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NAME AND ADDRESS OF PARTY OR ATTORNEY FOR PARTY: TELEPHONE NUMBER: FOR COURT USE ONLY

ATTORNEY FOR(NAME): SUPERIOR COURT OF CALIFORNIA, COUNTY OF IMPERIAL 939 W. Main Street El Centro, CA 92243 PETITIONER:

RESPONDENT:

APPLICATION RE: EX PARTE REQUEST CASE NUMBER:

REASONS FOR EX PARTE RELIEF

You must specify why this request cannot be heard on the court’s regular motion calendar. Only include factual information within your personal knowledge, and not conclusions, feelings or fears. (IF CUSTODY OR VISITATION IS AT ISSUE, YOU MUST CLEARLY SHOW WHY THERE IS A RISK OF IMMEDIATE HARM TO YOUR CHILD OR CHILDREN, OR WHY THERE IS AN IMMEDIATE RISK THAT YOUR CHILDREN WILL BE REMOVED FROM CALIFORNIA.)

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I declare under penalty of perjury, under the laws of the State of California, that the foregoing is true and correct, and that this declaration was signed at___________________, California.

Date: ___________________ Signature: _________________________________

Print Name: _________________________________

INTERPRETER’S DECLARATION

I certify under penalty of perjury under the laws of the State of California that I have, to the best of my ability, read or translated for the declarant above this Declaration for Ex Parte Hearing. The declarant above has expressly indicated that he or she understood this document before signing it.

Date: ___________________ Signature: _________________________________ Print Name:________________________________

Form Approved for Optional Use www.imperial.courts.ca.gov FL-06B (Adopted 01/01/10, Last Revised 01/01/24) APPLICATION RE: EX PARTE REQUEST