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CA DCSS 0053 2005-2024 free printable template

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STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF CHILD SUPPORT SERVICES VISITATION VERIFICATION DCSS 0053 08/29/05 CSE Case Number Name of person completing form I am the Custodial Party Noncustodial Parent PART 1. SHARED CUSTODY/VISITATION CHECK ONE Shared Custody Visitation Only Neither VISITATION HOURS Regular Visitation From specify day of the week at specify time Circle one a.m./p.m. To specify day of the week Vacation Visitation If Yes please specify dates/times Yes No...
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The parent(s) who visit the child(men) may either be both the father and mother. 2. ATTESTATION BY A PARENT OF THE NONCUSTODIAL PARENT 3. ADDRESS AND SIGN THE GATHERING MATERIALS 4. EXAMPLE OF GATHERING MATERIALS 5. COMPLETE THE APPLICATION: I, (NAME), declare under penalties of perjury that: I understand that I will be required to complete the visitation materials and answer any questions required before I will be allowed to view or photograph any physical evidence of child abuse; I understand that the evidence of child abuse may not be shown or photographed to any other person except the person in this case who is the custodial parent of such child(men) or a licensed medical practitioner or the court, as the judge may establish; I understand that I must sign and return all portions of the visitation material (including a signed and dated copy of the document I have just completed, together with my signature, before it will be accepted by the court); I understand that if I submit the custody agreement, visitation agreement, or parenting plan that I have signed and returned in my presence, I need not bring a third party with me; I understand that I may not sign this application until I have been served with this order; and I understand that the document I have signed and returned is only sufficient to permit me to view or photograph the physical evidence, not the child(men) whose photographs are to be shown or photographed, nor that the photos of the child(men) depicted on the documents I have signed and returned will be used for any purpose other than to show or photograph the child(men) whose photographs are to be shown or photographed, and that the photo will not be used in any other manner than to show or photograph the child(men) whose photographs are to be shown or photographed; and I understand that I have not signed an unwritten prenup agreement, and that I have not been granted exclusive physical custody of such child(men) or the court has rejected my plan to give up some or all of my rights and responsibilities to the noncustodial parent. I understand that I will be required to appear at the first scheduled court appearance if my visitation request for visitation is denied, and that I have ten (10) calendar days to provide the court with reason for my belief that I need more time for visitation.

Who needs a DCSS 0053?

This form is to be completed either by non custodial or custodial parent visiting their child during past 12 months.

What is DCSS 0053 for?

Department of Child Support Services of California use information provided by this form for visitation verification. Control data must coincide with the parameters that are set in the case of a particular parent by the state court. This form can serve as a source of information for all sorts of proceedings in matters of child’s custody.

Is DCSS 0053 accompanied by other forms?

This fillable Visitation Verification form does not need to be accompanied by other forms. However, it may be a necessary accompaniment for other documents related to regulation of the rights of custody.

When is DCSS 0053 due?

There is no deadline for the submission of this form. You can fill this out when the need arises.

How do I fill out DCSS 0053?

The form consists of two pages. The first is intended to be filled out by a noncustodial parent, and the second should provide information about shared custody/visitations. The completed form should be signed and dated.

Where do I send DCSS 0053?

Filled and signed, the form may be provided to anyone to whom it may concern, as well as directed to Department of Child Support.

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