PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

OTHER PARENT:

CASE NUMBER:

FL-130(A)

DECLARATION AND CONDITIONAL WAIVER OF RIGHTS 
UNDER THE SERVICEMEMBERS CIVIL RELIEF ACT 
Attachment to Appearance, Stipulations, and Waivers (form FL-130) 

                                                       Notice to Servicemember 
The Servicemembers Civil Relief Act (50 U.S.C. §§ 3901–4043) is a federal law that provides 
protections for military members when they enter active duty. You may obtain a copy of the act 
from the public law library or from the website of the United States Department of Justice at

.

By signing this conditional waiver and attaching it to Appearance, Stipulations, and Waivers (form 
FL-130), I declare that I am entitled to the benefits of the Servicemembers Civil Relief Act (SCRA), 
and: 

1. To permit the court to decide this cause as an uncontested matter and enter a judgment that 

incorporates the terms of the written agreement made between the petitioner and me (a copy of 
which is attached to this form), I make a knowing, intelligent, and voluntary conditional waiver of 
the right to seek to set aside a default judgment entered against me in this matter, as provided by 
section 3918 of the SCRA.

2.  This waiver is conditioned as follows:

a.  The waiver applies only to a default judgment that incorporates the terms and conditions of 

the written agreement between the petitioner and me that is titled (specify):
(1)

Stipulation for Judgment

(2)

(3)

Marital Settlement Agreement

Other (specify):

b.  The court must enter a judgment in this case that incorporates only the terms and conditions of 

the above written agreement without any change; and

c.  Should the court enter a judgment that changes the above written agreement in any way, then I 

do not waive any of my rights under the SCRA, including my right to seek to set aside the 
judgment at any time.

3.  This conditional waiver was executed during or after a period of military service.

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

Date:

 (form FL-130). 

Form Approved for Optional Use 
Judicial Council of California 
FL-130(A) [Rev. January 1, 2023]

(TYPE OR PRINT NAME)

(SIGNATURE OF RESPONDENT)

                                                             Attention: Clerk of the Court 

   By law, a servicemember must not be charged a fee to file Appearance, Stipulations, and Waivers 

DECLARATION AND CONDITIONAL WAIVER OF RIGHTS 
UNDER THE SERVICEMEMBERS CIVIL RELIEF ACT 

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 Government Code, § 70673