FL 170 DECLARATION FOR OR UNCONED DISSOLUTION LEGAL SEPARATION Fl170

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FL-170

FOR COURT USE ONLY

PETITIONER:

RESPONDENT:

CASE NUMBER:

DECLARATION FOR DEFAULT OR UNCONTESTED

DISSOLUTION LEGAL SEPARATION

(NOTE: Items 1 through 12 apply to both dissolution and legal separation proceedings.)

I declare that if I appeared in court and were sworn, I would testify to the truth of the facts in this declaration.

I agree that my case will be proven by this declaration and that I will not appear before the court unless I am ordered by the court to

do so.

Petition Response is true and correct.

All the information in the

Default without agreement

No response has been filed and there is no written agreement or stipulated judgment between the parties;

a.

No response has been filed and the parties have agreed that the matter may proceed as a default matter without

notice; and

(2)

Default with agreement

The parties have entered into a written agreement regarding their property and their marriage or domestic partnership

rights, including support, the original of which is being or has been submitted to the court. I request that the court

approve the agreement.

The following statement is true (check one):

Page 1 of 3

DECLARATION FOR DEFAULT OR UNCONTESTED

DISSOLUTION OR LEGAL SEPARATION

(Family Law)

Form Adopted for Mandatory Use

Judicial Council of California

FL-170 [Rev. July 1, 2012]

Family Code, § 2336

www.courts.ca.gov

1.

2.

3.

b.

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

TELEPHONE NO.:

ATTORNEY FOR (Name):

FAX NO. (Optional):

E-MAIL ADDRESS (Optional):

The default of the respondent was entered or is being requested, and I am not seeking any relief not requested in the

petition; and

Type of case (check a, b, or c):4.

(1)

The community and quasi-community assets and debts are listed on the completed current Property

Declaration (form FL-160), which includes an estimate of the value of the assets and debts that I propose

to be distributed to each party. The division in the proposed Judgment (form FL-180) is a fair and equal

(B)

division of the property and debts, or if there is a negative estate, the debts are assigned fairly and equitably.

There are no assets or debts to be disposed of by the court.

(3)

(A)

(2)

(1)

Both parties have appeared in the case; and

Uncontested

c.

(2)

(1)

Declaration of disclosure (check a, b, or c):

Both the petitioner and respondent have filed, or are filing concurrently, a Declaration Regarding Service of Declaration

a. of Disclosure (form FL-141) and an Income and Expense Declaration (form FL-150).

This matter is proceeding by default. I am the petitioner in this action and have filed a proof of service of the preliminary

Declaration of Disclosure (form FL-140) with the court. I hereby waive receipt of the final Declaration of Disclosure (form

b.

FL-140) from the respondent.

This matter is proceeding as an uncontested action. Service of the final Declaration of Disclosure (form FL-140) is mutually

waived by both parties. A waiver provision executed by both parties under penalty of perjury is contained on the Stipulation

and Waiver of Final Declaration of Disclosure (form FL-144), in the settlement agreement or proposed judgment or

another, separate stipulation.

c.

5.

The parties have entered into a written agreement regarding their property and their marriage or domestic partnership

rights, including support, the original of which is being or has been submitted to the court. I request that the court

approve the agreement.

amended

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PETITIONER: CASE NUMBER:

RESPONDENT:

Child support should be ordered as set forth in the proposed Judgment (form FL-180).

7.

b.

am receiving am not receiving intend to apply for public assistance for the child or children

To the best of my knowledge, the other party is is not receiving public assistance.

The petitioner respondent is presently receiving public assistance, and all support should be made

payable to the local child support agency at the address set forth in the proposed judgment. A representative of the local

child support agency has signed the proposed judgment.

If there are minor children, check and complete item (1) if applicable and item (2) or (3):

a.

petitioner’s respondent’s earning ability. The facts in support I request that this order be based on the

(3)

of my estimate of earning ability are (specify):

Continued on Attachment 7a(3).

FL-170 [Rev. July 1, 2012] DECLARATION FOR DEFAULT OR UNCONTESTED

DISSOLUTION OR LEGAL SEPARATION

(Family Law)

I

listed in the proposed order.

