Fillable Petition to Establish Parental Relationship September 4, 2018 (California)

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Petition to Establish Parental Relationship September 4, 2018 (California)

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Superior Court of California, County of Sacramento
Family Law & Probate
Petition-Marriage/Domestic Partnership Page 1 of 1
Cover Sheet:
Petition to Establish Parental Relationship
Effective Date:
September 4, 2018
Last Revision Date:
October 29, 2020
Purpose:
These forms are used to start a Parentage case. Once filed, this
case can be used to obtain orders for establishing parentage, child
custody, child support and changing a child’s name.
Assistance:
Parties who are acting as their own attorneys may receive help from
the Self Help Center to complete these forms. You may contact the
Self Help Center through the Court’s website, by creating an e-
Correspondence account.
Required Forms:
All forms are Judicial Council forms, unless otherwise indicated:
•
Summons, FL-210
•
Petition to Establish Parental Relationship, FL-200
•
Declaration Under Uniform Child Custody Jurisdiction and
Enforcement Act (UCCJEA), FL-105
•
Family Law Case Participant Enrollment Form (Party), local
form FL/E-LP-665
Filing Fee:
There is a $435 fee to file these documents. The current fee
schedule may be found on the Court’s website at:
https://www.saccourt.ca.gov/fees/docs/fee-schedule.pdf.
Copies:
Make two copies of the completed forms. The Court will file and
keep the original and will endorse and return the copies to you.
Filing:
All forms must be typewritten or printed in blue or black ink. (See
California Rules of Court, Rules 2.100-2.119)
Mail or place completed forms in the court drop-box located at the
Family Court at 3341 Power Inn Road, Sacramento, CA 95826.
Drop box hours are 8:00 am to 5:00 pm Monday through Friday,
excluding Court holidays.
Next Steps:
Filing these forms is the first step only. Seek legal assistance to
determine the next steps to complete your case.
FL-210
SUMMONS
(Parentage—Custody and Support)
CITACIÓN (Paternidad—Custodia y Manutención)
NOTICE TO RESPONDENT (Name):
FOR COURT USE ONLY
(SOLO PARA USO DE LA CORTE)
You have been sued. Read the information below and on the next page.
Lo han demandado. Lea la información a continuación y en la página siguiente.
Petitioner's name:
CASE NUMBER: (Número de caso)
AVISO AL DEMANDADO (Nombre):
El nombre del demandante:
You have 30 calendar days after this Summons and Petition
are served on you to file a Response (form FL-220 or FL-270)
at the court and have a copy served on the petitioner. A
letter, phone call, or court appearance will not protect you.
If you do not file your Response on time, the court may make
orders affecting your right to custody of your children. You
may also be ordered to pay child support and attorney fees
and costs.
For legal advice, contact a lawyer immediately. Get help
finding a lawyer at the California Courts Online Self-Help
Center (www.courts.ca.gov/selfhelp), at the California Legal
Services website (www.lawhelpca.org), or by contacting your
local bar association.
Tiene 30 dias de calendario después de habir recibido la entrega legal
de esta Citación y Petición para presentar una Respuesta (formulario
FL-220 o FL-270) ante la corte y efectuar la entrega legal de una copia
al demandante. Una carta o llamada telefónica o una audiencia de la
corte no basta para protegerlo.
Si no presenta su Respuesta a tiempo, la corte puede dar órdenes que
afecten la custodia de sus hijos. La corte también le puede ordenar que
pague manutención de los hijos, y honorarios y costos legales.
Para asesoramiento legal, póngase en contacto de inmediato con un
abogado. Puede obtener información para encontrar un abogado en el
Centro de Ayuda de las Cortes de California (www.sucorte.ca.gov), en
el sitio web de los Servicios Legales de California (www.lawhelpca.org),
o poniéndose en contacto con el colegio de abogados de su condado.
NOTICE: The restraining order on page 2 remains in effect
against each parent until the petition is dismissed, a judgment
is entered, or the court makes further orders. This order is
enforceable anywhere in California by any law enforcement
officer who has received or seen a copy of it.
AVISO: La órden de protección que aparecen en la pagina 2
continuará en vigencia en cuanto a cada parte hasta que se emita un
fallo final, se despida la petición o la corte dé otras órdenes. Cualquier
agencia del orden público que haya recibido o visto una copia de estas
orden puede hacerla acatar en cualquier lugar de California.
, Deputy (Asistente)
Clerk, by (Secretario, por)
[SEAL]
Page 1 of 2
Family Code, §§ 232, 233, 7700;
Cal. Rules of Court, rule 5.50
www.courts.ca.gov
Form Adopted for Mandatory Use
Judicial Council of California
FL-210 [Rev. January 1, 2015]
SUMMONS
(Parentage—Custody and Support)
Date (Fecha):
1.
2.
