Form DV-105 "Request for Child Custody and Visitation Orders" - California

This version of the form is not currently in use and is provided for reference only.
Download this version of Form DV-105 for the current year.

What Is Form DV-105?

This is a legal form that was released by the California Judicial Branch - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2012;
  • The latest edition provided by the California Judicial Branch;
  • Easy to use and ready to print;
  • Available in Korean;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DV-105 by clicking the link below or browse more documents and templates provided by the California Judicial Branch.

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Download Form DV-105 "Request for Child Custody and Visitation Orders" - California

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This Form button at the end of the form when finished.
Request for Child Custody and
Case Number:
DV-105
Visitation Orders
This form is attached to DV-100, Request for Domestic Violence Restraining Order.
Check the orders you want
.
1
1
Your name:
Mom
Dad
Other*
2
Other parent’s name:
Mom
Dad
Other*
*If Other, specify relationship to child:
Child Custody
3
I ask the court for custody as follows:
Legal Custody to:
Physical Custody to:
(Person
who makes decisions about
(Person you want the
child to live with)
health, education, and welfare)
Child’s Name
Date of Birth
Mom
Dad
Other
Mom Dad
Other
a.
b.
c.
d.
Check here if you need more space. Attach a sheet of paper and write “DV-105, Child Custody” for a title.
Change Current Court Order
4
I want to change a current child custody or visitation court order.
Case Number (if you have it): ____________________________________ County:______________________
Explain your current order and why you want a change.
Check here if you need more space. Attach a sheet of paper and write “DV-105, Change Current Court
Order” for a title.
Child’s Address
5
Where has the child in
3
(a) lived for the last 5 years? Give each city and state the child has lived unless it is
unknown to the other parent and you want to keep it confidential because of domestic violence or child abuse.
Start with where the child lives now and work backwards in time. (If the current address is confidential, check
the box below and just provide the current state).
Child
(a) lived with:
Dates lived there:
3
Child
3
(a) addresses (city and state):
Mom
Dad Other
Confidential
From
to present
From
to
From
to
From
to
Check here if you need more space. Attach a sheet of paper and write “DV-105, Child’s Address” for a
title.
This is not a Court Order.
DV-105,
Page 1 of 3
Judicial Council of California, www.courts.ca.gov
Request for Child Custody and Visitation Orders
Rev. January 1, 2012, Mandatory Form
(Domestic Violence Prevention)
Family Code, § 3063
To keep other people from seeing what you entered on your form, please press the Clear
This Form button at the end of the form when finished.
Request for Child Custody and
Case Number:
DV-105
Visitation Orders
This form is attached to DV-100, Request for Domestic Violence Restraining Order.
Check the orders you want
.
1
1
Your name:
Mom
Dad
Other*
2
Other parent’s name:
Mom
Dad
Other*
*If Other, specify relationship to child:
Child Custody
3
I ask the court for custody as follows:
Legal Custody to:
Physical Custody to:
(Person
who makes decisions about
(Person you want the
child to live with)
health, education, and welfare)
Child’s Name
Date of Birth
Mom
Dad
Other
Mom Dad
Other
a.
b.
c.
d.
Check here if you need more space. Attach a sheet of paper and write “DV-105, Child Custody” for a title.
Change Current Court Order
4
I want to change a current child custody or visitation court order.
Case Number (if you have it): ____________________________________ County:______________________
Explain your current order and why you want a change.
Check here if you need more space. Attach a sheet of paper and write “DV-105, Change Current Court
Order” for a title.
Child’s Address
5
Where has the child in
3
(a) lived for the last 5 years? Give each city and state the child has lived unless it is
unknown to the other parent and you want to keep it confidential because of domestic violence or child abuse.
Start with where the child lives now and work backwards in time. (If the current address is confidential, check
the box below and just provide the current state).
Child
(a) lived with:
Dates lived there:
3
Child
3
(a) addresses (city and state):
Mom
Dad Other
Confidential
From
to present
From
to
From
to
From
to
Check here if you need more space. Attach a sheet of paper and write “DV-105, Child’s Address” for a
