Declaration Of Physician Re Change Of Gender {CIV-393} | Pdf Fpdf Docx | California

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Declaration Of Physician Re Change Of Gender {CIV-393} | Pdf Fpdf Docx | California

Declaration Of Physician Re Change Of Gender {CIV-393}

This is a California form that can be used for Civil within Local County, San Diego.

Alternate TextLast updated: 3/28/2018

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SDSC CIV-393 (New 2/18) DECLARATION OF PHYSICIAN RE CHANGE OF GENDER Health & Saf. Code 247247 103425, 103430, Optional Form 103435, 103440 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): TELEPHONE NO.: FAX NO.(Optional): EMAIL ADDRESS (Optional): ATTORNEY FOR (Name): FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRAL DIVISION, CENTRAL COURTHOUSE, 1100 UNION ST., SAN DIEGO, CA 92101 CENTRAL DIVISION, CIVIL, 330 W. BROADWAY, SAN DIEGO, CA 92101 NORTH COUNTY DIVISION, 325 S. MELROSE DR., VISTA, CA 92081 PETITION OF: DECLARATION OF PHYSICIAN RE CHANGE OF GENDER CASE NUMBER I, , am a licensed physician in the state of . I attest that petitioner , whose medical record indicates a date of birth of , is a patient of mine for the purpose of gender transition. I attest the petitioner has undergone the clinically appropriate treatment for the purpose of gender transition to male female. Physician222s Medical License or Certificate Number: Physician222s Address: Physician222s Tel. No.: I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: Signature American LegalNet, Inc. www.FormsWorkFlow.com

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