The name and address of the court are: (El nombre y dirección de la corte son:)
The name, address, and telephone number of petitioner’s attorney, or petitioner without an
attorney, are: (El nombre, la dirección y el número de teléfono del abogado del demandante, o del
demandante si no tiene abogado, son:)
FEE WAIVER: If you cannot pay the filing fee, ask the clerk
for a fee waiver form. The court may order you to pay back all
or part of the fees and costs that the court waived for you or
the other party.
EXENCIÓN DE CUOTAS: Si no puede pagar la cuota de presentación,
pida al secretario un formulario de exención de cuotas. La corte puede
ordenar que usted pague, ya sea en parte o por completo, las cuotas y
costos de la corte previamente exentos a petición de usted o de la otra
parte.
William R. Ridgeway Family Relations Courthouse
3341 Power Inn Road
Sacramento, CA 95826
ORDEN DE RESTRICCIÓN ESTÁNDAR
(Paternidad—Custodia y Manutención)
Starting immediately, you and every other party are restrained from removing from the state, or applying for a
passport for, the minor child or children for whom this action seeks to establish a parent-child relationship or
a custody order without the prior written consent of every other party or an order of the court.
This restraining order takes effect against the petitioner when he or she files the petition and against the respondent
when he or she is personally served with the Summons and Petition OR when he or she waives and accepts service.
This restraining order remains in effect until the judgment is entered, the petition is dismissed, or the court makes
other orders.
This order is enforceable anywhere in California by any law enforcement officer who has received or seen a copy of it.
En forma inmediata, usted y cada otra parte tienen prohibido llevarse del estado a los hijos menores para
quienes esta acción judicial procura establecer una relación entre hijos y padres o una orden de custodia, ni
pueden solicitar un pasaporte para los mismos, sin el consentimiento previo por escrito de cada otra parte o
sin una orden de la corte.
Esta orden de restricción entrará en vigencia para el demandante una vez presentada la petición, y para el
demandado una vez que éste reciba la notificación personal de la Citación y Petición, o una vez que renuncie su
derecho a recibir dicha notificación y se dé por notificado.
Esta orden de restricción continuará en vigencia hasta que se emita un fallo final, se despida la petición o la corte dé
otras órdenes.
Cualquier agencia del orden público que haya recibido o visto una copia de esta orden puede hacerla acatar en
cualquier lugar de California.
Page 2 of 2
SUMMONS
(Parentage—Custody and Support)
FL-210 [Rev. January 1, 2015]
STANDARD RESTRAINING ORDER
(Parentage—Custody and Support)
FL-210
NOTICE—ACCESS TO AFFORDABLE HEALTH
INSURANCE Do you or someone in your household need
affordable health insurance? If so, you should apply for
Covered California. Covered California can help reduce the
cost you pay toward high-quality, affordable health care.
For more information, visit www.coveredca.com. Or call
Covered California at 1-800-300-1506.
AVISO
—ACCESO A SEGURA DE SALUD MÁS
ECONOMICO Necessita seguro de salud a un costo
asequible, ya sea para usted o alguien en su hogar? Si es
asi, puede presentar una solicitud con Covered California.
Covered California lo puede ayudar a reducir al costo que
paga por seguro de salud asequible y de alta calidad. Para
obtener más información, visite www.coveredca.com. O
llame a Covered California al 1-800-300-0213.
wants to be determined as not a parent of the children listed in item 2 because (specify):
respondent is the parent of the children listed in item 2 above.
respondent is the children's parent and has failed to support the children.
the children live or are found in this county.
parentage has been determined by a voluntary declaration of parentage or paternity. (Attach a copy if available.)
a.
PETITION TO DETERMINE PARENTAL RELATIONSHIP
(Uniform Parentage)
gave birth to the children listed in item 2.
e.
d.
c.
is the child or the child's personal representative
b.
wants to be determined as a parent of the children in item 2 because (specify):
PETITION TO DETERMINE PARENTAL RELATIONSHIP
FOR COURT USE ONLY
ATTORNEY FOR (name):
E-MAIL ADDRESS:
FAX NO.:TELEPHONE NO.:
ZIP CODE:STATE:CITY:
STREET ADDRESS:
FIRM NAME:
NAME:
PARTY WITHOUT ATTORNEY OR ATTORNEY
STATE BAR NUMBER:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
PETITIONER:
RESPONDENT:
CASE NUMBER:
FL-200
1. The petitioner
(specify court and date of appointment):
Other
Other
public assistance is being provided to the children.
(specify):
(name):
(specify):
Other
(specify):
2.
a child who is not yet born.
Child's name
Birthdate Age
b.
The children are
a.
3. The court has jurisdiction over the respondent because the respondent:
The action is brought in this county because (you must check one or more to file in this county):
Petitioner claims
(check all that apply):
6.
5.
4.
a.
b.
a.
b.
c.
a.
b.
c.
d. has furnished or is furnishing the following reasonable expenses
of pregnancy and birth for which the respondent as parent of the children should pay:
Amount Payable to
For (specify):
f.
