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In the next box to the right, print the address where the child resides – or as much of it as you know, such as the city, county and/or state. If you do not know the street address, you may print “unknown.” If the address is confidential, check the box provided. You must include at least a city and state for each period of residence or the Court will be unable to make custody or visitation orders.

Further to the right, print the name of the person the child is living with, followed by the relationship of that person to the child – for example, “mother,” “father” or “parents.” If the child is living with someone other than a parent, be sure to provide that person’s name, address and relationship to the child.

On the next line down, provide all the information requested relating to the child’s previous residence. Include the dates the child moved into and out of that address. Continue on separate lines for each address.

Complete box b if there is more than one child; complete the requested information for the second child. If the residence information is the same as the first child, check the box below the child’s name that says, “Residence information is the same as given above for child a.” If the information is not the same, provide the information on the lines below.

If there have been more addresses for the child(ren) than will fit in the boxes provided, check box c and attach an additional page labeled “Additional Residence Information.” Use this additional page to list all other addresses for the past five years in the same way you listed the most recent addresses.

If there are more than 2 children, check box d located at the bottom of the form and complete and attach form FL-105(A). Use this form to list the same information for the additional children as was included for the first two children.

In the bar at the top of the second page, print the case name below the words “Short Title.”

Item 4 asks whether you have information about, or have been a party or witness in a case in California or elsewhere, concerning custody of the child(ren) involved in this case. This includes family law, guardianships and juvenile dependency cases. If not, check the box for “No.” If you do know of a case, check the box for “Yes,” and provide the information requested about that case under the appropriate case type.

Item 5 asks if one or more domestic violence restraining/protective orders are now in effect. If not, leave this item blank. If you do know that such orders are in effect, check the box next to 5, check the box next to the type of case in which the restraining order was issued and provide the information requested. If you have a copy of the order, attach it.

Item 6 asks if there is anyone who is not a party to the case who has physical custody or claims to have custody or visitation rights with any child in this case. If not, check the box for “No.” If you do know of a non-parent seeking custody or visitation rights, check the box for “Yes” and provide the information requested about that person in items a, b and c.

FL-15-INFO ($1.00 includes FL-15, SUM-100, Page 4 of 6 FL-330, FL-105) (Adopted 1/1/11, Last Revised 07/01/20) GRANDPARENT VISITATION