This is not a Court Order.
This form is attached to DV-105, Request for Child Custody and Visitation Orders.
Other*Your name: Mom Dad
Other*Mom DadOther parent’s name:
*If “Other,” specify relationship with
Do you think the other parent may take the children without your permission to:
YesAnother county in Califo rnia? If “yes,” what county?Noa.
Another state? Yes If “yes,” what state?Nob.
Yes If “yes,” what country ?A foreign country? Noc.
YesIf “Yes,” is the other parent a citizen of that country? No
YesIf “Yes,” does the other parent have family or emotional ties to that country? No
Why do you think the other parent may take the children without your permission?
The other parent: (Check all that apply)
Has violated — or threatened to violate — a custody or visitation order in the past.
Does not have strong ties to California.
Sold his or her homeQuit his or her job
Ended a lease
Closed a bank account
Hidden or destroyed documents
Sold or gotten rid of assets
Applied for a passport, birth certificate, or school or medical records
Has a history of: (Check all that apply)
Not cooperating with me in parenting
Has a criminal record
Please explain your answers to a–e:
DV-108, Page 1 of 2
Has done things recently that make it easy for him or her to take the children away without permission.
He or she has: (Check all that apply)
Judicial Council of California, www.courts.ca.gov
Revised January 1, 2012, Mandatory F orm
Family Code, § 3048
Request for Order:
No Travel with Children
Request for Order: No Travel with Children
(Domestic Violence Prevention)