Page 215 — Imperial — Local Rules July 2026

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 Juvenile Division 939 W. Main Street El Centro, CA 92243 Name of Dependant Child:

CASE NUMBER:

DECLARATION RE: NOTICE OF EX PARTE APPLICATION

I, the undersigned, declare:

I am [ ] counsel [ ] social worker [ ] mother [ ] father [ ] minor [ ] Department of Family and Children's Services or [ ] other (explain) __________________________________________________________ in this dependency action.
Pursuant to Juvenile Court Local Rules, I have given notice of, and a copy of this application for ex parte orders to, the following persons: ______________________________________________

Notice to the above named persons was given in the following manner: [ ] telephone at ________ [ ] a.m. [ ] p.m. [ ] letter [ ] mailed [ ] e-mailed [ ] hand delivered to (insert name and address/e-mail):

______________________________________, on _______________________________, ______

I have received the following response: _____________________________________________

I have not given notice of this application for ex parte orders for the following reason(s): [ ] a. Would frustrate the purpose of the orders requested. [ ] b. Minor child would suffer immediate and irreparable harm before the orders could issue. [ ] c. No significant burden or inconvenience to responding party will result from the orders requested. [ ] d. I made reasonable, good faith efforts to give notice, as follows:

[ ] e. Other:___________________________________________________________________

I declare under penalty of perjury under the laws of the State of California the foregoing is true and correct. Executed at __________________, California, on ___________________ (DATE)

Declarant

Form Approved for Mandatory Use JV-02 (Adopted 07/01/07, Revised 01/01/13, 01/01/24) DECLARATION RE: NOTICE OF EX PARTE APPLICATION