Page 2 of 3

FL-170

6. Child custody and visitation (parenting time) should be ordered as set forth in the proposed Judgment (form FL-180).

d. Facts in support of requested judgment (In a default case, state your reasons below):

Contained on Attachment 6d.

The information in the child support calculation attached to the proposed judgment is correct based on my

personal knowledge.

(2)

a. The information in Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) (form FL-105)

has not changed since it was last filed with the court. (If changed, attach updated form.)

has

Complete items (1) and (2) regarding public assistance.

(2)

(1)

c.

Spousal, Partner, and Family Support (If a support order or attomey fees are requested, submit a completed Income and

Expense Declaration (form FL-150) unless a current form is on file. Include your best estimate of the other party’s income.

Check at least one of the following.)

a. I knowingly give up forever any right to receive spousal or partner support.

b. I ask the court to reserve jurisdiction to award spousal or partner support in the future to (name):

I ask the court to terminate forever spousal or partner support for:

c.

d.

8.

Family support should be ordered as set forth in the proposed Judgment (form FL-180).

e.

b. There is an existing court order for custody/parenting time in another case in (county):

The case number is (specify):

Child support is being enforced in another case in (county):

The case number is (specify):

(1)

Spousal support or domestic partner support should be ordered as set forth in the proposed Judgment (form FL-180)

based on the factors described in:

petitioner respondent.

Other (specify):

f.

c. The current custody and visitation (parenting time) previously ordered in this case, or current schedule is (specify):

Spousal or Partner Support Declaration Attachment (form FL-157)

written agreement

attached declaration (Attachment 8d.)

Contained on Attachment 6c.

THIS STATEMENT APPLIES ONLY TO LEGAL SEPARATIONS

I ask that the court grant the request for a judgment for legal separation based on irreconcilable differences and that the

court make the orders set forth in the proposed Judgment (form FL-180) submitted with this declaration.

I understand that a judgment of legal separation does not terminate a marriage or domestic partnership and that I am

still married or a partner in a domestic partnership.

Other (specify):

19.

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

Date:

(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)

18.

PETITIONER: CASE NUMBER:

RESPONDENT:

FL-170

FL-170 [Rev. July 1, 2012] DECLARATION FOR DEFAULT OR UNCONTESTED

DISSOLUTION OR LEGAL SEPARATION

(Family Law)

Page 3 of 3

STATEMENTS IN THIS BOX APPLY ONLY TO DISSOLUTIONS

If this is a dissolution of marriage or of a domestic partnership created in another state, the petitioner and/or the respondent

have been residents of this county for at least three months and of the state of California for at least six months continuously

and immediately preceding the date of the filing of the petition for dissolution of marriage or domestic partnership.

I ask that the court grant the request for a judgment for dissolution of marriage or domestic partnership based on irreconcilable

differences and that the court make the orders set forth in the proposed Judgment (form FL-180) submitted with this declaration.

17. This declaration is for the termination of marital or domestic partner status only. I ask the court to reserve jurisdiction

over all issues whose determination is not requested in this declaration.

15.

16.

There are irreconcilable differences that have led to the irremediable breakdown of the marriage or domestic partnership, and

there is no possibility of saving the marriage or domestic partnership through counseling or other means.

This declaration may be reviewed by a commissioner sitting as a temporary judge, who may determine whether to grant this

request or require my appearance under Family Code section 2336.

13.

14.

12. respondent requests restoration of his or her former name as set forth in the proposed Judgment

(form FL-180).

The petitioner

9. Parentage of the children of the petitioner and respondent born prior to their marriage or domestic partnership should be

ordered as set forth in the proposed Judgment (form FL-180).

10. Attorney fees should be ordered as set forth in the proposed Judgment (form FL-180)

a. A Voluntary Declaration of Paternity is attached.

11. The judgment should be entered nunc pro tunc for the following reasons (specify):

b. Parentage was previously established by the court in (county):

The case number is (specify):

facts in support in form FL-319

other (specify facts below):

Written agreement of the parties attached here or to the Judgment (form FL-180).

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