets and Debts and an Income and Expense Declaration and they HAVE NOT filed a Response within 30 days of service; you may ask for an Entry of Default. Please note if the other party is currently in the military, special rules may apply. The other party (respondent) may file a Response at any time before a default is entered — Even after 30 days have passed. Once the default is submitted and entered by the court the other party may no longer file a Response. STEPS TO FILE:

1. The following forms in this packet are to be completed. NOTE: The form with a () sign Only needs to be filled out if you have minor children from this relationship. C FL-165 Request to Enter Default (1FL-155 Financial Statement C) FL-160 Property Declaration () FL-141 Declaration Regarding Service of Declaration of Disclosure
2. The original forms and one (1) copy of all your forms must be submitted to the court for filing. The original will be for the court and the copy will be for the other party (respondent).
3. You MUST attach one (1) stamped envelope (addressed to the other party’s attorney or, if none, the other party’s last known address), once the default is filed, the clerk will mail the filed stamped copy to the other party. The Entry of Default is not a judgment. You must follow through and obtain a final judgment. Obtaining a judgment requires you to complete additional forms that are available as a separate packet. Revised 7/2/2025

FL-165 PARTY WITHOUT ATTORNEY OR ATTORNEY STATE BAR NUMBER: FOR COURT USE ONLY NAME YOUR NAME FIRM NAME YOUR ADDRESS SAM PLE a. ICITY, STATE, ZIP CODE CITY: , ? iP COPE: reverronewo. [YOUR TELEPHONE NUMBER ON LY EMAIL ADDRESS: DO NOT WRITE ON THIS COPY! ATTORNEY FOR fname}: SUPERIOR CGURT OF CALIFORNIA, COUNTY OF | FRESNO | snincaneess [2130 “O" Street cirvanozecove. |Fresno, CA 93724-2201 BRANCHNAME: | Central Division PETITIONER: | PARTY WHO INTIALLY OPENED CASE RESPONDENT: THE OTHER PARTY REQUEST TO ENTER DEFAULT ‘CASE NUMBER:

|couRT CASE NUMBER |

1. To the clerk: Please enter the default of the respondent who has failed to respond to the petition. A completed Income and Expense Decfaration (form FL-150) or Financial Statement (Simplified) (form FL-155) isattached [] isnotattached. Jar is atlached, is not attached if a completed Property Deciaration (form FL-160) is not attached, check at least one of the following boxes to indicate the reason: a. [__| There have been no changes since the previous filing. [-] The issues subject to disposition by the court in this proceeding are the subject of a written agreement. [J There are no issues of child, spousal, or partner support or attomey fees and costs subject to determination by the court, [7] The petition does not request money, property, costs, or attomey fees. (5 There are no issues of division of community property. [7 This is an action to establish parental retationship. Date: | TODAY'S DATE PRINT YOUR NAME > (TYPE GR PRINT NAME} moans SIGN YOUR NAME (SIGNATURE OF [ATTORNEY FOR] PETITIONER}
2. Deciaration a. [] No mailing is required because service was by publication or posting and the address of the respondent remains unknown. b. [] A copy of this Request fo Enter Default, including any attachments and an envelope with sufficient postage, was provided to the court clerk, with the envelope addressed as follows (address of the respondent’s attomey or, if none, the respondent's last known address):

| declare under penatty of perjury under the laws of the State of California that the foregoing is true and correct.

Date: TODAY'S DATE SIGN YOUR NAME [PRINT YOUR NAME | > {SIGNATURE OF DECLARANT} (TYPE OR PRINT NAME) FOR COURT USE ONLY (-] Request to Enter Defauit maited to the respondent or the respondent's attomey on (date): [-} Default entered as requested on (date): [J Defautt net entered. Reason: Clerk, by , Deputy Page 1 0f2 REQUEST TO ENTER DEFAULT Py Cade GE TD a 2985 {Family Law—Uniform Parentage) souts.ca.sey. Form Adopted for Mandatory Use Judicial Coureit of Caifor:a FLAGS fRew. duly 1, 2025] Form FL-165 Instructions

(ed EE | ee Check whether an Income and Expense Declaration (FL-150) or Simplified Financial Statement(FL-155) IS ATTACHED or IS NOT ATTACHED. NOTE: If you have children from this relationship, you MUST ATTACH an Income and Expense Declaration or a Simplified Financial Statement if there is no written agreement. Check whether a Property Declaration IS ATTACHED or IS NOT ATTACHED. NOTE: If you checked box 10 (b) on your dissolution petition (FL-100), you MUST attach a property Declaration (FL-160) if there is no written agreement and select the is 5 1 87 1 6 5 1461 1162 98 19 93.073196 attached 5 1 87 1 6 6 1569 1161 7 7 92.288940 box. Select any boxes that apply [(a)- (f) ]. If there are no children from this marriage and no property, you do not need to attach an Income and Expense Declaration (FL-150) or Financial Statement or Property Declaration (FL-155) - just check boxes (c), (d), and (e). Check box 4(b) and write the respondent's name and address.

PeTiTioNeR [PARTY WHO INTIALLY OPENED CASE _| CASE NUMBER RESPONDENT: [THE OTHER PARTY 1 [COURT CASE NUMBER _| 5. Memorandum of costs

& Cosis and disbursements are waived. Form FL-165 Instructions ib. Costs and disbursements are listed as follows: (1) ] Clerk's fees $ Check box Sa. (2) _] Process server's fees $ (3) [J Other (specty): 5 ~ $ DO NOT check any of the boxes 5 in 5b. s If the other party is NOT in the TOTAL $ c. fam the atforney, agent, or party who claims these costs. To the best of my knowledge and belief, the foregoing items of cost are correct and have been necessarily incurred in this cause or proceeding.

| declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct,

PRINT YOUR NAME > (TYPE OR PRINT NAME) [SIGN YOUR NAME {SIGNATURE OF DECLARANT) f

|6 Declaration of nonmilitary status (required for a judgment}

The respondent is not in the military service of the United States as defined by either the Servicemembers Civil Relief Act (see 50 U.S.C. § 3911(2)} or Califomia Military and Veterans Code sections 400 and 402(f).

| know that the respondent is not in the U.S. military service because (check ail that apply):

a. [] the search results that | received from scra.dmdc osd mil/ say the respondent is not in the U.S. military service. b. [-_] | am in regular communication with the respondent and know that they are not in the U_S. military service. c. [] I recently contacted the respondent, and they told me that they are not in the U_S. military service d. [] | know that the respondent was discharged from U.S. military service on or about (date): e. [] the respondent is not eligibte to serve in the U.S. military because they are incarcerated (in jail or prison). f [J other (specify) Note

