San Bernardino — SB-13-00050-360

Source: https://sanbernardino.courts.ca.gov/system/files/sb-13-00050-360.pdf

Attorney or Party Without An Attorney (Name, State Bar No. & Address) FOR COURT USE ONLY

Telephone:

NAME OF COURT: SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO STREET ADDRESS: MAILING ADDRESS: CITY, STATE ZIP: DISTRICT NAME:

.

IN THE NAME CHANGE OF:

CASE NUMBER

DECLARATION OF PETITIONER AND REQUEST FOR RECORDS CHECK (APPLICANT/PETITIONER THE AGE OF 14 OR OLDER)

I, ______________________________________________, declare under penalty of perjury that I am not under the jurisdiction of the Department of Corrections nor am I required to register as a sex offender pursuant to Section 290 of the Penal Code.

Date: _____________________________________________________ (Sign Your Name Here), Petitioner

TO: CLETS Operator for _______________________District.

REQUEST FOR CRIMINAL RECORDS CHECK

Pursuant to CCP 1279.5. Please conduct a criminal records check for the following individual:

CLETS CJIS

Applicant Name: _______________________________________________

Date of Birth: ____________________________ SSN: ________________________________

MALE FEMALE

Please forward results to the Civil Calendar Department at the above district.

DECLARATION OF PETITIONER AND REQUEST FOR RECORDS CHECK (APPLICANT/PETITIONER THE AGE OF 14 OR OLDER)

Local Court From (Rev. 10/20/22) SB- 13-00050-360 (Mandatory Use)