On December 29, 2021 a
Family Matters
was filed
involving a dispute between
Garrett, Dolores,
and
for Guardianship of Person Only
in the District Court of San Bernardino County.
Preview
FL-105/GC-1 20
ATTORNEY 0R PARTY WITHOUT ATTORNEY (Name, szate Bar number, and address): FOR COURT USE ONLY
rDoIores Garre‘t
L
22219 Sioux Rd
Apple Valley CA 92308
TELEPHONE N0; 760/713-0448 FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
‘5‘
I L E D
SUPERIOR COURY OF CALWORNM
ATTORNEY FOR (Name): Petitioner in Pro Per COUNTY 0F SAN BERNARDINO
SAN BERNARDNO DISTRICT °RDBATE DEPARTMENW
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO
STREET ADDRESS: 247 West 3rd Street
MAsLING ADDRESS: SAME AS ABOVE SEP l 5 2022
CITY AND ZIP CODE: San Bernardino, 92415-021 2
BRANCH NAME: Justice Center— Probate BY (9&9 p
PETITIONER‘.
(This section applies only to family law cases.) VALERIE URUE’KYA‘. DEPUTV
RESPONDENT:
OTHER PARTY:
GUARDIANSHIP OF (This section apples only to guardianship cases‘) CASE NUMBER:
Name): Tage Lozano GARSBZ1 00373
Minor
AMENDED DECLARATION UNDER UNIFORM CHILD CUSTODY
JURISDICTION AND ENFORCEMENT ACT (UCCJEA)
1. l am a party to this proceeding to determine custody of a child.
2. E] present address and the present address of each child residing with me is confidential under Family Code section 3429 as
My
have indicated in item 3.
I
3. There are (specify number): One (1) minor children who are subject to this proceeding, as follows:
(Insert the information requested below. The residence information must be given for the last FIVE years.)
a. Child‘s name Place of birth Date of birth Sex
Tage Lozano Victorville, CA 07/24/2011 Male
PeriOd 0f reSidence Address 2221 9 Sioux Rd Person child lived with (name and complete current address) Relationship
Apple Valley CA 92308 Dolores Garrett 2221 9 Sioux Rd
Maternal
03/2021 App‘e Va“e>" CA 92308
to present l I Confidential I l Confidential Grandmother
Child's residence (City, State) Person child lived with (name and complete current address)
1366 Lincoln Ln Cynthia Bustillos 22219 Sioux Rd Mother
2017 to 03/2021 Bullhead City, AZ Apple Valley, CA 92308
Child's residence (City, State) Person child lived with (name and complete current address)
Various unknown address‘s in Cynthia Bustillos 22219 Sioux Rd Mother
Unknown to 2017 Bullhead City, AZ Apple Valley, CA 92308
Child's reSidence (City, State) Person child lived with (name and complete current address)
to
b. Child's name Place of birth Date of birth Sex
Residence information is the same as given above for child a.
(If NOTthe same, provide the information below.)
Period of residence Address Person child lived with (name and complete current address) RelationShiP
to present Confidential Confidential
I I I I
Child's residence (City, State) Person child lived with (name and complete current address)
Child's residence (City, State) Person child lived with (name and complete current address)
t0
Child's residence (City, State) Person child lived with (name and complete current address)
to
c.
d.
D
E Additional residence information for a child listed
Additional children are listed
in
on form FL-105(A)/GC-120(A). (Provide
item a or b is continued on attachment 30.
al/ requested information for additional children.)
Page 1 of 2
Family Code. § 3400 et seq;
Form Adopted for Mandatory Use
Judicial Council of California
AMENDED DECLARATION UNDER UNIFORM CHILD CUSTODY Probate Code. §§ 1510(f). 1512
FL—105/GC-120 [Rev. January 1, 2009] JURISDICTION AND ENFORCEMENT ACT (UCCJEA) www.courtinfo.ca.gov
FL-1 05IGC-120
SHORT TITLE: CASE NUMBER:
Tage Lozano GARSBZ1 00373
4. Do you have information about, or have you participated as a party or as a witness 0r in some other capacity in, another court
case
D
or custody or visitation proceeding, in California or elsewhere, concerning a child subject
Yes
to this proceeding?