• if the respondent is in the military service, or their military status is unknown, the respondent is entitled to certain rights and protections under federal and state law before a default judgment can be entered.
• For more information, see selfhelp.couris.ca.gow/military-defautts. If the other party is in the military DO NOT date, print, and sign under section 6. If the respondent is in the active Date: TODAY'S DATE PRINT YOUR NAME > (TYPE OR PRINT NAME} rT | declare under penaity of perjury under the laws of the State of Califomia that the foregoing is true and correct. SIGN YOUR NAME {SIGNATURE OF DECLARANT) FL-166 Rew, daly 1, 2025] REQUEST TO ENTER DEFAULT (Family Law—Uniform Parentage} Page 20f2 military, check all the boxes that apply (a-f) under section 6. ~ Date, print your name, and sign under section 6. military, a default CANNOT be entered against him/her simply by filing these forms. Seek legal advice. .

x DO NOT USE tis rorm ror: Spousal Support, Attorney Fees or if you are self-employed. Read the INSTRUCTIONS on page 2 of the actual form to make sure you qualify to use this form. CITY, STATE, ZIP CODE | YOUR TELEPHONE NUMBER | ATTORNEY FOR (Name) i OT SUPERIOR COURT OF CALIFORNIA, COUNTY OF|FRESNO _| street aporess 11130 O Street MAILING ADDRESS: | Fresno, CA 93724-2201 CITY AND ZIP CODE: eee Central Division ONLY DO NOT FL-155 [ vow nove anaes cca cane ania TELEPHONENO | FOR COURT USE ONLY YOUR NAME YOUR ADDRESS SAMPLE WRITE ON Form FL-155 Instructions

Read and follow the INSTRUCTIONS section carefully. There is nothing to fill out, but there is information there that will help you. Eligible means allowed. Check 1.a., if you are receiving TANF, SSI, or GA/GR and this is the ONLY money you get. If you check this box, skip to item 6. Check 1.b., if you have applied for TANF, SSI, or GA/GR, but not getting money yet. BRANCH NAME- j PETITIONER/PLAINTIFF: {PARTY WHO INITIALLY OPENED CASE | TH IS co Py! RESPONDENT/DEFENDANT: THE OTHER PARTY | OTHER PARENT: | FINANCIAL STATEMENT (SIMPLIFIED) | cOURT CASE NUMBER

| NOTICE: Read page 2 to find out if you qualify to use this form and how to use it. |

1 ies a. Kc) My only source of income is TANF, SSI, or GA/GR. [BLT Thave applied for TANF. SSI_or GA/GR: | 2 | 2. | am the parent of the following number of natural or adopted children from this relationship

|

Item 2., enter the number of children born or adopted by you and the other party. 3. a. The children from this relationship are with me this amount of time ............. b. The children from this relationship are with the other parent this amount of time L a a c. Our arrangement for custody and visitation is (specify. using extra sheet if necessary): EA. My tax filing status is: (C) single (2) married filing jointly (2) head of household (] married filing separately. Item 3. a. & 3. b., write in the percentage of time you are with the child(ren) and the percentage of time the other parent is with them. EXAMPLE: Children are with you about 70% of the time and with the other parent about 7. C) There are (specify number) that | pay are ‘other minor children of mine living with me. Their monthly expenses Ez —_an 2 T spend the following average monthly amounts (please attach proof) : a. (.) Job-related expenses that are not paid by my employer (specify reasons for expenses on separate sheet) S. b. () Required union dues $ Ea c. Co) Required retirement payments (not social security, FICA, 401k or IRA) So d. () Health insurance costs go — e. Q Child support | am paying for other minor children of mine who are not living with me go {. (2) Spousal support | am paying because of a court order for another relationship { g. LJ Monthly housing costs: (C] rentor (C) mortgage S$ If mortgage: interest payments S eal property taxes S. 9. Information conceming LJ my current employment L_J my most recent employment. Employer: Address: Telephone number: | 10 | My occupation: Date work started: Date work stopped (if applicable) : What was your gross income (before taxes) before work stopped?: age tot2 Form Aporoved for FINANCIAL STATEMENT (SIMPLIFIED) Family Code, § 40680) Seesa as CEB Essential eco Ber 5. My current gross income (before faxes) per month is y 30% of the time. Attach 1 This income comes from the following: copy of pay [_]] Salary/wages: Amount before taxes per month So stubs for (C) Retirement: Amount before taxes per month test 2 (2] Unemployment compensation: Amount per month g- Item 4, check the box that tells how you months here Q) Workers’ compensation: Amount per month cOE_E—— . (cross out CJ Socialsecurity: (2) Ssi (2) Other Amount per month ss currently file your taxes. social (} Disability: Amount per month So security (] Interest income (from bank accounts or other): Amount per month. gS L.tumbers)_| have no income other than as stated in this paragraph 6. Tpay the following monthly expenses for the children in this case: a. () Day care or preschool to allow me to work or go to school So Item 5, list the amount of money you get b. CQ) Health care not paid for by insurance s— iy each month before taxes are taken out. c. L) School, education, tuition, or other special needs of the child = Then check the boxes where the money d. (2) Travel expenses for visitation So comes from and write each amount. When you add these amounts, the number should be the same as what you wrote for your total monthly income. Item 6, check all boxes that apply to you, and list the amount of each of these expenses. Item 7, specify the number of other children under age 18 living with you, who are not part of this case. Then list the amount of money you spend each month on them. Item 8, check all boxes that apply to you. List the average amount of money you spend each month on these items. Attach proof that you make these payments (statements, bills, invoices, etc.) Item 9, check the first box if you currently have a job or the second box if you are currently not working. Give the name, address and phone number of your current employer, or your most recent employer. Occupation means your job title( Example: mechanic). Write the date you started this job and /or stopped & what your income was.

| PETTIONERIPLAINTIFE: PARTY WHO INITIALLY OPENED CASE aS NER

— RESPONDENT/DEFENDANT| THE OTHER PARTY COURT CASE NUMBER.

| OTHER PARENT.