A completed Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) (form FL-105) is attached.
e.
had sexual intercourse in this state, which resulted in conception of the children listed in item 2.
lives in this state.
a parent is deceased and proceedings for administration of the estate have been or could be started in this county.
Form Approved for Optional Use
Judicial Council of California
FL-200 [Rev. January 1, 2020]
Family Code, § 7630
www.courts.ca.gov
Page 1 of 2
Sacramento
William R. Ridgeway Family Relations Courthouse
Sacramento, CA 95826
3341 Power Inn Road
3341 Power Inn Road
OTHER ORDERS REQUESTED
Petitioner
Petitioner requests genetic testing to determine whether the
The facts in support of the requested custody and visitation (parenting time) orders are
e.
FL-200 [Rev. January 1, 2020]
Page 2 of 2
PETITION TO DETERMINE PARENTAL RELATIONSHIP
(Uniform Parentage)
Date:
RESPONDENT:
PETITIONER:
CASE NUMBER:
FL-200
(TYPE OR PRINT NAME)
Petitioner asks the court to make the determinations indicated below.
CHILD CUSTODY AND VISITATION (PARENTING TIME)
PARENT-CHILD RELATIONSHIP (check all that apply):
7.
8.
is the parent of the children listed in item 2.
is found to be the parent of the children listed in item 2.a. If
CHILD SUPPORT
The court may make orders for support of the children and issue an earnings assignment without further notice to either party.
12.
REASONABLE EXPENSES OF PREGNANCY AND BIRTH
9.
NAME CHANGE11.
FEES AND COSTS OF LITIGATION
10.
a.
b.
Attorney fees to be paid by
Expert fees, guardian ad litem fees, and other costs of
the action or pretrial proceedings to be paid by
I have read the restraining order on the back of the
Summons
(FL-210) and I understand it applies to me when this Petition is filed.
14.
13.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Petitioner
Respondent Joint
Petitioner
Respondent Joint
Reasonable expenses of pregnancy
and birth to be paid by
a. Petitioner
Respondent
Respondent
children listed in item 2.
c. Petitioner
Respondent
is not the parent of the children listed in item 2.
b. Petitioner Respondent
Contained in the attached declaration.
Children's names be changed, according to Family Code section 7638, as follows (specify old and new names):
(SIGNATURE OF PETITIONER)
A blank Response to Petition to Determine Parental Relationship (form FL-220) must be served on the respondent with this petition.
NOTICE: If you have a child from this relationship, the court is required to order child support based upon the income of
both parents. Support normally continues until the child is 18. You should supply the court with information about your
finances. Otherwise, the child support order will be based upon information supplied by the other parent. Any party
required to pay child support must pay interest on overdue amounts at the "legal" rate, which is currently 10 percent.
(specify):
as follows:
is the parent of the
(specify):
Legal custody of children to
.........................................................
....................................................
Physical custody of children to
Child visitation (parenting time) be granted to
.............................
As requested in
Petitioner Respondent Joint Other
c.
d.
b.
form FL-311 form FL-312 form FL-341(C)
form FL-341(D) form FL-341(E) Attachment 6c(1)
Person child lived with
(name and complete current address)
Person child lived with
(name and complete current address)
Person child lived with
(name and complete current address)
Person child lived with
(name and complete current address)
Person child lived with
(name and complete current address)
Person child lived with
(name and complete current address)
Person child lived with
(name and complete current address)
Person child lived with
(name and complete current address)
Additional children are listed on form
FL-105
(
A)/GC-120(A)
.
(Provide all requested information for additional children.)
FL-105/GC-120
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
CASE NUMBER:
DECLARATION UNDER UNIFORM CHILD CUSTODY
JURISDICTION AND ENFORCEMENT ACT (UCCJEA)
1.
I am a party
to this proceeding to determine custody of a child.
2. My present address and the present address of each child residing with me is confidential under Family Code section 3429 as
I have indicated in item 3.
3. There are
(specify number):
(Insert the information requested below. The residence information must be given for the last FIVE years.)
a. Child’s name
Place of birth Date of birth Sex
Period of residence
Address
Relationship
Confidential
to present
to
to
to
b. Child’s name
Place of birth Date of birth Sex
Residence information is the same as given above for child a.
(If NOT the same, provide the information below.)
Period of residence
Address
Relationship
Confidential
to present
to
to
to
Additional residence information for a child listed in item a or b is continued on attachment 3c.
c.
Page 1 of 2
Family Code, § 3400 et seq.; Form Adopted for Mandatory Use
Judicial Council of California
FL-105/GC-120 [Rev. January 1, 2009]
DECLARATION UNDER UNIFORM CHILD CUSTODY
JURISDICTION AND ENFORCEMENT ACT (UCCJEA)
Probate Code, §§ 1510(f), 1512
minor children who are subject to this proceeding, as follows:
www.courtinfo.ca.gov
TELEPHONE NO.:
FAX NO.