No (Ifyes, attach a copy of the orders (ifyou have one) and provide the following information):
Calm Court order Your
Proceeding Case number orJUdeent Name of each child
connection to
(name, state, location) Case status
(date) the case
am Family
b. D Guardianship
c. D Other
Proceeding Case Number Court (name, state, location)
d. E Juvenile Delinquency/
Juvenile Dependency
e. E Adoption
5. E One or more domestic violence restraining/protective orders are now
and provide the following information):
in effect. (Attach a copy of the orders ifyou have one
Court County State Case number (if known) Orders expire (date)
a. fl Criminal
b. fl Family
c' a Juvenile Delinquency/
Juvenile Dependency
d. fl Other
Do you know any person who is not a party
6.
a.
of
visitation rights with
Name and
any child in this case?
address of person
E m to this
Yes
Name and
proceeding
No
who has physical custody or claims to have custody of or
(Ifyes, provide the following information):
address of person
b. c. Name and address of person
D Has physical custody
Claims custody rights
D Has physical custody
Claims custody rights
D Has physical custody
Claims custody rights
Claims visitation rights Claims visitation rights Claims visitation n'ghts
Name of each child Name of each child Name of each child
l declare under penthy of perjury under the laws of the State of California that the foregoing is true and correct.
Date: oq« ta, 7,0}2/ x
Doiores Garrett D
(TYPE 0R PRINT NAME) (SIGNATURE OF DECLARANT)
7. Number of pages attached:
NOTICE TO DECLARANT: You have a continuing duty to inform this court if you obtain any information about a custody
proceeding in a California court or any other court concerning a child subject to this proceeding.
AMENDED DECLARATION UNDER UNIFORM CHILD CUSTODY Page 2 of 2
FL-105/GC—120 [Rem January 1, 2009]
JURISDICTION AND ENFORCEMENT ACT (UCCJEA)
Document Filed Date
September 15, 2022
Case Filing Date
December 29, 2021
Category
Guardianship of Person Only
For full print and download access, please subscribe at https://www.trellis.law/.
Preview
FL-105/GC-1 20 ATTORNEY 0R PARTY WITHOUT ATTORNEY (Name, szate Bar number, and address): FOR COURT USE ONLY rDoIores Garre‘t L 22219 Sioux Rd Apple Valley CA 92308 TELEPHONE N0; 760/713-0448 FAX NO. (Optional): E-MAIL ADDRESS (Optional): ‘5‘ I L E D SUPERIOR COURY OF CALWORNM ATTORNEY FOR (Name): Petitioner in Pro Per COUNTY 0F SAN BERNARDINO SAN BERNARDNO DISTRICT °RDBATE DEPARTMENW SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO STREET ADDRESS: 247 West 3rd Street MAsLING ADDRESS: SAME AS ABOVE SEP l 5 2022 CITY AND ZIP CODE: San Bernardino, 92415-021 2 BRANCH NAME: Justice Center— Probate BY (9&9 p PETITIONER‘. (This section applies only to family law cases.) VALERIE URUE’KYA‘. DEPUTV RESPONDENT: OTHER PARTY: GUARDIANSHIP OF (This section apples only to guardianship cases‘) CASE NUMBER: Name): Tage Lozano GARSBZ1 00373 Minor AMENDED DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) 1. l am a party to this proceeding to determine custody of a child. 2. E] present address and the present address of each child residing with me is confidential under Family Code section 3429 as My have indicated in item 3. I 3. There are (specify number): One (1) minor children who are subject to this proceeding, as follows: (Insert the information requested below. The residence information must be given for the last FIVE years.) a. Child‘s name Place of birth Date of birth Sex Tage Lozano Victorville, CA 07/24/2011 Male PeriOd 0f reSidence Address 2221 9 Sioux Rd Person child lived with (name and complete current address) Relationship Apple Valley CA 92308 Dolores Garrett 2221 9 Sioux Rd Maternal 03/2021 App‘e Va“e>" CA 92308 to present l I Confidential I l Confidential Grandmother Child's residence (City, State) Person child lived with (name and complete current address) 1366 Lincoln Ln Cynthia Bustillos 22219 Sioux Rd Mother 2017 to 03/2021 Bullhead City, AZ Apple Valley, CA 92308 Child's residence (City, State) Person child lived with (name and complete current address) Various unknown address‘s in Cynthia Bustillos 22219 Sioux Rd Mother Unknown to 2017 Bullhead City, AZ Apple Valley, CA 92308 Child's reSidence (City, State) Person child lived with (name and complete current address) to b. Child's name Place of birth Date of birth Sex Residence information is the same as given above for child a. (If NOTthe same, provide the information below.) Period of residence Address Person child lived with (name and complete current address) RelationShiP to present Confidential Confidential I I I I Child's residence (City, State) Person child lived with (name and complete current address) Child's residence (City, State) Person child lived with (name and complete current address) t0 Child's residence (City, State) Person child lived with (name and complete current address) to c. d. D E Additional residence information for a child listed Additional children are listed in on form FL-105(A)/GC-120(A). (Provide item a or b is continued on attachment 30. al/ requested information for additional children.) Page 1 of 2 Family Code. § 3400 et seq; Form Adopted for Mandatory Use Judicial Council of California AMENDED DECLARATION UNDER UNIFORM CHILD CUSTODY Probate Code. §§ 1510(f). 1512 FL—105/GC-120 [Rev. January 1, 2009] JURISDICTION AND ENFORCEMENT ACT (UCCJEA) www.courtinfo.ca.gov FL-1 05IGC-120 SHORT TITLE: CASE NUMBER: Tage Lozano GARSBZ1 00373 4. Do you have information about, or have you participated as a party or as a witness 0r in some other capacity in, another court case D or custody or visitation proceeding, in California or elsewhere, concerning a child subject Yes to this proceeding? No (Ifyes, attach a copy of the orders (ifyou have one) and provide the following information): Calm Court order Your Proceeding Case number orJUdeent Name of each child connection to (name, state, location) Case status (date) the case am Family b. D Guardianship c. D Other Proceeding Case Number Court (name, state, location) d. E Juvenile Delinquency/ Juvenile Dependency e. E Adoption 5. E One or more domestic violence restraining/protective orders are now and provide the following information): in effect. (Attach a copy of the orders ifyou have one Court County State Case number (if known) Orders expire (date) a. fl Criminal b. fl Family c' a Juvenile Delinquency/ Juvenile Dependency d. fl Other Do you know any person who is not a party 6. a. of visitation rights with Name and any child in this case? address of person E m to this Yes Name and proceeding No who has physical custody or claims to have custody of or (Ifyes, provide the following information): address of person b. c. Name and address of person D Has physical custody Claims custody rights D Has physical custody Claims custody rights D Has physical custody Claims custody rights Claims visitation rights Claims visitation rights Claims visitation n'ghts Name of each child Name of each child Name of each child l declare under penthy of perjury under the laws of the State of California that the foregoing is true and correct. Date: oq« ta, 7,0}2/ x Doiores Garrett D (TYPE 0R PRINT NAME) (SIGNATURE OF DECLARANT) 7. Number of pages attached: NOTICE TO DECLARANT: You have a continuing duty to inform this court if you obtain any information about a custody proceeding in a California court or any other court concerning a child subject to this proceeding. AMENDED DECLARATION UNDER UNIFORM CHILD CUSTODY Page 2 of 2 FL-105/GC—120 [Rem January 1, 2009] JURISDICTION AND ENFORCEMENT ACT (UCCJEA)