10. My estimate of the other party's gross monthly income (before taxes) is
11. My current spouse's monthly income (before taxes) is S_. —
12. Other information | want the court to know concerning child support in my case (attach extra sheet with the information). 13.) tam attaching a copy of page 3 of form FL-150. income and Expense Declaration showing my expenses.

| declare under penalty of perjury under the laws of the State of California that the information contained on all pages of this form and

any attachments is true and correct. Date: [TODAY'S DATE SIGN YOUR NAME Form FL-155 Instructions

SRATURE OF DECRANT) (C) eermonerevanmier (CO) resronventiverennant PRINT YOUR NAME 7 7 INSTRUCTIONS Step 1: Are you eligible to use this form? /f your answer is YES to any of the following questions, you may NOT use this form: @ Are you asking for spousal support (alimony) or a change in spousal support? ®@ \s your spouse or former spouse asking for spousal support (alimony) or a change in spousal support? @ Are you asking the other party to pay your attorney fees? @ is the other party asking you to pay his or her attomey fees? @ Do you receive money (income) from any source ather than the following? @ Welfare (such as TANF, GR, or GA) © Interest ® Salary or wages @ Workers’ compensation © Disability ® Social security @ Unemployment @ Retirement @ Are you self-employed? If you are eligible to use this form and choose to do so, you do not need to complete the Income and Expense Declaration (form FL-150). Even if you are eligible to use this form, you may choose instead to use the Income and Expense Declaration (form FL-150). Step 2: Make 2 copies of each of your pay stubs for the last two months. If you received money from other than wages or salary. include copies of the pay stub received with that money. Privacy notice: !f you wish, you may cross out your social security number if it appears on the pay stub, other payment notice or your tax return Step 3: Make 2 copies of your most recent federal income tax form. Step 4: Complete this form with the required information. Type the form if possible or complete it neatly and clearly in black ink. If you need additional room, please use plain or lined paper, 8%-by-11", and staple to this form Step 5: Make 2 copies of each side of this completed form and any attached pages. Step 6: Serve a copy on the other party. Have someone other than yourself mail to the attorney for the other party, the other party, and the local child support agency, if they are handling the case, 1 copy of this form, 1 copy of each of your stubs for the last two months, and 1 copy of your most recent federal income tax return. Step 7: File the original with the court. Staple this form with 1 copy of each of your pay stubs for the last two months. Take this document and give it to the clerk of the court. Check with your local court about how to submit your return. Step 8: Keep the remaining copies of the documents for your file. Step 9: Take the copy of your latest federal income tax return to the court hearing. It is very important that you attend the hearings scheduled for this case. If you do not attend a hearing, the court may make an order without considering the information you want the court to consider. Item 10 & 11, enter the total amount of money you think the other party makes in a month before taxes are taken out. If you have remarried, write your current spouse's income(before taxes). Item 13,If you want the court to know what your expenses are, you can attach page 3 of form FL-150. FL-185 [Rev. January 1. 2004} FINANCIAL STATEMENT (SIMPLIFIED)

If you have something else you want the court to know about your case, write it down on another piece of paper and attach it to this form. Y~ Make sure to attach check stubs for the last 2 months. Cross out your social security number.

FL-160 STATE 848 NO PARTY WITHOUT ATTORNEY OR ATTORNEY mie [YOUR NAME BS" YOUR ADDRESS

| STREET

eay CITY, STATE, ZIP CODE

| Tasso YOUR TELEPHONE NUMBER

ZP CODE

| EMAL | ATTORNEY FOR inams)

NOTE: This form must be used if you marked box 10b on the Divorce Petition(FL-100) and do not have a Marital Settlement Agreement.

| SUPERIOR COURT OF CALIFORNIA, COUNTY OF [FRESNO _|

srreer D0%€ss{1130 O Street MENG ASSESS! Fresno, CA 93724-2201 CITY AND ZP COE] wae Central Division i PETITIONER PARTY WHO INITIALLY OPENED CASE If you do not have community property and did not mark box 10b on the RESPONDENT:| THE OTHER PARTY OTHER PARENT/PAR —— ] PETITIONER'S | [_] RESPONDENT'S

| COMMUNITY AND GUASI-COMMUNITY PROPERTY DECLARATION

1's Divorce Petition, you do NOT need to complete this form. (] SEPARATE PROPERTY DECLARATION CASE NUMBER: COURT CASE NUMBER See Instructions on page 4 for information about completing this form. For additional space, use Continuation of Property Declaration (form FL-161). A B c ; D = E F GROSS FAIR NET FAIR | |PROPOSAL FOR DIVISION ITEM BRIEF DESCRIPTION DATE MARKET ||} AMOUNT MARKET Award or Confirm to: NO. ACQUIRED VALUE OF DEBT VALUE | PETITIONER RESPONDENT}

1. REALESTATE Example: list all real estate (land, buildings), including addresses and attach copies of deeds, etc.
2. HOUSEHOLD FURNITURE, FURNISHINGS, APPLIANCES. Example: sofas, lamps, televisions, computers, etc.
3. JEWELRY, ANTIQUES, ART, COIN COLLECTIONS, etc. Example: these should be appraised (given a dollar value by someone in that business)
4. VEHICLES. BOATS, TRAILERS Example: List all vehicles such as cars, motorcycles, boats, and trailers. Attach copies of documents that show ‘ownership, such as DMV registration, ete.
5. SAVINGS ACCOUNTS
6. CHECKING ACCOUNTS (4 a S| Page tof 4 Woektosu atacand” CEB! Essential PROPERTY DECLARATION FL-16) Rev July 1. 2015} oan (Family Law) Family Code, §§ 115, 2104, 2500-2560 mew. cOurts.c2.gOY Form FL-160 Instructions

[check the PETITIONER'S box. Check the COMMUNITY 5 1 93 1 1 4 1491 521 43 16 92.399635 AND 5 1 93 1 1 5 1542 521 70 18 91.667297 QUASI- 4 1 93 1 2 0 1238 551 241 17 -1 5 1 93 1 2 1 1238 552 134 16 95.967697 COMMUNITY 5 1 93 1 2 2 1380 551 99 17 96.431480 PROPERTY 4 1 93 1 3 0 1239 580 197 18 -1 5 1 93 1 3 1 1239 580 151 18 96.753563 DECLARATION box. Column A: Write each item in its appropriate category (1-6) listed, if you have such items. If you need more space, attach FL-161 and number the item the same number as the item (1-16) that you need more Column B: Enter the date (MM/DD/ YYYY) the item was acquired. Column C: For each category (1-6)that you list property, you must list the GROSS FAIR MARKET VALUE (an estimate of the amount of money you could get if you sold the item to another person through an - advertisement) of that item. Column D: For each item listed, you must list the AMOUNT OF DEBT (amount owed) on that item. Column E: List the GROSS MARKET FAIR VALUE (C), deduct the AMOUNT OF DEBT (D) on that item. This gives you the NET FAIR MARKET VALUE(E). Example: C - D = E $400 $150 $250 Column F: Write the amount that each party is to be awarded as his/her share of that item(s) in column A. It is not a requirement that each item be divided equally; however, the division must be in equal amounts on the TOTALS (column F on page 2 of 4). Note: You may always assume more of the debt, but cannot assign more of the debt to the other party, unless a Marital Settlement Agreement is submitted with the judgment.