(Optional):
E-MAIL ADDRESS
(Optional):
ATTORNEY FOR
(Name):
ATTORNEY OR PARTY WITHOUT ATTORNEY
(Name, State Bar number, and address):
PETITIONER:
RESPONDENT:
GUARDIANSHIP OF
(Name):
Minor
OTHER PARTY:
Child's residence (
City, State)
Child's residence
(City, State)
Child's residence
(City, State)
d.
Child's residence (
City, State
)
Child's residence
(City, State)
Child's residence
(City, State)
(
This section applies only to family law cases.)
(This section apples only to guardianship cases.)
Confidential
Confidential
Sacramento
Juvenile Delinquency/
Juvenile Dependency
and provide the following information):
5. One or more domestic violence restraining/protective orders are now in effect.
(Attach a copy of the orders if you have one
a. Criminal
b. Family
d. Other
Court State Case number
(if known)
County Orders expire
(date)
Court
(name, state, location)
Court order
or judgment
(date)
Case status
b. Guardianship
c. Other
Name of each child
a. Family
Case number
Court
(name, state, location)
e. Adoption
Juvenile Delinquency/
Juvenile Dependency
Case Number
Your
connection to
the case
CASE NUMBER:
SHORT TITLE:
Do you have information about, or have you participated as a party or as a witness or in some other capacity in, another court case
or custody or visitation proceeding, in California or elsewhere, concerning a child subject to this proceeding?
Yes
(If yes, attach a copy of the orders (if you have one) and provide the following information):
Do you know of any person who is not a party to this proceeding who has physical custody or claims to have custody of or
visitation rights with any child in this case?
(If yes, provide the following information):
Yes
a. Name and address of person
b. Name and address of person
c. Name and address of person
Has physical custody
Has physical custody
Has physical custody
Claims custody rights
Claims custody rights
Claims custody rights
Claims visitation rights
Claims visitation rights
Claims visitation rights
Name of each child Name of each child Name of each child
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)
7. Number of pages attached:
NOTICE TO DECLARANT: You have a continuing duty to inform this court if you obtain any information about a custody
FL-105/GC-120 [Rev. January 1, 2009]
Page 2 of 2
DECLARATION UNDER UNIFORM CHILD CUSTODY
JURISDICTION AND ENFORCEMENT ACT (UCCJEA)
4.
6.
No
proceeding in a California court or any other court concerning a child subject to this proceeding.
No
FL-105/GC-120
Proceeding
Proceeding
c.
d.
Important Notice about Access to Your Case
Due to the court closure and significant reduction in services, the court is
unable to provide court orders, minute orders, and child custody mediation
reports in person or by mail; they are only available online using our Public
Case Access System. The court is also unable to provide you with access
to your court file.
Access to court orders and minute orders is the only way to obtain
instructions on how to appear for hearings and trials, and to know what the
court ordered in your case. Access to child custody mediation reports is
necessary so that you know what child custody, visitation, or other
requirements that the mediator recommended to the court.
To get secure access to your case online, you must complete and submit to
the court the attached Family Law Case Participant Enrollment Form -
Party, along with a copy of your driver’s license to get an account to our
Public Case Access System. A separate form must be filed for each case
or when you change your email address.
Once you complete the form, you must submit it in person at the courthouse
(Monday through Friday 8:00 a.m. to 5:00 p.m.) using the Drop Box, or by
US Mail at 3341 Power Inn Road, Sacramento, CA 95826.
Submitting the form immediately is important because it takes:
• Three working days for the court to process it if filed by Drop Box
• Seven working days for the court to process it after mailing using
US Mail
Once your access is set up you will receive an email letting you know that
you are subscribed to your case. If you do not receive an email notifying
you that you are subscribed to your case during the timeframes identified
above, please inform the court using our Contact Us page at:
https://www.saccourt.ca.gov/contact.aspx.
Local Form Adopted for Mandatory Use
FAMILY LAW CASE PARTICIPANT ENROLLMENT FORM
CONFIDENTIAL
FOR COURT USE ONLY
CASE PARTICIPANT
NAME: STATE BAR NO:
FIRM NAME:
ADDRESS:
CITY: STATE: ZIP CODE:
E-MAIL ADDRESS: (must be legible) TELEPHONE NO.:
ATTORNEY FOR (Name): FAX NO. (Optional):
NAME OF COURT:
Superior Court of California, County of Sacramento
STREET ADDRESS:
3341 Power Inn Road
MAILING ADDRESS:
CITY AND ZIP CODE:
Sacramento, CA 95826
BRANCH NAME:
William R. Ridgeway Family Relations Courthouse
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
CLAIMANT:
FAMILY LAW CASE PARTICIPANT ENROLLMENT FORM (PARTY)
CASE NUMBER:
You may access orders for law and motion hearings, and mediation reports prepared by Family Court Services using the
court's online Public Case Access System. Free access is available for 72 hours from the time the order is issued or the
report is prepared, or from the time the court creates your case subscription. After 72 hours, you may pay for copies.