title.
This is not a Court Order.
DV-105,
Page 1 of 3
Judicial Council of California, www.courts.ca.gov
Request for Child Custody and Visitation Orders
Rev. January 1, 2012, Mandatory Form
(Domestic Violence Prevention)
Family Code, § 3063
Case Number:
Other Children’s Addresses
6
5
Check here if the other child’s (or children’s) address information is the same as listed in
.
If it is different, check here. Attach a sheet of paper and write “DV-105, Other Children’s Addresses” for a
title. List other children’s address information, including dates, and name of person child lived with.
1
Other Custody Case
7
Were you involved in, or do you know of, any other custody case for any child listed in this form?
No
Yes If yes, fill out below and attach a copy of any custody or visitation orders if you have them:
a. Name of each child in other custody case:
b. Type of case:
Parentage (Paternity)
Divorce
Child Support
Guardianship
Juvenile/Dependency
Domestic Violence
Other
(specify):
c. I was a
Party
Witness
Other (specify):
d. Court (name):
Address:
County:
State:
e. Date of court order:
f.
Case number (if you have it):
8
Other People With or Claiming to Have Custody or Visitation Rights
Do you know of anyone who is not involved in this case who has or claims to have custody or visitation
No
rights with any child listed on this form?
Yes If yes, fill out below:
Name and address of that person:
Has custody
Claims custody rights
Claims visitation rights
For these children (name of each child):
Check here if you need more space. Attach a sheet of paper and write “DV-105, Other People With or
Claiming Custody or Visitation” for a title.
9
Visitation
I ask the court to order that the person in
have the following temporary visitation rights:
2
(Check all that apply)
a.
No visitation until the hearing
b.
No visitation after the hearing
c.
The following visitation
until the hearing
after the hearing
(1)
Weekends
(starting):
(The 1st weekend of the month is the 1st weekend with a Saturday.)
1st
2nd
3rd
4th
5th weekend of month
from
at
a.m.
p.m. to
at
a.m.
p.m.
(day of week)
(time)
(day of week)
(time)
(2)
Weekdays
(starting):
from
at
a.m.
p.m. to
at
a.m.
p.m.
(day of week)
(time)
(day of week)
(time)
This is not a Court Order.
DV-105,
Rev. January 1, 2012
Page 2 of 3
Request for Child Custody and Visitation Orders
(Domestic Violence Prevention)
Case Number:
Other Visitation
10
Attach a sheet of paper with other visitation days and times, like summer vacation, holidays, and birthdays.
List dates and times. Write “DV-105, Visitation” for a title.
Responsibility for Transportation
11
The parent will take or pick up the child or make arrangements for someone else to do so.
I ask the court to order that:
a.
Other (name):
Mom
Dad
take children to the visits.
b.
Mom
Dad
Other (name):
pick up children from the visits.
Drop-off / pick-up of children will be at (address):
c.
d.
Check here if other arrangement. Attach a sheet of paper and write “DV-105, Responsibility for
Transportation” for a title.
Supervised Visitation
12
9
a. I ask that the visitation in
be supervised by
A professional supervisor
A non-professional supervisor
Other
Name and telephone number, if known: ______________________________________________________
b. I ask that the visitation in
10
be supervised by
A professional supervisor
A non-professional supervisor
Other
Name and telephone number, if known: ______________________________________________________
c. I ask that any costs for supervision be paid by:
Mom
%
Dad
%
Other (name)
%
Travel With Children
13
I ask the court to order that:
Mom
Dad
Other (name):
must have written permission
from the other parent, or a court order, to take the children outside of:
The State of California
County of: ________________________________________________
a.
b.
Other place(s) (list):
Child Abduction Risk
14
I believe that there is a risk the other parent will take our child out of California and hide the child from me.
If you check this box you must fill out and attach Form DV-108, Request for Order: No Travel with Children.
Important Instructions
You must tell the court if you find out any other information about a custody case in any court for the children
listed on this form.
If the court makes a temporary custody order, the parent receiving custody must not take the child out of
California without a noticed hearing. (See Family Code §3063.)
This is not a Court Order.
Rev. January 1, 2012
Request for Child Custody and Visitation Orders
DV-105,
Page 3 of 3
(Domestic Violence Prevention)
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