SURRENDER OR LOAN VALUE 11. STOCKS, BONDS, SECURED NOTES, MUTUAL FUNDS 12. RETIREMENT AND PENSIONS 13. PROFIT-SHARING, IRAS DEFERRED COMPENSATION, ANNUITIES 14. ACCOUNTS RECEIVABLE, UNSECURED NOTES 15. PARTNERSHIP, OTHER BUSINESS INTERESTS 16. OTHER ASSETS 17. ASSETS FROM CONTINUATION SHEET

| 18. TOTAL ASSETS

FL-160 [Rev. Juy 1, 2018] GB orm PROPERTY DECLARATION (Family Law) FL-160 A B Cc a) =| OE F pate _ [GROSS FAIR NET FAIR | PROPOSAL FOR DIVISION ITEM BRIEF DESCRIPTION aAcauineo | MARKET || AMOUNT | |] MARKET Award or Confirm to NO. ; __|_VALUE |} OF DEBT VALUE _| PETITIONER RESPONDENT| 7. CREDIT UNION, OTHER 19] | id 44) 12] DEPOSITORY ACCOUNTS 8. CASH 9. TAX REFUND 10. LIFE INSURANCE WITH CASH

Form FL-160 Instructions

Column A: Write each item in its appropriate category (7-16) listed on this form, if you have such items. If you need more space, attach FL-161 and number the item the same number as the item (1-16) that you need more space for. Column B: Enter the date (MM/DD/ YYYY) the item was acquired. Column C: For each category (1-17) that you list property, you must list the GROSS FAIR MARKET VALUE of that item. Column D: For each item listed, you must list the AMOUNT OF DEBT on that item. Column E: From the GROSS FAIR MARKET VALUE (C), deduct the AMOUNT DEBT OWED (D) on that item. This gives you the NET FAIR MARKET VALUE (E). Example: C - D = E $400 $150 $250 Column F: Write the amount each party is to be awarded as his/her share of that item. Item #17: If you used the FL-161, add all amounts and list them in the proper columns (C, D, E, & F). Enter the total of all the numbers in the GROSS FAIR MARKET VALUE (C) column from pages 1-2. Enter the total of all the numbers in the AMOUNT OF DEBT (D)column from pages 1-2. Enter the total of all the numbers in the NET FAIR MARKET VALUE (E) column from pages 1-2. Enter the total of all the numbers in the PROPOSAL FOR DIVISION Award or Confirm to: (F) column and total for each the PETITIONER and RESPONDENT from pages 1-2.

25. OTHER DEBTS FROM CONTINUATION SHEET FL-160 A B c D Z 19) - ~_ PROPOSAL FOR DIVISION ITE! DEBTS - DATE INCURRED | TOTAL OWING Award or Confirm to: NO SHOW TO WHOM OWED PETITIONER RESPONDENT
26. STUDENT LOANS | 20 | iS | 24 | oF
27. TAXES
28. SUPPORT ARREARAGES
29. LOANS-UNSECURED
30. CREDIT CARDS |
31. OTHER DEBTS

| |

[26. TOTAL DEBTS 1 26 M@ 26 & EZjo A Continuation of Property Declaration (form FL-161) is attached and incorporated by reference.

| declare under penalty of perjury under the laws of the State of California that, to the best of my knowledge, the foregoing is a true

and cpsract listing of assets and obligations and the amounts shown are correct. Date| TODAY'S DATE Form FL-160 Instructions

Column A: Write each item in its appropriate category (19-24), if you have such items. If you need more space, attach FL-161 and number the item the same number as the item (19-25) that you need more space for. Column B: Enter the date (MM/DD/ YYYY) the item was acquired. Column C: for each item(19-24) listed, you must list the TOTAL OWING (amount of debt) on that item. Column D: Write the amount each party (PETITIONER and RESPONDENT) is to be awarded as his/her share of that item (19-25). Item #25: If you used the FL-161, add all amounts and list them in the proper columns (C, D). Check this box if you attached form FL-161. Enter the total of all the numbers in TOTAL OWING (C) column. Enter the total of all the numbers in the PROPOSAL FOR DIVISION Award or Confirm to: (D) column from pages 3 and enter the total for each the PETITIONER and RESPONDENT . [INFORMATION ONLY | PRINT YOUR NAME » SIGN YOUR NAME (Wee 0n PRINT NAME) SIGNATURE If you would like additional information and steps for this form, please see page 4. Must be attached Feta My 208 PROPERTY DECLARATION Paget still. GB Storms (Family Law)

FL-141

| ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address)

YOUR NAME | YOUR ADDRESS CITY, STATE, ZIP CODE |

| te.eeHone| YOUR TELEPHONE NUMBER ;.Ot~<“—sSSC‘

ONLY ATTORNEY FOR (Name). _ | DO N OT SUPERIOR COURT OF CALIFORNIA, COUNTY OF| FRESNO. | WRITE ON STREET ADDRESS. [4139 OQ Street THIS COPY! SAMPLE NANG 00% lEresno, CA 93724-2201 CITY AND ZIP CODE: eae arancu name. (Central Division PETITIONER] PARTY WHO INITIALLY OPENED CASE | RESPONDENTITHE OTHER PARTY ‘| OTHER PARENT/PARTY:" DECLARATION REGARDING SERVICE OF DECLARATION OF casewowaen [court CASE NUMBER Form FL-141 Instructions

DI: AND INCOME AND EXPENSE DECLARATION (CC) Petitioners (CC) Preliminary (2) Respondent's (CQ Final