INSTRUCTIONS
To setup your account you must:
I,
Law case.
I understand if I change my email address I must file a new enrollment form with the court.
, request that the court create an account and/or subscription to my Family
I acknowledge that confidential mediation reports contain private information that is not part of the public court file. I
understand that without a court order, I must not disclose any contents of the Report to anyone (including any minor
children) other than the parties to my case (Petitioner/Respondent/Claimant), their attorneys and court professionals. I
acknowledge that the court may impose a penalty for any unauthorized disclosure of any content of the Family Court
Services report.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)
•
File this form with the court with a copy of your driver license or a state or federal issued photo identification card.
•
A separate form must be filed for each of your Family Law cases.
•
Once the court has created your subscription to your case, you will receive a confirming email. You must follow
the instructions in that email to complete the process.
www.saccourt.ca.gov
FL/E-LP-665 (Rev 5/17/2021)
(Please use Ø for zero, 1 for one and clearly differentiate i, L, S, 5, 3 and 8's).
(PARTY)
•
Once your subscription is completed, you will receive an email notification each time an order or report is added to
your case.
I declare that my private email address is (must be legible):
CA
At the time of service I was at least 18 years of age and not a party to this action. I served the respondent with copies of:
PROOF OF SERVICE OF SUMMONS
(Family Law—Uniform Parentage—Custody and Support)
Form Approved for Optional Use
Judicial Council of California
FL-115 [Rev. January 1, 2015]
FL-115
1.
and
a.
(1)
(2)
(3)
(7)
b.
c.
–or–
–or–
(5)
(6)
(4)
a.
I served the respondent by the following means (check proper boxes):
on (date): at (time):
b.
(1)
(2)
(name):
d.
Page 1 of 2
(8)
Code of Civil Procedure, § 417.10
www.courts.ca.gov
who is (specify title or relationship to respondent):
PROOF OF SERVICE OF SUMMONS
FOR COURT USE ONLY
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
PETITIONER:
RESPONDENT:
CASE NUMBER:
Family Law—Marriage/Domestic Partnership: Petition—Marriage/Domestic Partnership (form FL-100), Summons (form
FL-110), and blank Response—Marriage/Domestic Partnership (form FL-120)
Uniform Parentage: Petition to Establish Parental Relationship (form FL-200), Summons (form FL-210), and blank
Response to Petition to Establish Parental Relationship (form FL-220)
Custody and Support: Petition for Custody and Support of Minor Children (form FL-260), Summons (form FL-210), and
blank Response to Petition for Custody and Support of Minor Children (form FL-270)
Completed and blank Declaration Under
Uniform Child Custody Jurisdiction and
Enforcement Act (form FL-105)
Completed and blank Declaration of
Disclosure (form FL-140)
Completed and blank Schedule of Assets
and Debts (form FL-142)
Completed and blank Income and
Expense Declaration (form FL-150)
Completed and blank Financial Statement
(Simplified) (form FL-155)
Completed and blank Property
Declaration (form FL-160)
Request for Order (form FL-300), and blank
Responsive Declaration to Request for Order (form
FL-320)
Other (specify):
2.
3.
Personal service. I personally delivered the copies to the respondent (Code Civ. Proc., § 415.10)
Substituted service. I left the copies with or in the presence of
(Business) a person at least 18 years of age who was apparently in charge at the office or usual place of
business of the respondent. I informed him or her of the general nature of the papers.
(Home) a competent member of the household (at least 18 years of age) at the home of the respondent. I
informed him or her of the general nature of the papers.
on (date):
A declaration of diligence is attached, stating the actions taken to first attempt personal service.
I thereafter mailed additional copies (by first class, postage prepaid) to the respondent at the place where the
copies were left (Code Civ. Proc., § 415.20b) on
(date):
at (time):
Address where respondent was served:
Sacramento
William R. Ridgeway Family Relations Courthouse
Sacramento, CA 95826
3341 Power Inn Road
3341 Power Inn Road
Person who served papers
The fee for service was (specify): $
a.
b.
c.
(1)
Registration no.:
County:
5.
6.
PROOF OF SERVICE OF SUMMONS
(Family Law—Uniform Parentage—Custody and Support)
FL-115 [Rev. January 1, 2015]
4.
This person is
(2)
c.
(1)
(2)
(specify code section):
d.
–or–
Name:
Telephone number:
d.
Page 2 of 2
CASE NUMBER:
RESPONDENT:
PETITIONER:
FL-115
3.
Mail and acknowledgment service. I mailed the copies to the respondent, addressed as shown in item 2, by
first-class mail, postage prepaid, on
Other
with two copies of the Notice and Acknowledgment of Receipt (form FL-117) and a postage-paid return
envelope addressed to me. (Attach completed Notice and Acknowledgment of Receipt (form FL-117).)
