FL-172
Page 1 of 2
Form Approved for Optional Use
Judicial Council of California
FL-172 [New January 1, 2012]
www.courts.ca.gov
PETITION2.
The petition for
dissolution legal separation nullity parentage other (specify):
was filed on (date):
BACKGROUND DATA
3.
There is a dispute about the length of the marriage or partnership.
Date of marriage/registered domestic partnership:a.
b.
c.
Date of separation on the petition:
on the response (if different):
Length of marriage or partnership:
Name of child or children
Birthdate Age
CHILDREN
4.
Gender
Additional children listed on Attachment 4.
RELATED CASES
5.
One or both of the parties, or a child or children of the parties, has been involved in other related court cases. (List county or district
and case number, if known):
Custody or visitation (parenting time) for the children of this case:
Juvenile delinquency:
Juvenile dependency:
Domestic violence/protective order:
Bankruptcy:
Criminal (only if reasonably related to the issues of this case):
Other:
CASE INFORMATION—FAMILY LAW
a.
b.
c.
d.
e.
f.
g.
6.
JUDGMENT TERMINATING STATUS OF MARRIAGE OR DOMESTIC PARTNERSHIP HAS BEEN ENTERED
a.
Date of termination:
Date status judgment entered:
b.
(THIS FORM IS FOR COURT USE ONLY)
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
CASE NUMBER:
CASE INFORMATION—FAMILY LAW
ASSIGNMENT Case assigned to
1.
OTHER PARTY:
Judicial Officer (name): Dept. No.
Interpreter needed
Petitioner's Language:
Respondent's Language:
Other Party's Language:
(1)
(2)
(3)
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FL-172
PETITIONER:
CASE NUMBER:
RESPONDENT:
Page 2 of 2
FL-172 [New January 1, 2012]
DISCLOSURE
8.
Service of declarations of disclosure has been completed by:
Preliminary
Final
Petitioner Respondent
PROTECTIVE ORDERS
9.
The parties have a restraining order that expires on (date):
Protected party (name):
Children are included as protected persons.
DEPARTMENT OF CHILD SUPPORT SERVICES
10.
The Department of Child Support Services has a separate case open.
The Department of Child Support Services has intervened in this case.
CUSTODY/PARENTING TIME (VISITATION)
11.
The parties have participated in child custody and visitation (parenting time) mediation.
An agreement has been reached.
Counsel has been appointed to represent the minor child or children.
A child custody evaluation has been ordered report has been filed.
CASE INFORMATION—FAMILY LAW
a.
b.
a.
b.
a.
b.
c.
d.
Petitioner Respondent
EXPERTS
12.
The following experts have been appointed (include issues):
OTHER
13.
SERVICE AND RESPONSE
7.
Respondent was served with the petition on (date): , by (method):
personal service substituted service publication or posting notice and acknowledgement
other (specify):
Respondent has not been served with the petition.
Respondent filed a response on (date):
Respondent has not filed a response with the court.
Default has been entered against respondent.
a.
b.
c.
d.
e.
Final has been waived by Petitioner Respondent
OTHER PARTY:
Respondent appeared by filing an Appearance, Stipulations, and Waivers (form FL-130).f.
of receipt
a.
b.
c.
Other (specify):
d.
Petitioner Respondent
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