1. lamthe (C] attorney for [(CJ petitioner [C) respondent _ in this nate: fy 4 | 2. Petitioner's Respondent's|Preliminary Declaration of Disclosure (form FL-140), current* Income and Expense Declaration (form FL-150), completed Schedule of Assets and Debts (form FL-142) or Community and Separate Property Declarations (form FL-160) with appropriate attachments, all tax returns filed by the party in the two years before service of the preliminary disclosures. and all other required information under Family Code section 2104 were served on: 5 | ] the other party () the other party's attorney|by personal service (} mail Check the box that identifies you as the Petitioner or the Respondent. [Check the Preliminary box. Check the box that identifies you as the Petitioner or Respondent in the case. Check the box that identifies you as the Petitioner or Respondent in the case. Note: The documents listed in number 2. are the ones you are confirming were given to the other party. Check the box that confirms who got served.
2. Cy Petitioners (J Respondent's Final Declaration of Disclosure (form FL-140). current* Income and Expense Declaration (form FL-150), completed Schedule of Assets and Debts (form FL-142) or Community or Separate Property Declarations (form 8 | FL-160) with attachments, and the material facts and information required by Family Code section 2105 were served on: (Co the other party (C] other party's attorney by (CJpersonal service (J mail () Other (specify): on (date): . LJ Senice of (J Petitioners “LJ Respondent's (LJ preliminary CT final {] current income and expense declaration has been waived as follows: aiver_[] was filed on (date): declaration of am 10 (21 is being fled at the same time as this “form. b. [J The party has failed to comply with disclosure requirements, and the court has granted the request for voluntary waiver of teceipt under Family Code section 2107 on (date): Ic. (J This is a default proceeding that does not include a stipulated judgment or settlement agreement. Petitioner waives final disclosure requirements under Family Code section 2110. “Current is defined as completed within the past three months providing no facts have changed. (Cal. Rules of Court, rule 5.260.) I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date-[TODAY'S DATE

SIGN YOUR NAME Check the box that confirms how the service was done. Note: personal service= the forms were personally delivered to the other party/other party's attorney. mail= the forms were mailed to the other party/ other party's attorney. Other(specify)= another method was used, make sure to describe in the space provided. Enter the date the forms listed under item 2. were served to the other party/other party's attorney. PRINT YOUR NAME SIGNATURE (TYPE OR PRINT NAME) NOTE: File this document with the court. Do not file a copy of the Preliminary or Final Declaration of Disclosure or any attachments to either declaration of disclosure with this document. Page fof t Fay Aor or Manat se DECLARATION REGARDING SERVICE OF DECLARATION OF Fay Cog, 212 218 Fitatiper uy) 2008) DISCLOSURE AND INCOME AND EXPENSE DECLARATION swe outs 08904 (eaty Essential (Family Law) cchcom [2)Forms: a ees ES eee ee Complete item 3. the same way as item 2. If this is a Default Judgment and you DO NOT havea written agreement with the other party, check the following boxes in item 4: Service 4 1 118 1 5 0 1267 1778 349 22 -1 5 1 118 1 5 1 1267 1778 35 21 94.952377 of; Respondent's; preliminary; “final declaration of disclosure; current income and expense declaration has been waived as follows:" and c If YOU HAVE a written agreement with the other party, check the appropriate boxes("Service of"; Petitioner's; Respondent's; preliminary; final 5 1 121 1 5 3 1474 2044 111 34 85.507599 declaration 5 1 121 1 5 4 1593 2059 20 18 95.559578 of 2 1 122 0 0 0 1577 2089 29 7 -1 3 1 122 1 0 0 1577 2089 29 7 -1 4 1 122 1 1 0 1577 2089 29 7 -1 5 1 122 1 1 1 1577 2089 29 7 48.257465 wan 2 1 123 0 0 0 1268 2090 329 22 -1 3 1 123 1 0 0 1268 2090 329 22 -1 4 1 123 1 1 0 1268 2090 329 22 -1 5 1 123 1 1 1 1268 2090 117 22 93.362381 disclosure) in item 4 and box a 2 1 124 0 0 0 1394 2056 26 25 -1 3 1 124 1 0 0 1394 2056 26 25 -1 4 1 124 1 1 0 1394 2056 26 25 -1 5 1 124 1 1 1 1394 2056 26 25 95.000000 2 1 125 0 0 0 1255 430 10 1690 -1 3 1 125 1 0 0 1255 430 10 1690 -1 4 1 125 1 1 0 1255 430 10 1690 -1 5 1 125 1 1 1 1255 430 10 1690 95.000000 2 1 126 0 0 0 1626 167 21 1952 -1 3 1 126 1 0 0 1626 167 21 1952 -1 4 1 126 1 1 0 1626 167 21 1952 -1 5 1 126 1 1 1 1626 167 21 1952 95.000000 2 1 127 0 0 0 1262 2116 375 4 -1 3 1 127 1 0 0 1262 2116 375 4 -1 4 1 127 1 1 0 1262 2116 375 4 -1 5 1 127 1 1 1 1262 2116 375 4 95.000000

FL-165 PARTY WITHOUT ATTORNEY OR ATTORNEY STATE BAR NUMBER’ NAME: FIRM NAME: STREET ADDRESS: CITY: TELEPHONE NO.: EMAIL ADDRESS: ATTORNEY FOR (name): STATE: FAX NO. ZIP CODE: FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PETITIONER: RESPONDENT: REQUEST TO ENTER DEFAULT CASE NUMBER:

1. To the clerk: Please enter the default of the respondent who has failed to respond to the petition.
2. Acompleted /ncome and Expense Declaration (form FL-150) or Financial Statement (Simplified) (form FL-155) [] is attached [__] is not attached.
3. Acompleted Property Declaration (form FL-160) [] is attached [1] is not attached If a completed Property Declaration (form FL-160) is not attached, check at least one of the following boxes to indicate the reason: a. [] There have been no changes since the previous filing. b. [] The issues subject to disposition by the court in this proceeding are the subject of a written agreement. c. [] There are no issues of child, spousal, or partner support or attorney fees and costs subject to determination by the court. d. [] The petition does not request money, property, costs, or attorney fees. e. [] There are no issues of division of community property. f. [{_] This is an action to establish parental relationship. Date: (TYPE OR PRINT NAME)
4. Declaration

(SIGNATURE OF [ATTORNEY FOR] PETITIONER) a. [] No mailing is required because service was by publication or posting and the address of the respondent remains unknown. b. [] A copy of this Request to Enter Default, including any attachments and an envelope with sufficient postage, was provided to the court clerk, with the envelope addressed as follows (address of the respondent's attorney or, if none, the respondent's last known address):

| 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 OF DECLARANT) [] Default entered as requested on (date): [] Default not entered. Reason: FOR COURT USE ONLY [-_] Request to Enter Default mailed to the respondent or the respondent's attorney on (date): Clerk, by , Deputy

Form Adopted for Mandatory Use Judicial Council of California FL-165 [Rev. July 1, 2025] REQUEST TO ENTER DEFAULT (Family Law—Uniform Parentage) Code of Civil Procedure, §§ 585, 587, Family Code, §§ 2330.5 and 2335.5 courts.ca.gov