(Code Civ. Proc., § 415.30.)
to an address outside California (by registered or certified mail with return receipt requested). (Attach signed
return receipt or other evidence of actual delivery to the respondent.) (Code Civ. Proc., §§ 415.40, 417.20.)
Continued on Attachment 3d.
Address:
exempt from registration under Business and Professions Code section 22350(b).
not a registered California process server.
a registered California process server:
an employee or an independent contractor
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
I am a California sheriff, marshal, or constable, and I certify that the foregoing is true and correct.
Date:
(NAME OF PERSON WHO SERVED PAPERS)
(SIGNATURE OF PERSON WHO SERVED PAPERS)
(date):
from (city):
I agree I received the following:
NOTICE AND ACKNOWLEDGMENT OF RECEIPT
(Family Law)
Form Approved for Optional Use
Judicial Council of California
FL-117 [Rev. January 1, 2015]
FL-117
a.
b.
c.
Page 1 of 1
Code of Civil Procedure, § 415.30, 417.10
www.courts.ca.gov
NOTICE AND ACKNOWLEDGMENT OF RECEIPT
FOR COURT USE ONLY
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
PETITIONER:
RESPONDENT:
CASE NUMBER:
Family Law: Petition—Marriage/Domestic Partnership (form FL-100), Summons (form FL-110), and blank Response—
Marriage/Domestic Partnership (form FL-120)
Uniform Parentage: Petition to Establish Parental Relationship (form FL-200), Summons (form FL-210), and blank
Response to Petition to Establish Parental Relationship (form FL-220)
Custody and Support: Petition for Custody and Support of Minor Children (form FL-260), Summons (form FL-210), and
blank Response to Petition for Custody and Support of Minor Children (form FL-270)
ACKNOWLEDGMENT OF RECEIPT
NOTICE
The documents identified below are being served on you by mail with this acknowledgment form. You must personally sign, or a
person authorized by you must sign, this form to acknowledge receipt of the documents.
If the documents described below include a summons and you fail to complete and return this acknowledgment form to the sender
within 20 days of the date of mailing, you will be liable for the reasonable expenses incurred after that date in serving you or
attempting to serve you with these documents by any other methods permitted by law. If you return this form to the sender, service
of a summons is deemed complete on the date you sign the acknowledgment of receipt below. This is not an answer to the action.
If you do not agree with what is being requested, you must submit a completed Response form to the court within 30 calendar days.
To (name of individual being served):
Recipient signed this acknowledgment on (specify date):
Date of mailing (specify):
(TYPE OR PRINT SENDER'S NAME)
(SIGNATURE OF SENDER—MUST NOT BE A PARTY IN THIS CASE
AND MUST BE 18 YEARS OR OLDER)
(SIGNATURE OF PERSON ACKNOWLEDGING RECEIPT)
(TYPE OR PRINT NAME OF PERSON ACKNOWLEDGING RECEIPT)
(1)
(2)
(3)
(7)
(4)
d.
(8)
Completed and blank Declaration Under Uniform
Child Custody Jurisdiction and Enforcement Act
(form FL-105)
Completed and blank Declaration of Disclosure
(form FL-140)
Completed and blank Schedule of Assets and
Debts (form FL-142)
Completed and blank Property Declaration (form
FL-160)
Request for Order (form FL-300), and blank
Responsive Declaration to Request for Order
(form FL-320)
Other (specify):
(6)
Completed and blank Financial Statement
(Simplified) (form FL-155)
Completed and blank Income and Expense
Declaration (form FL-150)
(5)
4.
2.
1.
3.
5.
6.
(Sender completes items 1 through 4 and signs before mailing. Recipient completes items 5 and 6, signs, then returns)
Sacramento
William R. Ridgeway Family Relations Courthouse
Sacramento, CA 95826
3341 Power Inn Road
3341 Power Inn Road
FL-220
FOR COURT USE ONLY
RESPONSE TO PETITION TO ESTABLISH PARENTAL RELATIONSHIP
(Uniform Parentage)
CASE NUMBER:
1. The children are
(name each):
Date of birth
SexAge
A child who is not yet born
b.
3. The respondent
a.
was in California when the listed children were conceived.
b.
c.
4. The children
a.
are children of a parent who is deceased, and proceedings for administration of the estate have been or could be started
in this county.
b.
5. The respondent is
a. the father of the children listed in item 1 above.
b. the mother of the children listed in item 1 above.
not certain if he or she is the parent of the children listed in item 1 above.
c.
d.
Page 1 of 2
RESPONSE TO PETITION TO ESTABLISH PARENTAL RELATIONSHIP
(Uniform Parentage)
Form Approved for Optional Use
Judicial Council of California
FL-220 [Rev. January 1, 2006]
Family Code, § 7600
www.courtinfo.ca.gov
a. Child’s name
neither a nor b
lives in the State of California.
live or are in this county.
not the parent of the children listed in item 1 above.
