Lassen — Declaration of Notice Regarding Request for Ex-Parte Orders

Source: https://www.lassen.courts.ca.gov/system/files/local-forms/lsc-fl-120.pdf

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number, and Address) FOR COURT USE ONLY State Bar No.

TELEPHONE NO. FAX NO. (OPTIONAL)

ATTORNEY FOR:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF LASSEN 2610 Riverside Drive, Susanville, CA 96130

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

DECLARATION OF NOTICE REGARDING CASE NUMBER:
REQUEST FOR EX-PARTE ORDERS

HEARING DATE: _____________________ TIME:___________________

1. Type of relief requested: ____________________________________________________________________________________

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2. Reason(s) ex parte relief is necessary: _________________________________________________________________________

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3. Name of opposing parties (or attorneys): _______________________________________________________________________

4. Was Notice of the ex parte application given to the opposing parties: ☐ Yes ☐ No

The Declaration, Request for Order, and Temporary Orders must be submitted no later than 12 PM the day before the hearing. If not submitted timely, the matter will be continued to the following day.

5. ☐ NOTICE GIVEN: The opposing parties were notified of the relief and that the ex parte application would be heard by the court on

   (date) ______________, at (time) __________ ☐ a.m. ☐ p.m., as indicated below.

   a. Notice was given to the ☐ attorney for the ☐ plaintiff/petitioner ☐ defendant/respondent.

   b. Notification occurred on (date) ______________, at (time) __________ ☐ a.m. ☐ p.m.

   c. I gave notice by this method:
   ☐ personally on (date):, at (location):, California; at _________ ☐ a.m. ☐ p.m.
   ☐ telephone on (date):, telephone no.:, at _________ ☐ a.m. ☐ p.m.
   ☐ voicemail on (date):, voicemail no.:___________, at _________ ☐ a.m. ☐ p.m.
   ☐ fax machine on (date):, fax no.:_____________________________, at _________ ☐ a.m. ☐ p.m.
   d. I notified the person in 3 that the following temporary emergency orders are being requested (specify orders being

   requested): ___________________________________________________________________________________

   _____________________________________________________________________________________________

   _____________________________________________________________________________________________

Form Adopted for Mandatory Use DECLARATION OF NOTICE REGARDING Lassen Superior Court REQUEST FOR EX-PARTE ORDERSLSC-FL-120 [Rev. September 3, 2024] www.Lassen.Courts.ca.gov

e. The person in 3 responded as follows: ______________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________
f. I ☐ do ☐ do not believe that the person in 3 will oppose the request for temporary emergency orders.

6. ☐ I did not give notice about the request for temporary emergency orders. I request the court waive notice to the other party

due to the following exceptional circumstances (check all that apply):
(1) ☐ To help prevent an immediate danger or irreparable harm to myself (or my client) or to the children in the case.

(2) ☐ There is an immediate risk that the children in the case will be removed from the state of California.

(3) ☐ To help prevent immediate loss or damage to property subject to disposition in the case.

(4) ☐ Other exceptional circumstances (specify): _____________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________
7. Have you appeared ex-parte before for the same relief? ☐ Yes ☐ No If yes, relief was ☐ granted ☐ denied

I declare under penalty of perjury under the laws of the State of California that the above information and all attachments are

true and correct.

Date: _____________________

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(TYPE OR PRINT NAME) (SIGNATURE)

Form Adopted for Mandatory Use DECLARATION OF NOTICE REGARDING Lassen Superior Court REQUEST FOR EX-PARTE ORDERSLSC-FL-120 [Rev. September 3, 2024] www.Lassen.Courts.ca.gov