PETITIONER: CASE NUMBER: RESPONDENT: 5. Memorandum of costs a. [] Costs and disbursements are waived. b. Costs and disbursements are listed as follows: (1) [7] Clerk's fees (2) [_] Process server's fees (3) [] Other (specify): TOTAL $s. c. |am the attorney, agent, or party who claims these costs. To the best of my knowledge and belief, the foregoing items of cost are correct and have been necessarily incurred in this cause or proceeding.

| 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 OF DECLARANT) 6. Declaration of nonmilitary status (required for a judgment). The respondent is not in the military service of the United States as defined by either the Servicemembers Civil Relief Act (see 50 U.S.C. § 3911(2)) or California Military and Veterans Code sections 400 and 402(f).

| know that the respondent is not in the U.S. military service because (check all that apply):

[] the search results that | received from scra.dmdc.osd.mil/ say the respondent is not in the U.S. military service. [-] | am in regular communication with the respondent and know that they are not in the U.S. military service. [-] | recently contacted the respondent, and they told me that they are not in the U.S. military service. [] | know that the respondent was discharged from U.S. military service on or about (date): [-] the respondent is not eligible to serve in the U.S. military because they are incarcerated (in jail or prison). [_] other (specify): ~9 29 5D Note

• U.S. military status can be checked online at scra.dmdc.osd.mil/.
• Ifthe respondent is in the military service, or their military status is unknown, the respondent is entitled to certain rights and protections under federal and state law before a default judgment can be entered.
• For more information, see selfhelp.courts.ca.gov/military-defaults .

| 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 OF DECLARANT) FL-165 (Rev. July 1, 2025] REQUEST TO ENTER DEFAULT Page 2 of 2 (Family Law—Uniform Parentage)

FL-155 ATTORNEY FOR Your name and address or attorney's name and address: TELEPHONE NO. FOR COURT USE ONLY (Name): CITY AND ZIP BRANCH SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS MAILING ADDRESS: CODE: NAME: PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT: CASE NUMBER: FINANCIAL STATEMENT (SIMPLIFIED) NOTICE: Read page 2 to find out if you qualify to use this form and how to use it.

1. a. My only source of income is TANF, SSI, or GA/GR. b. | have applied for TANF, SSI, or GA/GR.
2. |am the parent of the following number of natural or adopted children from this relationship .................. —___
3. a.The children from this relationship are with me this amount of time ......... 6.0 cece eee eet eee % b. The children from this relationship are with the other parent this amount of time .................000000008 OB c. Our arrangement for custody and visitation is (specify, using extra sheet if necessary):
4. My tax filing status is: || single | married filing jointly | head of household | married filing separately.
5. My current gross income (before taxes) permonthis ©... 1.1... cece cette enn eens go Attach 1 This income comes from the following: copy of pay Salary/wages: Amount before taxes per Month. .... 0... eee ee gS stubs for Retirement: Amount before taxes per month. ....... 0... ccc eee eee eee eens $ last 2 Unemployment compensation: Amount per month .o 0... eee eee eee $ months here Workers' compensation: Amount per month .......0.. cece cee ccc eee eee eee S$ (cross out Social security: [] SSI [—_] Other Amount permonth ............. 0.0.00. e eee So social Disability: Amount per month 2.0.0.0... cece eee eee eenaeeeeenaene nn eneees $ security [] Interest income ( from bank accounts or other): Amount per month ............-00 eee eee $ numbers) | have no income other than as stated in this paragraph.
6. | pay the following monthly expenses for the children in this case: a. [__] Day care or preschool to allow me to work or go to school . . ce eben eee vee & b. Health care not paid for by insurance ... 00... cent nett teen eee eens SO c. School, education, tuition, or other special needs of the child ........... 0.0 e eee eee S$ d. Travel expenses for visitation 20... tenet eee tenet teens $
7. CI There are (specify number) _____ other minor children of mine living with me. Their monthly expenses that | pay are ee eee tnt e tee e nett been eee eeees $
8. | spend the following average monthly amounts (please attach proof): e@meaooD Job-related expenses that are not paid by my employer (specify reasons for expenses on separate sheet) $ Required union dues 2.0.0.0... eee tenet teens S$ Required retirement payments (not social security, FICA, 401k or IRA) 2.0.0... ccc eee eee $ Health insurance costs ....... 00. cece nen e eee e eee eee e eee t teens $ Child support | am paying for other minor children of mine who are not living withme.................. S_ Spousal support | am paying because of a court order for another relationship....................0.. sO Monthly housing costs: CJ rent or CJ mortgage oo cece ete eee $ If mortgage: interest payments $. real property taxes §.
9. Information concerning [[_] my current employment [__] my most recent employment: Employer: Address: Telephone number: My occup ation: Date work started: Date work stopped (if applicable): What was your gross income (before taxes) before work stopped?:

ore Couel of Calforia FINANCIAL STATEMENT (SIMPLIFIED) Family Codo,§ 4068() FL-155 [Rev. January 1, 2004] www.courtinfo.ca. gov

PETITIONER/PLAINTIFF: CASE NUMBER

| RESPONDENT/DEFENDANT:

OTHER PARENT: 10. My estimate of the other party's gross monthly income (before taxes) iS. 60.06. ccc ccc ceeeee $ 11. My current spouse's monthly income (before taxes) iS. oo ec cece cust cuueeeeeeeeeeeees $ 12. Other information | want the court to know concerning child support in my case (attach extra sheet with the information). 13. CC) lam attaching a copy of page 3 of form FL-150, /ncome and Expense Declaration showing my expenses.

| declare under penalty of perjury under the laws of the State of California that the information contained on all pages of this form and

any attachments is true and correct. Date: (TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)

| PETITIONERPLAINTIFE [___] RESPONDENTIDEFENDANT

INSTRUCTIONS Step 1: Are you eligible to use this form? /f your answer is YES to any of the following questions, you may NOT use this form:

• Are you asking for spousal support (alimony) or a change in spousal support?

• Is your spouse or former spouse asking for spousal support (alimony) or a change in spousal support?