PETITIONER:
RESPONDENT:
ATTORNEY OR PARTY WITHOUT ATTORNEY
(Name, State Bar number, and address):
TELEPHONE NO.:
FAX NO.
(Optional):
E-MAIL ADDRESS
(Optional):
ATTORNEY FOR
(Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
2. The petitioner is
a. the mother of the children listed above.
b. the father of the children listed above.
not certain whether he or she is the biological parent of the children listed above.c.
d.
e. other
(specify):
the child or child
’
s representative
(specify court and date of appointment):
d. other
(specify):
6. Additional statements
a. Parentage has been established by a Voluntary Declaration of Paternity
(attach copy).
c. Public assistance is being provided to the children.
other
(specify):
e
b. Parentage has been established in another case governmental child support
other
(specify):
3341 Power Inn Road
Sacramento
3341 Power Inn Road
Sacramento, CA 95826
William R. Ridgeway Family Relations Courthouse
PETITIONER:
CASE NUMBER:
RESPONDENT:
The respondent requests that the court make the orders listed below.
Petitioner Respondent a.
is the parent of the children listed in item 1.
8.
Child custody and visitation
Petitioner Joint
Other
b. Legal custody of the children should go to
c. Physical custody of the children should go to
None(1)
(2) Reasonable visitation
Petitioner Respondent should have the right to visit the children as follows
(specify):
(3)
Visitation should occur with the following restrictions
(specify):
(4)
(5)
9.
Reasonable expenses of pregnancy and birth
Reasonable expenses of pregnancy and birth should be paid by
Both
Petitioner
10.
Fees and costs of litigation
Both
a. Attorney fees should be paid by
b. Expert fees, guardian ad litem fees, and other costs
of the action or pretrial proceedings should be paid by
11.
Name change.
The children’s names should be changed, according to Family Code section 7638, as follows
(specify old
13.
Child support.
The court may make orders for support of the children and issue an earnings assignment without further notice
to either party.
I have read the restraining order on the back of the
Summons
(form FL-210) and I understand it applies to me.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME) (SIGNATURE OF RESPONDENT)
NOTICE: If you have a child from this relationship, the court is required to order child support based upon the income of
both parents. Support normally continues until the child is 18. You should supply the court with information about your
finances. Otherwise, the child support order will be based upon information supplied by the other parent. Any party
required to pay child support must pay interest on overdue amounts at the “legal” rate, which is currently
10 percent.
FL-220 [Rev. January 1, 2006]
Page 2 of 2
7.
Parent-child relationship
(check all that apply):
d. Visitation of the children should be as follows:
I request mediation to work out a parenting plan.
RespondentPetitioner
Respondent
Respondent
RESPONSE TO PETITION TO ESTABLISH PARENTAL RELATIONSHIP
(Uniform Parentage)
b.
Other
(specify):
Petitioner Respondent
is not the parent of the children listed in item 1.Other
(specify):
a. If
Respondent Petitioner
Other is found to be the parent of the children in listed in item 1:
FL-220
12.
Other orders requested
(specify):
Respondent requests genetic (blood) tests to determine whether the petitioner respondent is the parent
of the children listed.
c.
and new names):
INFORMATION SHEET FOR PROOF OF SERVICE BY MAIL
Use these instructions to complete the
Proof of Service by Mail
(form FL-335).
A person at least 18 years of age or older must serve the documents. There are two ways to serve documents:
(1) personal delivery and (2) by mail. See the
Proof of Personal Service
(form FL-330) if the documents are being
personally served. The person who serves the documents must complete a proof of service form for the documents
being served.
You cannot serve documents if you are a party to the action.
INSTRUCTIONS FOR THE PERSON WHO SERVES THE DOCUMENTS (TYPE OR PRINT IN BLACK INK)
You must complete a proof of service for each package of documents you serve. For example, if you serve the respondent
and the other parent, you must complete two proofs of service; one for the respondent and one for the other parent.
Complete the top section of the proof of service forms as follows:
documents.
Second box, left side:
Print the name of the county in which the legal action is filed and the court’s address in this box.
Third box, left side
: Print the names of the petitioner/plaintiff, respondent/defendant, and other parent in this box. Use
the same names listed on the documents you are serving.
First box, top of form, right side:
Leave this box blank for the court’s use.
You cannot serve a temporary restraining order by mail. You must serve those documents by personal service.
You are stating that you are at least 18 years old and that you are not a party to this action. You are also stating that
you either live in or are employed in the county where the mailing took place.
Print your home or business address.
List the name of each document that you mailed (the exact names are listed on the bottoms of the forms).
Check this box if you put the documents in the regular U.S. mail.
Check this box if you put the documents in the mail at your place of employment.
Print the name you put on the envelope containing the documents.
Print the address you put on the envelope containing the documents.
Print the date that you put the envelope containing the documents in the mail.
Print the city and state you were in when you mailed the envelope containing the documents.
You are stating under penalty of perjury that the information you have provided is true and correct.
