SAMPLE DECLARATION / AFFIDAVIT

Double-space everything from the first number, down to the end, and indent paragraphs by ten spaces.



Name:

________________________________________

Address:

________________________________________

________________________________________

Phone:

________________________________________

Email:

________________________________________





                                  DECLARATION OF FACTS







        I, (Your Name), state:

                             

        1. I am the mother/father of three children: (Names of kids.) 

        2. This declaration is being written (state reason for writing the declaration of facts - for example, "in support of a motion to return children to mother" or "in support of a national class action lawsuit" or "to let the public know about the injustice done to us in (name of county) Superior Court".

        3. This is in reference to (Case Name, Case Number, Date Filed and the name of the court.)

        4. (Just state facts one at a time... I'll give some examples.) On June 2, 2002 I let my children go to school as usual and while they were there a CPS employee interviewed them without letting me know first.

        5. My children were detained by the CPS employee and I was not notified by the school so by 4:30 when they didn't come home from school I was worried about them and called the school to find out if they knew anything.

        6. When I called the school nobody wanted to talk to me and they handed the phone to three different people and put me on hold for fifteen minutes.

        7. When the principal got on the line he told me that CPS took one of my kids because he had a bruise on his arm and said I did it.

        8. The bruise happened because he climbed the apple tree and then got scared and couldn't get down. I climbed up there and grabbed him and had to lower him down by his arm and that's how he got bruised.

        9. I haven't seen my children in three weeks because they say I'm a danger to them. This is not true. 

        10. The CPS employees I talk to on the phone are extremely rude to me. They are Judy Jones and their supervisor, Mr. Smith. Judy Jones said very sarcastically that I should never have had kids if I was going to hurt them. She won't believe this happened in the apple tree. 

[NOTE: This last part should state the exact words used, just change the date and place to match your circumstance.]

        Executed June 28, 2002 at Yreka, California.

        I declare under penalty of perjury that the foregoing is true and correct.

                                                                            _________________________________

                                                                                                        (Your Name)