• Are you asking the other party to pay your attorney fees?
• Is the other party asking you to pay his or her attorney fees?
• Do you receive money (income) from any source other than the following?
• Welfare (such as TANF, GR, or GA) + Interest
• Salary or wages * Workers' compensation
• Disability * Social security
• Unemployment + Retirement
• Are you self-employed? If you are eligible to use this form and choose to do so, you do not need to complete the /ncome and Expense Declaration (form FL-150). Even if you are eligible to use this form, you may choose instead to use the /ncome and Expense Declaration (form FL-150). Step 2: Make 2 copies of each of your pay stubs for the last two months. If you received money from other than wages or salary, include copies of the pay stub received with that money. Privacy notice: If you wish, you may cross out your social security number if it appears on the pay stub, other payment notice or your tax return Step 3: Make 2 copies of your most recent federal income tax form. Step 4: Complete this form with the required information. Type the form if possible or complete it neatly and clearly in black ink. If you need additional room, please use plain or lined paper, 8’72-by-11", and staple to this form. Step 5: Make 2 copies of each side of this completed form and any attached pages. Step 6: Serve a copy on the other party. Have someone other than yourself mail to the attorney for the other party, the other party, and the local child support agency, if they are handling the case, 1 copy of this form, 1 copy of each of your stubs for the last two months, and 1 copy of your most recent federal income tax return. Step 7: File the original with the court. Staple this form with 1 copy of each of your pay stubs for the last two months. Take this document and give it to the clerk of the court. Check with your local court about how to submit your return. Step 8: Keep the remaining copies of the documents for your file. Step 9: Take the copy of your latest federal income tax return to the court hearing. It is very important that you attend the hearings scheduled for this case. If you do not attend a hearing, the court may make an order without considering the information you want the court to consider. FL-185 [Rev. January 1, 2004] FINANCIAL STATEMENT (SIMPLIFIED) Page 2 of 2

FL-160 PARTY WITHOUT ATTORNEY OR ATTORNEY STATE BAR NUMBER: NAME: FIRM NAME: STREET ADDRESS: CITY: STATE: ZIP CODE TELEPHONE NO. FAX NO. E-MAIL ADDRESS ATTORNEY FOR (name) SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS CITY AND ZIP CODE: BRANCH NAME: PETITIONER: RESPONDENT: OTHER PARENT/PARTY: [] PETITIONER'S [] RESPONDENT'S [__] SEPARATE PROPERTY DECLARATION [-{] COMMUNITY AND QUASI-COMMUNITY PROPERTY DECLARATION CASE NUMBER: (form FL-161). See Instructions on page 4 for information about completing this form. For additional space, use Continuation of Property Declaration A B Cc. D E F GROSS FAI NET FAIR ITEM _ BRIEF DESCRIPTION DATE MARKET Ry} AMOUNT MARKET PROPOSAL FOR DINISION NO. ACQUIRED | VALUE OF DEBT VALUE |PETITIONER RESPONDENT 7. REAL ESTATE $ $ $ $ 2. HOUSEHOLD FURNITURE, FURNISHINGS, APPLIANCES 3. JEWELRY, ANTIQUES, ART, COIN COLLECTIONS, etc. 4. VEHICLES, BOATS, TRAILERS 5. SAVINGS ACCOUNTS 6. CHECKING ACCOUNTS

Form Approved for Mandatory Use PROPERTY DECLARATION Family Code, §§ 115,2104, 2500-2660 Judicial Council of California 7 FL-160 (Rev. July 1, 2016] (Family Law) www.courts.ca.gov

FL-160 A B (o7 - D = E F ITEM _ BRIEF DESCRIPTION pate | SROSSFAIR| amount | NETFAIR | PROPOSAL FOR DIVISION NO ACQUIRED MARKET OF DEBT MARKET Award or Confirm to: ; VALUE VALUE _|PETITIONER RESPONDENT 7. CREDIT UNION, OTHER $ $ $ $ $ DEPOSITORY ACCOUNTS 8. CASH 9. TAX REFUND 10. LIFE INSURANCE WITH CASH SURRENDER OR LOAN VALUE 11. STOCKS, BONDS, SECURED NOTES, MUTUAL FUNDS 12. RETIREMENT AND PENSIONS 13. PROFIT-SHARING, IRAS, DEFERRED COMPENSATION, ANNUITIES 14. ACCOUNTS RECEIVABLE, UNSECURED NOTES 15. PARTNERSHIP, OTHER BUSINESS INTERESTS 16. OTHER ASSETS 17. ASSETS FROM CONTINUATION SHEET 18. TOTAL ASSETS FL-160 [Rev. July 1, 2016] PROPERTY DECLARATION Page 2 of 4 (Family Law)

FL-160 A B Cc D ITEM DEBTS— NO. SHOW TO WHOM OWED DATE INCURRED TOTAL OWING PROPOSAL FOR DIVISION Award or Confirm to: PETITIONER RESPONDENT 19. STUDENT LOANS 20. TAXES 21. SUPPORT ARREARAGES 22. LOANS—UNSECURED 23. CREDIT CARDS 24. OTHER DEBTS 25. OTHER DEBTS FROM CONTINUATION SHEET $ 26. TOTAL DEBTS [-_]A Continuation of Property Declaration (form FL-161) is attached and incorporated by reference.

| declare under penalty of perjury under the laws of the State of California that, to the best of my knowledge, the foregoing is a true

and correct listing of assets and obligations and the amounts shown are correct. Date: Y (TYPE OR PRINT NAME) SIGNATURE FL-160 (Rev. July 1, 2016] PROPERTY DECLARATION (Family Law)

FL-160 INFORMATION AND INSTRUCTIONS FOR COMPLETING FORM FL-160 Property Declaration (form FL-160) is a multipurpose form, which may be filed with the court as an attachment to a Petition or Response or served on the other party to comply with disclosure requirements in place of a Schedule of Assets and Debts (form FL-142). Courts may also require a party to file a Property Declaration as an attachment to a Request to Enter Default (form FL-165) or Judgment (form FL-180). When filing a Property Declaration with the court, do not include private financial documents listed below. Identify the type of declaration completed

