Fill and Sign the Child Custody Visitation and Form

Y our n am e: O th er p are n t's n am e: M om M om D ad D ad O th er O th er I w an t t o k ee p m y c u rre n t c h ild c u sto dy c o urt o rd er w ith o ut a n y c h an ges. I f t h ere a re n o c o urt o rd ers f o r c u sto dy,C hil d C usto d y a. b. c. If m ore c h ild re n , c h eck h ere . A tta ch a s h eet o f p aper a nd w rite ''D V-1 05, I te m 5 - * If O th er, s p ecify r e la tio nsh ip t o c h ild a nd n am e o f p erso n:  *If O th er, s p ecify r e la tio nsh ip t o c h ild a nd n am e o f p erso n:  Chec k h ere i f t h e o th er c h ild 's ( o r c h ild re n 's ) a d dre ss i n fo rm atio n i s t h e s a m e a s l is te d i n I f i t i s d iffe re n t, c h eck h ere . A tta ch a s h eet o f p aper a nd w rite ''D V -1 0 5, I te m 7 O th er C hild re n 's A ddre sse s'' b y y o ur D V-1 05C hild C usto dy, V is it a tio n, a n dCase N um ber:S upport R eq uestThis f o rm i s a tta ch ed t o D V-1 0 0, I te m 9 .C han ge o f C urren t C ou rt O rd ersI w an t t o c h an ge a c u rre n t c h ild c u sto dy o r v is ita tio n c o urt o rd er.E xp la in y o ur c u rre n t o rd er a nd w hy y o u w ant a c h ange. T hen s k ip t o a nd f in is h t h e f o rm . - If y o u d o n ot w an t a c h ange,skip to a nd f in is h t h e f o rm .yo u c a nnot c h eck t h is b ox. I f y o u c h eck t h is b ox, s k ip t h e r e st o f t h is f o rm . I f y o u h ave a c o py o f t h e c u rre n t c o urt o rd er,a tta ch i t.I a sk t h e c o urt f o r c u sto dy a s f o llo w s:P hysic a l C usto d y t o : (P erso n t h e c h ild l iv es with . C heck a t l e a st o ne)L eg al C usto d y t o : ( P erso n who m ake s d ecis io ns a bout h ea lth , educa tio n, e tc . C heck a t l e a st o ne)C hild 's N am eDate o f B ir th M omD adO th er*M omD adO th er*C hild C usto dy'' b y y o ur r e q uest.C hild 's A ddressC hild a l iv ed w ith : 's a d dre sse s:M omD ad O th er* D ate s l iv ed t h ere :W here h as t h e c h ild i n a l iv ed f o r t h e l a st 5 y ears ? G iv e e ach a d dre ss u nle ss i t i s p riv ate . S ta rt w ith w here th e c h ild l iv es n ow a n d w ork b ack w ard s i n t im e. Ch ild t o p re se n ttototoO th er C hild ren 's A ddresse slis t. L is t o th er c h ild re n 's a ddre ss i n fo rm atio n, i n clu din g d ate s, a nd n am e o f p erso n c h ild l iv ed w ith .T his is n ot a C ourt O rd er.Ju dic ia l C oun cil o f C alif o rn iaC hild C usto d y, V is it a tio n , a nd S upport R equest (Dom estic V io le nce P re ve ntio n)D V-1 05, P age 1 o f 3R ev. J a nuary 1 , 2 004, M and ato ry F orm Fa m ily C ode, § 6 200 e t s e q.213456ele ctr o nic f o rm  2 004 WWW.LawCA.com La w P ublis h ers NoY es I f y es, f ill o ut b elo w :N oY es I f y es, f i ll o ut b elo w : Y our n am e: D iv orc eG uard ia n sh ipA doptio nJu ven ileO th er ( s p ecify ): W itn essP artyO th er ( s p ecify ): C ourt ( n am e): A ddre ss: e . D ate o f c o urt o rd er:  H as c u sto dyC la im s c u sto dy r ig htsC la im s v is ita tio n r ig hts  C heck h ere i f y o u n eed m ore s p ace. A tta ch a s h eet o f p aper a nd w rite ''D V -1 05, I te m 9 '' b y y o ur s ta te m en t.V is it a tio nN o v is ita tio n u ntil t h e h earin gN o v is ita tio n a fte r t h e h earin gT he f o llo w in g v is ita tio nuntil t h e h earin gafte r t h e h earin gW eek en ds ( s ta rtin g): 1st2 nd3rd4 th5 th w eek en d o f m onth f ro m P .M . t o p.m.W ee k days ( s ta rtin