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Petitioner: Case Number:

Respondent:

5. A completed Summons and Declaration Under Uniform Child Custody Jurisdiction & Enforcement Act – Judicial Council Form (FL-105) is attached.

6. Petitioner(s) request(s) that the court grant reasonable visitation with the above named child(ren), and such other relief as the court may deem appropriate, pursuant to Family Code Section 3103.

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

Date: __________________

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Type or print name Signature of Petitioner

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Type or print name Signature of Petitioner

PARENT CONSENT TO PETITIONER’S REQUEST FOR GRANDPARENT VISITATION

I consent to and join in this Petition for Grandparent Visitation

Date: __________________

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Type or print name Signature of Parent of Minor Child(ren)

Form Approved for Mandatory Use Page 2 of 3 FL-15 (Adopted 01/01/11, Revised 01/01/12, 01/01/13, 07/01/19) PETITION FOR GRANDPARENT VISITATION