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Samples:
Caregiver's Authorization Affidavit
De Facto Parent Declaration
Power of Attorney
Letter to Attorney
Letter to Social Worker
Letter to Probation Officer
Letter to Judge
Letter to Family Law Facilitator
Letter to Court Clerk
 
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De Facto Parent Declaration

IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA

IN AND FOR THE COUNTY OF__________________________

JUVENILE DIVISION

In re:




A Minor.

_________________________________/

Petition No.
APPLICATION FOR
DE FACTO PARENT STATUS

In Pro Per

Date of Hearing:
Time:
Dept:

NAME OF APPLICANT:
ADDRESS OF APPLICANT:
 
TELEPHONE NO.:
RELATIONSHIP TO CHILD:
 

  1. I am requesting the Court declare that I am the de facto parent of the child.
     
  2. I had responsibility for the day-to-day care of the child from __________________ to ____________________________.
     
  3. The child lived with me from _________________ to ____________________.
     
  4. Other information the Court should know about my relationship with the child:
     
     
     
     
     
     
  5. I am requesting an attorney be appointed to represent me if I am declared to be a de factoparent. Yes___ No___

 

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 Petitioner)

 

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