g): fr o m : P .M . t o p.m.Other Visitation C ase N um ber:O th er c u sto d y c a se ? Were y o u i n volv ed i n , o r d o y ou k now o f, a n y o th er c u sto dy c ase f o r a n y c h ild l is te d i n t h is f o rm ?a. N am e o f e ach c h ild i n o th er c u sto dy c ase :b . T ype o f c ase :c . I w as ad .C ity :S ta te :O th er p eo p le c la im t o h ave c u sto d y? Do y ou k now o f a n yone w ho i s n ot i n volv ed i n t h is c ase w ho h as o r c la im s t o h av e c u sto dy o r v is ita tio n r ig htsw ith a n y c h ild l is te d o n t h is f o rm ? Nam e a n d a d dre ss o f t h at p ers o n :F or t h ese c h ild re n ( n am e o f e a ch c h ild ):I a sk t h e c o urt t o o rd er t h at t h e p ers o n i n (C heck a ll t h at a pply )h av e t h e f o llo w in g t e m pora ry v is ita tio n r ig hts :a .b .C.(1 )(T he I s t w eeken d o fth e m onth i s t h e I s t w eeken d w ith a S atu rd ay.)ata.m.at( tim e)(d ay o f w eek)(tim e)a.m.(d ay o f w eek)(2 )ata.m.ata.m .(d ay o f w eek)(tim e)(d ay o f w eek)(tim e)(3 )A tta ch a s h eet o f p aper w ith o th er v is ita tio n d ays a nd t im es, l ik e h olid ays, b ir th days, s p orts e ven ts . L is t d ate s an d t im es. W rite ''D V-1 05, I te m 1 0 V is ita tio n '' b y y o ur s ta te m en t.T his is n ot a C ourt O rd er.Rev. J an uary 1 , 2 004C hild C usto dy, V is it a tio n, a n d S upport R eq uest (Dom estic V io le n ce P re ven tio n)DV-1 05, Page 2 of 38910ele ctr o nic f o rm  2 004 WWW.LawCA.com La w P ublis h ers Your n am e: S up erv is e d V is it a tio n M om D ad O th er ( n a m e) R esp on sib ilit y f o r T ra n sp orta tio n f o r V is it a tio nM omM omD adD adO th er ( n am e):O th er ( n am e): D ro p-o ff / p ic k -u p o f c h ild re n w ill b e a t ( a ddre ss): T ra vel W it h C hild renM omD adO th er ( n am e): T he S ta te o f C alif o rn ia .O th er p la ce(s ) ( lis t) : C hild A bductio nI b elie v e t h at t h ere i s a r is k t h e o th er p are n t w ill t a k e o ur c h ild o ut o f C alif o rn ia w ith out m y p erm is sio n.C hild S upportI a sk t h e c o u rt f o r c h ild s u pport. Y ou m ust f ill o ut a nd f ile F L-1 50 o r F L-1 55 b efo re y o ur h ea rin g.I n ow r e ceiv e o r h av e a p plie d f o r T A NF, W elf a re , C alW ORK S, o r M ed i- C al.I a lr e ad y h av e a c h ild s u ppo rt o rd er, b ut I w an t i t c h an ged . Case Number:a. I a sk t h at t h e v is ita tio n i n b e s u perv is e d b y ( w rite n am e a n d t e le p hone n um ber):b . I a sk t h at a n y c o sts f o r s u perv is io n b e p aid a s f o llo w s:%%%''R esp onsib ility f o r t r a nsp orta tio n '' m ea ns t h e p are n t w ill t a ke o r p ic k u p t h e c h ild o r m ake a rra ngem en ts f o r s o m eo ne els e t o d o s o .a.to t h e v is its .b .fro m t h e v is its .C.M UST h av e w ritte n p erm is sio nfro m t h e o th er p are n t, o r a c o urt o rd er, t o t a k e t h e c h ild re n o uts id e o fa.b .If y o u c h ec k t h is b ox y o u m ust f ill o ut a nd a tta ch f o rm D V-1 08.a.b .C.I m porta n t! Yo u m ust t e ll t h e c o urt i f y ou f in d o ut a n y o th er i n fo rm atio n a b out a c u sto dy c ase i n a n y c o urt f o r t h e c h ild re n lis te d o n t h is f o rm .This is n ot a C ourt O rd er.Rev. J a nuary 1 , 2 004C hild C usto dy, V is it a tio n, a n d S upport R eq uest (D om estic V io le n ce P re ven tio n)DV-105, Page 3 of 3111213141515ele ctr o nic f o rm  2 004 WWW.LawCA.com La w P ublis h ers