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PETITIONER: CASE NUMBER: RESPONDENT:

5. The other party or their attorney has or has not confirmed receipt of the motion (state
details)
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

6. The other party/attorney was served with all of the moving papers in support of this ex-parte
request on ___________ at ___________.
Date Time

*PROOF OF SERVICE MUST BE FILED WITH THE COURT.

7. I anticipate the other party will oppose this application. I do not anticipate the opposing
party will oppose this application.

8. I have not given notice to the other party or attorney for the following reasons:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

I declare under penalty of perjury under the laws of the State of California that the foregoing
is true and correct.

Dated: _____________________ ______________________________
Signature of Declarant

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 2 of 2