1. Check Community 5 1 4 2 1 4 383 454 44 20 93.060104 and 5 1 4 2 1 5 438 454 217 26 92.438011 Quasi-Community 5 1 4 2 1 6 666 455 102 26 96.865410 Property 5 1 4 2 1 7 779 455 148 21 90.265106 Declaration on page 1 to use Property Declaration (form FL-160) to provide a combined list of community and quasi-community property assets and debts. Quasi-communhity property is property you own outside of California that would be community property if it were located in California.
2. Do not combine a separate property declaration with a community and quasi-community property declaration. Check Separate 5 1 5 1 2 2 269 607 101 26 97.001160 Property 5 1 5 1 2 3 382 607 146 21 95.487358 Declaration on page 1 when using Property Declaration to provide a list of separate property assets and debts. Description of the Property Declaration chart Pages 1 and 2
3. Column A is used to provide a brief description of each item of separate or community or quasi-community property.
4. Column B is used to list the date the item was acquired.
5. Column C is used to list the item's gross fair market value (an estimate of the amount of money you could get if you sold the item to another person through an advertisement).
6. Column D is used to list the amount owed on the item.
7. Column E is used to indicate the net fair market value of each item. The net fair market value is calculated by subtracting the dollar amount in column D from the amount in column C ("C minus D").
8. Column F is used to show a proposal on how to divide (or confirm) the item described in column A. Page 3
9. Column A is used to provide a brief description of each separate or community or quasi-community property debt.
10. Column B is used to list the date the debt was acquired.
11. Column C is used to list the total amount of money owed on the debt.
12. Column D is used to show a proposal on how to divide (or confirm) the item of debt described in column A. When using this form only as an attachment to a Petition or Response
13. Attach a Separate Property Declaration (form FL-160) to respond to item 9. Only columns A and F on pages 1 and 2 and columns A and D on page 3 are required.
14. Attach a Community or Quasi-Community Declaration (form FL-160) to respond to item 10, and complete column A on all pages. When serving this form on the other party as an attachment to Declaration of Disclosure (form FL-140)
15. Complete columns A through E on pages 1 and 2, and columns A through C on page 3.
16. Copies of the following documents must be attached and served on the other party: (a) For real estate (item 1): deeds with legal descriptions and the latest lender's statement. (b) For vehicles, boats, trailers (item 4): the title documents. (c) For all bank accounts (item 5, 6, 7): the latest statement. (d) For life insurance policies with cash surrender or loan value (item 10): the latest declaration page. (e) For stocks, bonds, secured notes, mutual funds (item 11): the certificate or latest statement. (f) For retirement and pensions (item 12): the latest summary plan document and latest benefit statement. (g) For profit-sharing, IRAs, deferred compensation, and annuities (item 13): the latest statement. (h) For each account receivable and unsecured note (item 14): documentation of the account receivable or note. (i) For partnerships and other business interests (item 15): the most current K-1 and Schedule C. (j) For other assets (item 16): the most current statement, title document, or declaration. (k) For support arrearages (item 21): orders and statements. (l) For credit cards and other debts (items 23 and 24): the latest statement.
17. Do not file copies of the above private financial documents with the court. When filing this form with the court as a attachment to Request to Enter Default (FL-165) or Judgment (FL-180) Complete all columns on the form. For more information about forms required to process and obtain a judgment in dissolution, legal separation, and nullity cases, see /http:/Avww.courts.ca.gov/8218.htm. FL-160 [Rev. July 1, 2016] PROPERTY DECLARATION Page 4 of 4 (Family Law)

FL-141 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): TELEPHONE NO. FAX NO. E-MAIL ADDRESS: ATTORNEY FOR (Name) SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PETITIONER: RESPONDENT: OTHER PARENT/PARTY: DECLARATION REGARDING SERVICE OF DECLARATION OF CASE NUMBER DISCLOSURE AND INCOME AND EXPENSE DECLARATION [] Petitioner's [_] Preliminary [] Respondent's [_] Final

1. lamthe[— ] attorney for [—_] petitioner [__] respondent _ in this matter.
2. [] Petitioner's [-]Respondent's Preliminary Declaration of Disclosure (form FL-140), current* Income and Expense Declaration (form FL-150), completed Schedule of Assets and Debts (form FL-142) or Community and Separate Property Declarations (form FL-160) with appropriate attachments, all tax returns filed by the party in the two years before service of the preliminary disclosures, and all other required information under Family Code section 2104 were served on: [] the other party []the other party's attorney by [] personalservice [] mail [__] Other (specify): on (date):
3. [-] Petitioners | [—] Respondent's Final Declaration of Disclosure (form FL-140), current* Income and Expense Declaration (form FL-150), completed Schedule of Assets and Debts (form FL-142) or Community or Separate Property Declarations (form FL-160) with attachments, and the material facts and information required by Family Code section 2105 were served on: [] the other party [] other party's attorney by [] personal service [] mail [__] Other (specify): on (date):
4. Service of [] Petitioner's [7 ]Respondent's [—_] preliminary [] final declaration of disclosure current income and expense declaration has been waived as follows: a. CJ The parties agreed to waive final declaration of disclosure requirements under Family Code section 2105(d.) (Form FL-144 may be used for this purpose.) The waiver LC] was filed on (date):

| is being filed at the same time as this form.

b. [the party has failed to comply with disclosure requirements, and the court has granted the request for voluntary waiver of receipt under Family Code section 2107 on (date): c. [-_] This is a default proceeding that does not include a stipulated judgment or settlement agreement. Petitioner waives final disclosure requirements under Family Code section 2110. *Current is defined as completed within the past three months providing no facts have changed. (Cal. Rules of Court, rule 5.260.)

| 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 NOTE: File this document with the court. Do not file a copy of the Preliminary or Final Declaration of Disclosure or any attachments to either declaration of disclosure with this document.

Form Adopted for Mandatory Use DECLARATION REGARDING SERVICE OF DECLARATION OF Famly Code, $§ 2102, 2104 FL-141 (Rev. July 12013] DISCLOSURE AND INCOME AND EXPENSE DECLARATION wa courts ea gov For your protection and privacy, please press the Clear {Family Law) . This 5 1 42 1 2 2 204 2136 53 17 96.821953 Form 5 1 42 1 2 3 265 2119 61 44 84.808220 button 5 1 42 1 2 4 337 2119 50 44 93.927505 after 5 1 42 1 2 5 393 2138 39 19 93.927505 you 5 1 42 1 2 6 440 2136 49 16 96.919914 have 5 1 42 1 2 7 497 2135 73 22 96.919914 printed 5 1 42 1 2 8 577 2135 33 17 96.091599 the 5 1 42 1 2 9 617 2135 57 17 90.899818 form. 5 1 42 1 2 10 750 2131 62 31 96.421021 Print 5 1 42 1 2 11 820 2130 51 32 96.906517 this 5 1 42 1 2 12 872 2130 64 32 96.895050 form 5 1 42 1 2 13 950 2122 5 41 96.594864 | 5 1 42 1 2 14 970 2121 10 42 96.271095 | 5 1 42 1 2 15 988 2121 63 42 96.171249 Save 5 1 42 1 2 16 1060 2130 48 21 96.943764 this 5 1 42 1 2 17 1117 2129 61 21 96.642090 form 2 1 43 0 0 0 1382 2113 229 56 -1 3 1 43 1 0 0 1382 2113 229 56 -1 4 1 43 1 1 0 1382 2113 229 56 -1 5 1 43 1 1 1 1382 2113 229 56 95.000000 2 1 44 0 0 0 731 2161 465 7 -1 3 1 44 1 0 0 731 2161 465 7 -1 4 1 44 1 1 0 731 2161 465 7 -1 5 1 44 1 1 1 731 2161 465 7 95.000000