Case Number:
DV-140 Child Custody and Visitation Order
This form is attached to (check one): DV-110 DV-130
1 Protected person’s name: Mom Dad Other
2 Other parent’s name: COURT Mom Dad Other
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
The Court Orders: Index No.
: Calendar No.
3 Child Custody is ordered as follows: Legal Custody to: (Person Physical Custody to:
:
who makes
Plaintiff(s) decisions about health, (Person the child lives with.
JUDICIAL SUBPOENA
-against-
education, etc. Check at least one.) Check at least one.)
:
Child’s Name Date of Birth Mom Dad Other* Mom Dad Other*
:
a.
b. :
c. Defendant(s) :
......................................................
If more children, check here. Attach a sheet of paper and write “DV-140, Item 3 — Child Custody” at the top.
* If Other, specify relationship to child and name of person:
THE PEOPLE OF THE STATE OF NEW YORK
4 Child Visitation is ordered as follows:
a. No visitation to
TO Mom Dad Other (name):
b. See the attached - page document, dated:
c. The parties must go to mediation at:
d. Until the next court order, visitation for
GREETINGS: Mom Dad Other will be:
(1) Weekends (starting): business and excuses being laid is the 1st and each of you Saturday.)
WE COMMAND YOU, that all(The 1st weekend of the month aside, youweekend with a attend before
2nd
1st the Honorable 3rd 4th 5th weekend of monthCourt
at the ,
from County of at located at
a.m. p.m. to at a.m. p.m.
in(day of week)
room (time) day of
, on the , 20 (day
, at of week) (time) noon, and at any recessed
o'clock in the
or adjourned date, to testify and give evidence as a witness in this action on the part of the
(2) Weekdays (starting):
from at a.m. p.m. to at a.m. p.m.
(day of week) (time) (day of week) (time)
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
(3) the Visitation
Other party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of attach a sheet of paper
Check here and your failure to comply. if there are other visitation days and times, like holidays, birthdays, sports events.
List dates and times. Write “DV-140, Item 4 — Visitation” at the top.
Witness, Honorable , one of the Justices of the
5 Supervised Visitation
Court in — Follow orders on
County, attached
day of Form DV-150.
, 20
6 Responsibility for Transportation for Visitation
(Attorney must sign
or and type name below)
“Responsibility for transportation” means the parent will take or pick up the childabovemake arrangements for
someone else to do so.
a. Mom Dad Other (name): to the visits.
Attorney(s) for
b. Mom Dad Other (name): from the visits.
c. Drop-off / pick-up of children will be at (address):
Office and P.O. Address
This is a Court Order. Telephone No.:
Facsimile No.:
Judicial Council of California, www.courtinfo.ca.gov E-Mail Address:
Child Custody and Visitation Order DV-140, Page 1 of 2
Rev. July 1, 2003, Mandatory Form
Family Code, §§ 3020, 3022, 3040–3043, 3100, 6340, 7604 (Domestic Violence Prevention)
Mobile Tel. No.:
➔
American LegalNet, Inc.
www.USCourtForms.com
Case Number:
Protected person’s name:
7 Travel With Children
Mom Dad Other (name): must have written permission from the other
parent, or a court order, to take the children outside of:
a. The State of California
b. Other place(s) (list):
8 Child Abduction
There is a risk that one of the parents will take the children out of California without the other parent’s
permission. The orders in Form DV-145 are attached and must be obeyed. (Fill out and attach DV-145 to this
form.)
9 Other Orders
Check here and attach any other orders to this form. Write “DV-140, Item 9 — Other Orders” on the orders.
10 Jurisdiction
This court has jurisdiction to make child custody orders in this case under the Uniform Child Custody Jurisdiction
and Enforcement Act (part 3 of the California Family Code starting with section 3400).
11 Notice and Opportunity to Be Heard
The responding party was given notice and an opportunity to be heard as provided by the laws of the State of
California.
12 Country of Habitual Residence
The country of habitual residence of the child or children in this case is the United States of America
or other (specify): _______________________________________.
13 Penalties for Violating This Order
If you violate this order, you may be subject to civil or criminal penalties, or both.
This is a Court Order.
Rev. July 1, 2003 DV-140, Page 2 of 2
Child Custody and Visitation Order
(Domestic Violence Prevention)