Riverside local form RI-PR103

Source: https://riverside.courts.ca.gov/system/files/local-forms/ri-pr103.pdf

SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE

MURRIETA 30755-D Auld Rd., Murrieta, CA 92563 RIVERSIDE 4050 Main St., Riverside, CA 92501 PALM SPRINGS 3255 E. Tahquitz Canyon Wy., Palm Springs, CA 92262 RI-PR103 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):

IN THE MATTER OF:

CASE NUMBER:

Hearing Date: Time: Department:

CONFIDENTIAL

BIRTH CERTIFICATE COVER SHEET Family Code §3140, Local Rule 7301

NOTICE TO PETITIONER

This cover sheet should be used for a birth certificate of a minor. If more than one birth certificate is being submitted, please use a separate cover sheet for each.

1. The minor whose birth certificate is attached is ( name):

2. The guardian/ proposed guardian providing the attache m ent is (name):

3. I received the attached certified copy or certified informational copy of the birth certificate from the issuing

   government agency, consisting of (number): page(s). I have attached without alteration the document a true and correct copy of the document.

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

Date: (SIGNATURE OF PROPOSED GUARDIAN/GUARDIAN)

Adopted for Mandatory Use BIRTH CERTIFICATE COVER SHEET FamilyLocalCodeRule§ 73013140Riverside Superior Court F orm RI-PR103 [New 01/01/23] riverside.courts.ca.gov (Reformatted 12/23/24)