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ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY

TELEPHONE NO.: FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF IMPERIAL
939 W. Main Street
El Centro, CA 92243

PETITIONER:

RESPONDENT:

DECLARATION REGARDING EX PARTE NOTICE CASE NUMBER:

Other party (or attorney if represented):

a. Name: ___________________________________________

b. Address: _________________________________________

c. Phone Number: ___________________________________

DECLARATION REGARDING NOTICE

1. The undersigned has has not made any prior applications on the same issue in this case
or another case.

2. If there has been another case, fill in the County in which the case is pending:
County: __________________ Case number: _________________.

3. This order will will not result in a change of the status quo.

4. I have given notice to the other party/attorney that on ___________ at __________ in
Date Time
Department ____, I would make an ex parte application for these orders. Notice was given by
the following method before 10:00 a.m. on the Court day before the hearing:

Personal Delivery* Fax with confirmation of receipt*

First Class Mail* Telephone

Other (explain):___________________________________________

Date and time I gave notice: _____________________________________
(Date) (Time)

Form Approved for Optional Use www.imperial.courts.ca.gov FL-06A (Adopted 01/01/10; Last Revised 01/01/22) DECLARATION REGARDING EX PARTE NOTICE Page 1 of 2