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
V FL-105/GC-1 20
ATFORNEY 0R PARTY WITHOUT ATTORNEY (Name, Slate Bar number, and address): FOR COURT USE ONLY
_ Dolores Garrett
22219 Sioux Rd., Apple Valley, CA 92308
TELEPHONE N0.: (760) 71 3'0448 FAX No.
E-MAIL ADDRESS (Optional):
(Optional):
F l
SUPERIOR COURT 0F CALnFORMA
L E D
ATTORNEY FOR COUNTY 0F SAN BERNARmNo
(Name):
IN PRO PER
SAN BERNARDINO DISTRICT
SUPERIOR COURT OF CALIFORNIA, COUNTY OF San Bernardino
STREET ADDRESS 247 W. 3rd Street, 2nd Floor
MAlLING ADDRESS:
DEC 2 9 2021
ctTY AND ZIP CODE: San Bernardino, CA 9241 5-02 1 2
BRANCH NAME:
PETITIONER:
Probate Division
(This section applies only to family law cases.)
BY _ W S A RAZO, DEPUTY
RESPONDENT:
OTHER PARTY:
(This section apples only to guardianship cases.) CASE NUMBER:
GUARDIANSHIP 0F (Name).- .
M'”°'
Tage Lozano
DECLARATION UNDER UNIFORM CHILD CUSTODY
AND ENFORCEMENT ACT (UCCJEA)
JURISDICTION
1. l am a party to this proceeding to determine custody of a child.
2. E3 My present address and me is confidential under Family Code section 3429 as
the present address of each child residing with
have indicated in item 3.
I
3. There are (specify number): one minor children who are subject to this proceeding, as follows:
(Insert the information requested below. The residence information must be for the last FIVE years.)
LEgiven
a. Child's name
,wmyPmived lace of hp
a «b Date of binh Sex
x
Tage Lozano
Period 0' residence
”\fi to present
(name c
Address 22219 Sioux Rd., Apple Valley,
D
92308
Confidential
Child' s residence (City. Stare)
CA
‘c,
E
6A
Person
n
onfidential
with
t
child lived with
Pr
07/24/11
(name and com
@us'rt
and
M
late curr
mp/ete current address)
‘
M
RelationShiP 2»
moTH a1.
MB? TEFE‘fl.
“
WKQ’V’“)(>974 [3&9 Ltflwb") L‘NE ’rIM. LIMEY
bvxuu—aean c‘r‘y, L chTA—na
Child's residence (City, State)
éflm
Person chilflived with (name and complete current address)
Fme
MgrfielL
(o
Child's residence (City, State) Person child lived wkh (name and complete current address)
to
b. Child's name Place of birth Date of birth Sex
E Residence information is the same as given above
(If NOT the same, provide the information below.)
for child a.
Period of residence Address Person child lived with (name and complete current address) Re'ationShiP
m present E Confidential
Child's residence (City, State)
a
Person
Confidential
child lived with (name and complete current address)
IO
Child's residence (City, State) Person child lived with (name and complete current address)
to
Child's residence (CITY. State) Person child lived with (name and complete current address)
to
d.
E
E Additional residence information for a child listed
Additional children are |isted
in item a or b
on form FL-105(A)/GC-120(A). (Provide
is continued on attachment 30.
all requested information for additional children.)
Lage 1 ovz
Pygmcmgaggggygggrgsguse DECLARATION UNDER UNIFORM CHILD CUSTODY Fm“! °°de~§34°°e‘se~q
FL-wos/sc-1zoxaev.Januaw 1, zoos] JURISDICTION AND ENFORCEMENT ACT (UCCJ EA)
PW“ C‘infifoliififi’ea‘jli
\r y FL-1 05/GC-120
CASE NUMBER:
SHORT TITLE: Guardianship 0f:
Tage Lozano “$31.53 Dntm
thgyF”???
other capacity in, ‘fi'o'TE'er‘gourt case
. Do you have information about, or have you participated as a party or as a witness or in some
concerning a subject to this proceeding?
D m
or custody or visitation proceeding, in
Yes
I
California or elsewhere, child
No (Ifyes, attach a copy of the orders (ifyou have one) and provide the following information):
Court order I
Your
Court Name 0f eaCh Ch'ld
Proceeding Case number orjudgment connection to Case status
(name '
State location)
I
the case
(date)
a. E Family
b. E] Guardianship
c. E Other
Case Number Court (name, state, location)
Proceeding
d' D Juvenile Delinquency/
Juvenile Dependency
e. E Adoption
5. E One or
and provide
more domestic violence restraining/protective orders are
the following information):
now in effect. (Attach a copy of the orders ifyou have one
County State Case number (ifknown) Orders expire (date)
Court
a. E Criminal
b. E Family
C' E Juvenile Delinquency/
Juvenile Dependency
d. E Other
6.
a.
Do you know
visitation rights
Name and
of any person who is not a party
with any child in this case?
address of person
E
b.
