DV-140 Child Custody and Visitation Order

DV-140
This is a Court Order.
Case Number:
Child Custody and Visitation
Order
DV-130DV-110This form is attached to (check one):
Mom Dad Other*Name of Protected Person:
Mom Dad Other*
Other Parent’s Name:
The Court Orders:
Physical Custody to:
(Person the child lives with.
Check at least one.)
Legal Custody to: (Person
who makes decisions about
health, education. Check at
least one.)
Child Custody is ordered as follows:
Mom Dad Other* Mom Dad Other*Date of BirthChild’s Name
a.
b.
c.
If more children, check here. Attach a sheet of paper and write “DV-140, Child Custody” for a title.
* If Other, specify relationship to child and name of person:
Child Visitation is ordered as follows:
Mom DadNo visitation toa. Other (name):
See the attachedb. - page document, dated:
The parties must go to mediation at:
c.
Mom Dad Other (name):Until the next court order, visitation for
will be:d.
(1) (The 1st weekend of the month is the 1st weekend with a Saturday.)
Weekends (starting):
1st 2nd 4th3rd
5th weekend of month
from
at ata.m. a.m.p.m. to
p.m.
(time) (time)(day of week) (day of week)
(2)
Weekdays
(starting):
from
at ata.m. a.m.p.m. to
p.m.
(time) (time)(day of week) (day of week)
Other Visitation(3)
Check here and attach a sheet of paper if there are other visitation days and times, like holidays,
birthdays, sports events. List dates and times. Write “DV- 140, Other Visitation” for a title.
Supervised Visitation or Exchange
Judicial Council of California, www.courts.ca.gov
Rev. January 1, 2012 , Ma ndatory Form
Family Code, §§ 3020, 3022, 3040–3043, 3100 , 6340,7604
DV-140, Page 1 of 2
Child Custody and Visitation Order
5
* If Other, specify relationship to child:
1
2
3
4
5
(Domestic Violence Prevention)
Visits and/or exchanges of children are supervised as specified on Form DV-150, Supervised Visitation and
Exchange Order.
To keep other people from seeing what you entered on your form, please press the
Clear This Form button at the end of the form when finished.
Page 1/2
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