The MC-361A form serves a critical role within the California judicial system, offering a structured method for individuals to petition the court to establish the facts, time, and place of birth. This necessity arises under various circumstances, such as when birth records are misplaced, destroyed, or were never filed. The form must be completed by an attorney or a party acting without legal representation and encompasses detailed sections for personal declarations, supported by factual evidence and documents. It provides for the inclusion of personal knowledge or evidence found within specified documents, such as hospital records, physician's reports, and witness statements, all required to substantiate the claim of birth details unequivocally. Additionally, the form addresses the implications of the petition within ongoing legal proceedings, ensuring that any court order regarding the established facts of birth will be recognized and enforceable. The declaration made within the form carries the weight of perjury under California law, underscoring the seriousness with which such petitions are treated. Overall, the MC-361A form embodies an essential tool for rectifying vital records, thereby enabling individuals to assert their identity and rights within and beyond the judicature.
| Question | Answer |
|---|---|
| Form Name | Form Mc 361A |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | state court mc form, documents mc pdf, declaration fact mc form, 361a |
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
TELEPHONE NO.: |
FAX NO. (Optional): |
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ATTORNEY FOR (Name): |
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SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
IN THE MATTER OF
(Name):
DECLARATION IN SUPPORT OF PETITION TO ESTABLISH FACT, TIME, AND PLACE OF BIRTH
FOR COURT USE ONLY
CASE NUMBER:
HEARING DATE AND TIME: |
DEPT.: |
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(Name of declarant): |
declares as follows: |
1.I make the statements in this declaration based on my personal knowledge or on the contents of the documents identified in item 5. (“Personal knowledge” of a fact is knowledge that is not gained from another person's statements to you about that fact.)
2.a. I am at least 18 years of age.
b. I reside at (street address and city):
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3. (Name): |
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was born at |
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approximately (time of birth): |
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a. m. |
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p. m. |
on (date): |
at the following place: |
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a. City, town, township, or other (identify “other” if known): |
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b. |
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County: |
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State (U.S.): |
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c. |
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State or province: |
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Country: |
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4. Facts showing when and where the person named in item 3 was born and explaining how I have personal knowledge of those facts
are stated in the space below |
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are stated in Attachment 4 to this declaration. |
(If you are relying solely on the contents of the documents identified in item 5, please advise in the space below.)
Page 1 of 2
Form Adopted for Mandatory Use
Judicial Council of California
DECLARATION IN SUPPORT OF PETITION TO ESTABLISH FACT, TIME, AND PLACE OF BIRTH
Health & Safety Code, §§
(Miscellaneous)
IN THE MATTER OF
(Name):
CASE NUMBER:
5.
a.
b.
c.
d.
Attached are true and correct copies of the following documents (check each box that applies; statements of witnesses must be signed under oath, in an affidavit sworn before a Notary Public or with the following statement just above the signature:
“I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct”):
Hospital records dated (date of each):
Physician's report dated (date of each):
Witness statements dated (date of each):
Other documents dated (describe and give the date of each document; “Other documents” could include school or college records, vaccination certificates and other medical records, employment records, documents showing sources of support other than employment, family correspondence, diaries, photographs, and other similar family records):
Continued on Attachment 5d. |
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6. The birth of the person named in item 3, or the date, time, or place of birth |
is not |
is important to a court case or |
proceeding that is now pending and described below. (If you selected “is,” briefly describe the proceeding and provide the case name and number, the name and address of the court where the proceeding is pending, the names of all parties to the proceeding, and the names, addresses, and telephone numbers of their attorneys. Note: A court order made on a petition under Health and
Safety Code section 103450, et seq., may not be effective against claims of persons or organizations not given notice of the petition for the order.)
Continued on Attachment 6.
7.Number of pages attached:
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME OF DECLARANT) |
(SIGNATURE OF DECLARANT) |
DECLARATION IN SUPPORT OF PETITION TO ESTABLISH
FACT, TIME, AND PLACE OF BIRTH
Page 2 of 2
(Miscellaneous)