Form JV-296 "De Facto Parent Statement" - California

What Is Form JV-296?

This is a legal form that was released by the California Superior Court - 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, 2007;
  • The latest edition provided by the California Superior Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form JV-296 by clicking the link below or browse more documents and templates provided by the California Superior Court.

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Download Form JV-296 "De Facto Parent Statement" - California

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Clerk stamps below when form is filed.
JV-296
De Facto Parent Statement
To keep other people from
seeing what you entered on
your form, please press the
Clear This Form button at the
1
My/Our name(s):
end of the form when finished.
2
The child’s name:
Boy
Girl
3
Child’s date of birth:
Age:
Relationship to child (grandparent, foster parent, etc.):
Court name and street address:
Superior Court of California, County of
4
The child has lived with me from:
(date)
to (date)
(date)
to (date)
5
I have had responsibility for the day-to-day care of the child
Case Number:
from:
(date)
to (date)
(date)
to (date)
Information the judge should know about my relationship with
6
the child. (This part must be completed).
a. Amount of time I spend with the child (daily, weekly, etc.):
d. I
have
have not attended
court hearings about the child.
e. I
have
have not sent a written
report to the court about the child.
b. Activities I do with the child:
c. Kinds of information I have about the child that others may not have (medical, educational, behavioral, etc.):
7
I declare under penalty of perjury under the laws of the State of California that the information on this form is
true and correct to my knowledge. This means if I lie on this form, I am committing a crime.
Date:
Type or print your name
Signature of person requesting de facto parent status
Date:
Type or print your name
Signature of person requesting de facto parent status
JV-296,
Judicial Council of California‚ www.courtinfo.ca.gov
Page 1 of 1
De Facto Parent Statement
Revised January 1, 2007, Mandatory Form
Cal. Rules of Court‚ rule 5.534(e)
For your protection and privacy, please press the Clear This Form
Save This Form
Print This Form
Clear This Form
button after you have printed the form.
Clerk stamps below when form is filed.
JV-296
De Facto Parent Statement
To keep other people from
seeing what you entered on
your form, please press the
Clear This Form button at the
1
My/Our name(s):
end of the form when finished.
2
The child’s name:
Boy
Girl
3
Child’s date of birth:
Age:
Relationship to child (grandparent, foster parent, etc.):
Court name and street address:
Superior Court of California, County of
4
The child has lived with me from:
(date)
to (date)
(date)
to (date)
5
I have had responsibility for the day-to-day care of the child
Case Number:
from:
(date)
to (date)
(date)
to (date)
Information the judge should know about my relationship with
6
the child. (This part must be completed).
a. Amount of time I spend with the child (daily, weekly, etc.):
d. I
have
have not attended
court hearings about the child.
e. I
have
have not sent a written
report to the court about the child.
b. Activities I do with the child:
c. Kinds of information I have about the child that others may not have (medical, educational, behavioral, etc.):
7
I declare under penalty of perjury under the laws of the State of California that the information on this form is
true and correct to my knowledge. This means if I lie on this form, I am committing a crime.
Date:
Type or print your name
Signature of person requesting de facto parent status
Date:
Type or print your name
Signature of person requesting de facto parent status
JV-296,
Judicial Council of California‚ www.courtinfo.ca.gov
Page 1 of 1
De Facto Parent Statement
Revised January 1, 2007, Mandatory Form
Cal. Rules of Court‚ rule 5.534(e)
For your protection and privacy, please press the Clear This Form
Save This Form
Print This Form
Clear This Form
button after you have printed the form.