Fillable FAM201 (LA Court)

Fill Online, Printable, Fillable, Blank FAM201 (LA Court) Form

Use Fill to complete blank online LA COURT pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

FAM201 (LA Court)

On average this form takes 9 minutes to complete

The FAM201 (LA Court) form is 2 pages long and contains:

  • 0 signatures
  • 41 check-boxes
  • 16 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your LA Court forms online.

BROWSE LA COURT FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Page 1 of 2
SURROGACY JUDGMENT CHECKLIST
LASC FAM 201 Rev. 05/21
For Mandatory Use
NAME, ADDRESS AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT ATTORNEY:
STATE BAR NUMBER
Reserved for Clerk’s File Stamp
ATTORNEY FOR (NAME): EMAIL:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES
COURT HOUSE ADDRESS:
PETITIONER / PLAINTIFF
RESPONDENT / DEFENDANT
OTHER
SURROGACY JUDGMENT CHECKLIST
CASE NUMBER:
DEPT. NUMBER:
DATE PETITIONED:
SUBJECT MATTER JURISDICTION
The Court has jurisdiction in this proceeding to determine
parentage of the child pursuant to Family Code Section
7620(b) because (check all that apply):
the Petitioner(s) reside(s) in this state;
the Petitioner(s) resided in this state at the time the
assisted reproduction agreement for gestational
carriers was executed;
the Respondent(s) reside(s) in this state;
the Respondent(s) resided in this state at the time the
assisted reproduction agreement for gestational
carriers was executed;
the medical procedures leading to conception,
including in vitro fertilization or embryo transfer, or
both, were carried out in this state; and/or
the child was/is expected to be born in this state.
VENUE
COMPLIANCE WITH FAMILY CODE 7962
If a case does not technically meet all of the requirements
of Family Code Section 7962, then under Family Code
Section 7962(f)(2), the court is not prevented from
entering a parentage order, so long as the parties have
provided sufficient proof entitling them to the relief
sought. However, in this case, the parties have complied
with all the requirements of Family Code Section 7962
for the reasons stated below:
1)
7962(
a) The assisted reproduction agreement for
gestational carriers contains:
(1) the date on which the assisted reproduction
agreement for gestational carriers was executed;
(2) the persons from which the gametes originated
(unless anonymously donated, in which case the
donated gametes are identified in the agreement)
Source of Ova:
Venue is proper before this Court pursuant to Family Code
Sections 7620(c)(5) and 7962(e) because (check all that
apply):
Intended Parent(s):
Donor
Source of Sperm:
Intended Parent(s):
Donor;
it is anticipated the child(ren) will be born in this county;
the intended parent(s) reside(s) in this county;
the gestational surrogate resides in this county;
the assisted reproduction agreement for gestational
carriers was executed in this county; and/or
the medical procedures pursuant to the assisted
reproduction agreement for gestational carriers were
performed in this county.
(3)
the identity, or identities, of the intended parents;
and
(continued on next page)
Page 2 of 2
SURROGACY JUDGMENT CHECKLIST
LASC FAM 201 Rev. 05/21
For Mandatory Use
CA Bar #:
(4) disclosure of how the intended parent(s) will cover
the medical expenses of the gestational carrier and
newborn(s). Any health care coverage used to
cover the medical expenses was reviewed for any
possible liability of the gestational carrier, including
any third-party liability liens or other insurance
coverage, and any notice requirements that could
affect coverage or liability of the gestational carrier.
If coverage of liability was uncertain at the time of
execution, a statement of that fact is included in the
The following documents are submitted in support of this
action to establish a parent-child relationship:
Judicial Council Forms:
FL-105 UCCJEA -- Petitioner(s)
FL-105 UCCJEA -- Respondent(s)
FL-130 Appearance, Stipulation, and Waivers
FL-190 Notice of Entry of Judgment
FL-200 Petition to Determine Parental Relationship
FL-210 Summons
assisted reproduction agreement for gestational
FL-220 Response to Petition to Determine Parental
carriers.
2)
7962(b) Prior to executing the written assisted
reproduction agreement for gestational carriers, the
surrogate and the intended parent(s) were represented by
separate independent licensed attorneys of their choosing.
3)
7962(c) The assisted reproduction agreement for
gestational carriers was executed by the parties in the
presence of a Notary Public, or witnessed by an equivalent
method of affirmation as required in the jurisdiction the
agreement was executed in.
Relationship
FL-230 Declaration for Default or Uncontested
Judgment -- Petitioner(s)
FL-230 Declaration for Default or Uncontested
Judgment -- Respondent(s)
FL-235 Advisement and Waiver of Rights -- Petitioner(s)
FL-235 Advisement and Waiver of Rights -- Respondent(s)
FL-240 Stipulation for Entry of Judgment
FL-250 Judgment
Attachment 5h to FL-250
Long Forms:
Declaration(s) of Petitioner(s)
Declaration(s) of Respondent(s)
4)
7962(d) The parties did not undergo an embryo transfer
Declaration of IVF Physician
procedure, or commence injectable medication in
Declaration of Attorney for Petitioner(s)
preparation for an embryo transfer until the assisted
Declaration of Attorney for Respondent(s)
reproduction agreement for gestational carriers was fully
executed as required by Family Code Sections 7962(b) and
7962(c).
5)
7962(e) A copy of the assisted reproduction agreement
for gestational carriers has been lodged with this court.
Other:
A Copy of the assisted reproduction agreement for
gestational carriers has been executed, notarized
(or the equivalent), and is lodged with the Court.
A true and accurate copy is acceptable.
6)
7962(e) The parties have attested, under penalty of
Criminal Background Check(s) for Petitioner(s)
perjury and to the best of their knowledge and belief, as to
Order Sealing Records (if requested) is:
their compliance with Family Code Section 7962 in entering
Filed as a separate Order
into the assisted reproduction agreement.
Included in Attachment 5h to the FL-25
Filing Fees:
$435 Filing Fee for Petitioners
$435 Filing Fee for Respondents
I declare under penalty of perjury of the law of the Status of California that the foregoing is true and correct.
Signature Date
, Esq.
Attorney for Petitioners
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

FAM201 (LA Court)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 30 October 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document