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ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY

TELEPHONE NO.: FAX NO. (Optional): E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF IMPERIAL 939 W. Main Street El Centro, CA 92243

PETITIONER:

RESPONDENT:

RESPONSE TO PETITION FOR GRANDPARENT VISITATION (Fam. Code Section 3104) CASE NUMBER:

Respondent admits, denies and alleges as follows:
1. Petitioner(s) is/are a maternal paternal grandparent(s) and
2. Respondent is/are a maternal paternal grandparent(s)
of the following minor child(ren):

Child’s Name Birthdate Age Gender
a.

b.

c.

d.

3. The parents of the child(ren) are currently married, and one or more of the following
circumstances exist(mark all that apply):

The parents are currently living separately and apart on a permanent or
indefinite basis;
One of the parents has been absent for more than one month without the other
parent knowing the whereabouts of the absent parent;
One of the parents joins in the petition with the grandparent;
The child is not residing with either parent;
The child has been adopted by a stepparent.

4. The parents of the child(ren) are divorced. A Judgment of Dissolution of Marriage
was entered on _____________, in _________________________________ County,
case number _____________________, or other location ___________________, case
number ______________________.

Form Approved for Mandatory Use Page 1 of 3 FL-16 (Adopted 01/01/11, Revised 07/01/19) RESPONSE TO PETITION FOR GRANDPARENT VISITATION