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Item 3. Describe the visitation plan that you feel would be serve the needs of your grandchild(ren).

Item 4. Describe the relationship between you and your grandchild(ren) and why the visitation plan in item 3 is necessary to maintain the relationship.

Read items 5 and 6.

Below item 6, print the date and your name and sign your name to the right above the words “Signature of Petitioner.” The second line is for your spouse, if applicable.

If one of the parents supports your request for visitation, he or she must complete the consent section of the form, below your signature(s).

Completing the Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA), Form FL-105

At the top of the page, print your name, mailing address, and telephone number.

In the second box down, the Court’s name and address may already appear. If not, print the following information:

Superior Court, County of Imperial 939 W. Main St. El Centro, CA 92243

In the third box down, print your name and the parents’ names next to the words “Case Name.”

The fourth box down applies to guardianship cases only.

Item 1 states that you are a party in this case.

Item 2 Check the box if your address is confidential and you are using a mailing address other than your physical address.

Item 3 Print the number of minor children in this case.

Box (a) If there is more than one child, start with the oldest child. Print the child’s full name, city and state of birth, date of birth and sex.

Under “period of residence,” provide the time period the child lived at each address during the last 5 years, or to the child’s date of birth if less than 5 years old. The first line is for the current information. Print the date that the child moved into the home where the child now resides.

FL-15-INFO ($1.00 includes FL-15, SUM-100, Page 3 of 6 FL-330, FL-105) (Adopted 1/1/11, Last Revised 07/01/20) GRANDPARENT VISITATION