Yes
Name and
g
to this proceeding who has physical custody or claims to have custody
No (IfyeS. provide the following information):
address of person c, Name and address of person
of or
D
E Has physical custody E
D Has physical custody E
E Has physical custody
D Clagms cy§toqy rights
Clalms VISItatIon rights E
Name
Claims custody rights
c|aims visitation rights
of each child
EName
Claims custody rights
Claims visitation rights
of each child
Name of each child
and correct.
declare u der penalty of perjury under the laws of the State of California thatt e
foregqing is true
|
Date: \L.‘L“ -uz,\
Dolores Garrett ’
(TYPE 0R PRINT NAME) (SIGNATURE 0F DECLARANT)
7. E 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.
Pasezor
DECLARATION UNDER UNIFORM CHILD CUSTODY
2
FL-ws/Gc-womev-Januaw1.20091
JURISDICTION AND ENFORCEMENT ACT (UCCJEA)
Document Filed Date
December 29, 2021
Case Filing Date
December 29, 2021
Category
Guardianship of Person Only
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Preview
V FL-105/GC-1 20 ATFORNEY 0R PARTY WITHOUT ATTORNEY (Name, Slate Bar number, and address): FOR COURT USE ONLY _ Dolores Garrett 22219 Sioux Rd., Apple Valley, CA 92308 TELEPHONE N0.: (760) 71 3'0448 FAX No. E-MAIL ADDRESS (Optional): (Optional): F l SUPERIOR COURT 0F CALnFORMA L E D ATTORNEY FOR COUNTY 0F SAN BERNARmNo (Name): IN PRO PER SAN BERNARDINO DISTRICT SUPERIOR COURT OF CALIFORNIA, COUNTY OF San Bernardino STREET ADDRESS 247 W. 3rd Street, 2nd Floor MAlLING ADDRESS: DEC 2 9 2021 ctTY AND ZIP CODE: San Bernardino, CA 9241 5-02 1 2 BRANCH NAME: PETITIONER: Probate Division (This section applies only to family law cases.) BY _ W S A RAZO, DEPUTY RESPONDENT: OTHER PARTY: (This section apples only to guardianship cases.) CASE NUMBER: GUARDIANSHIP 0F (Name).- . M'”°' Tage Lozano DECLARATION UNDER UNIFORM CHILD CUSTODY AND ENFORCEMENT ACT (UCCJEA) JURISDICTION 1. l am a party to this proceeding to determine custody of a child. 2. E3 My present address and me is confidential under Family Code section 3429 as the present address of each child residing with have indicated in item 3. I 3. There are (specify number): one minor children who are subject to this proceeding, as follows: (Insert the information requested below. The residence information must be for the last FIVE years.) LEgiven a. Child's name ,wmyPmived lace of hp a «b Date of binh Sex x Tage Lozano Period 0' residence ”\fi to present (name c Address 22219 Sioux Rd., Apple Valley, D 92308 Confidential Child' s residence (City. Stare) CA ‘c, E 6A Person n onfidential with t child lived with Pr 07/24/11 (name and com @us'rt and M late curr mp/ete current address) ‘ M RelationShiP 2» moTH a1. MB? TEFE‘fl. “ WKQ’V’“)(>974 [3&9 Ltflwb") L‘NE ’rIM. LIMEY bvxuu—aean c‘r‘y, L chTA—na Child's residence (City, State) éflm Person chilflived with (name and complete current address) Fme MgrfielL (o Child's residence (City, State) Person child lived wkh (name and complete current address) to b. Child's name Place of birth Date of birth Sex E Residence information is the same as given above (If NOT the same, provide the information below.) for child a. Period of residence Address Person child lived with (name and complete current address) Re'ationShiP m present E Confidential Child's residence (City, State) a Person Confidential child lived with (name and complete current address) IO Child's residence (City, State) Person child lived with (name and complete current address) to Child's residence (CITY. State) Person child lived with (name and complete current address) to d. E E Additional residence information for a child listed Additional children are |isted in item a or b on form FL-105(A)/GC-120(A). (Provide is continued on attachment 30. all requested information for additional children.) Lage 1 ovz Pygmcmgaggggygggrgsguse DECLARATION UNDER UNIFORM CHILD CUSTODY Fm“! °°de~§34°°e‘se~q FL-wos/sc-1zoxaev.Januaw 1, zoos] JURISDICTION AND ENFORCEMENT ACT (UCCJ EA) PW“ C‘infifoliififi’ea‘jli \r y FL-1 05/GC-120 CASE NUMBER: SHORT TITLE: Guardianship 0f: Tage Lozano “$31.53 Dntm thgyF”??? other capacity in, ‘fi'o'TE'er‘gourt case . Do you have information about, or have you participated as a party or as a witness or in some concerning a subject to this proceeding? D m or custody or visitation proceeding, in Yes I California or elsewhere, child No (Ifyes, attach a copy of the orders (ifyou have one) and provide the following information): Court order I Your Court Name 0f eaCh Ch'ld Proceeding Case number orjudgment connection to Case status (name ' State location) I the case (date) a. E Family b. E] Guardianship c. E Other Case Number Court (name, state, location) Proceeding d' D Juvenile Delinquency/ Juvenile Dependency e. E Adoption 5. E One or and provide more domestic violence restraining/protective orders are the following information): now in effect. (Attach a copy of the orders ifyou have one County State Case number (ifknown) Orders expire (date) Court a. E Criminal b. E Family C' E Juvenile Delinquency/ Juvenile Dependency d. E Other 6. a. Do you know visitation rights Name and of any person who is not a party with any child in this case? address of person E b. Yes Name and g to this proceeding who has physical custody or claims to have custody No (IfyeS. provide the following information): address of person c, Name and address of person of or D E Has physical custody E D Has physical custody E E Has physical custody D Clagms cy§toqy rights Clalms VISItatIon rights E Name Claims custody rights c|aims visitation rights of each child EName Claims custody rights Claims visitation rights of each child Name of each child and correct. declare u der penalty of perjury under the laws of the State of California thatt e foregqing is true | Date: \L.‘L“ -uz,\ Dolores Garrett ’ (TYPE 0R PRINT NAME) (SIGNATURE 0F DECLARANT) 7. E 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. Pasezor DECLARATION UNDER UNIFORM CHILD CUSTODY 2 FL-ws/Gc-womev-Januaw1.20091 JURISDICTION AND ENFORCEMENT ACT (UCCJEA)