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Annual Declaration Under Penalty Of Perjury Conflict Accountability FM-1084 - California
| Annual Declaration Under Penalty Of Perjury Conflict Accountability Form. This is a California form and can be used in Family Law Santa Clara Local County . |
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CONFLICT AND ACCOUNTABLITY PROGRAM PROVIDER (Name and Address): FOR COURT USE ONLY TELEPHONE NO: E-MAIL ADDRESS (Optional): FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH: 170 Park Avenue 191 North First Street San Jose, California 95113 Park Avenue Courthouse Family ANNUAL DECLARATION UNDER PENALTY OF PERJURY CONFLICT ACCOUNTABILITY I, Name of Professional Provider , do hereby declare under penalty of perjury that I and everyone I employ as a provider of Conflict and Accountability agree to abide by the standards for structure and content as published on September 16, 2008 by the Conflict and Accountability Task Group, a subcommittee of the DV Court Systems Committee. www.sccsuperiorcourt.org. This publication is attached and available on the Court's website at Name of Provider: Address of Provider: Name of Signatory: Signature of Signatory: Date: Please send completed original form to: Superior Court of California, County of Santa Clara Attn: Family Court Services 191 North First Street, San Jose, CA 95113 FM-1084 REV 9/2/09 ANNUAL DECLARATION UNDER PENALTY OF PERJURY CONFLICT ACCOUNTABILITY Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com
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