Print your name, fill in the date, and sign the form.
If you need additional assistance with this form, contact the family law facilitator in your county.
INFORMATION SHEET FOR PROOF OF SERVICE BY MAIL
FL-335-INFO [New January 1, 2012]
Page 1 of 1
First box, left side:
In this box print the name, address, and phone number of the person for whom you are serving the
Second box, right side:
Print the case number in this box. This number is also stated on the documents you are serving.
2.
1.
3.
a.
b.
4. a.
b.
c.
d.
6.
Check this box if you are serving an address verification form (required for service by mail of a postjudgment request to
change a child custody, visitation, or child support order).
5.
Third box, right side:
Print the hearing date, time, and department. Use the same information that is on the documents
you are serving.
FL-335-INFO
Code of Civil Procedure, §§ 1013, 1013a
www.courts.ca.gov
Use the same address for the court that is on the documents you are serving.
FL-335
ATTORNEY OR PARTY WITHOUT ATTORNEY
(Name, State Bar number, and address):
FOR COURT USE ONLY
CASE NUMBER:
PROOF OF SERVICE BY MAIL
NOTICE: To serve temporary restraining orders you must use personal service (see form FL-330).
I am at least 18 years of age, not a party to this action, and I am a resident of or employed in the county where the mailing took
place.
My residence or business address is:
I served a copy of the following documents
(specify):
by enclosing them in an envelope AND
a.
depositing
the sealed envelope with the United States Postal Service with the postage fully prepaid.
b.
The envelope was addressed and mailed as follows:
Name of person served:
Date mailed:
Place of mailing
(city and state):
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME) (SIGNATURE OF PERSON COMPLETING THIS FORM)
Page 1 of 1
Form Approved for Optional Use
Judicial Council of California
FL-335 [Rev. January 1, 2012]
PROOF OF SERVICE BY MAIL
Code of Civil Procedure, §§ 1013, 1013a
1.
2.
3.
placing
the envelope for collection and mailing on the date and at the place shown in item 4 following our ordinary
business practices. I am readily familiar with this business’s practice for collecting and processing correspondence for
mailing. On the same day that correspondence is placed for collection and mailing, it is deposited in the ordinary course of
business with the United States Postal Service in a sealed envelope with postage fully prepaid.
4.
Address:b.
a.
c.
d.
6.
www.courts.ca.gov
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF Sacramento
STREET ADDRESS: 3341 Power Inn Road
MAILING ADDRESS: 3341 Power Inn Road
CITY AND ZIP CODE: Sacramento, CA 95826
BRANCH NAME: William R. Ridgeway Family Relations Courthouse
I served a request to modify a child custody, visitation, or child support judgment or permanent order which included an
5.
address verification declaration.
(Declaration Regarding Address Verification—Postjudgment Request to Modify a Child
Custody, Visitation, or Child Support Order
(form FL-334) may be used for this purpose.)
HEARING DATE:
DEPT.:
HEARING TIME:
FAX NO.
(Optional):
E-MAIL ADDRESS
(Optional):
ATTORNEY FOR
(Name):
TELEPHONE NO.:
(If applicable, provide):
NOTICE OF RIGHTS AND RESPONSIBILITIES
Health-Care Costs and Reimbursement Procedures
IF YOU HAVE A CHILD SUPPORT ORDER THAT INCLUDES A PROVISION FOR THE
REIMBURSEMENT OF A PORTION OF THE CHILD'S OR CHILDREN'S HEALTH-CARE COSTS
AND THOSE COSTS ARE NOT PAID BY INSURANCE, THE LAW SAYS:
Notice.
You must give the other parent an itemized
statement of the charges that have been billed for any health-
care costs not paid by insurance. You must give this
statement to the other parent within a reasonable time, but no
more than 30 days after those costs were given to you.
Proof of full payment.
If you have already paid all of the
uninsured costs, you must (1) give the other parent proof that
you paid them and (2) ask for reimbursement for the other
parent's court-ordered share of those costs.
Court-ordered insurance coverage.
If a parent provides
health-care insurance as ordered by the court, that insurance
must be used at all times to the extent that it is available for
health-care costs.
Proof of partial payment.
If you have paid only your share
of the uninsured costs, you must (1) give the other parent
proof that you paid your share, (2) ask that the other parent
pay his or her share of the costs directly to the health-care
provider, and (3) give the other parent the information
necessary for that parent to be able to pay the bill.
a. Burden to prove.
The party claiming that the coverage is
inadequate to meet the child's needs has the burden of
proving that to the court.
Cost of additional coverage.
If a parent purchases health-
care insurance in addition to that ordered by the court, that
parent must pay all the costs of the additional coverage. In
addition, if a parent uses alternative coverage that costs
more than the coverage provided by court order, that parent
must pay the difference.
Payment by notified parent.
If you receive notice from a
parent that an uninsured health-care cost has been incurred,
you must pay your share of that cost within the time the court
orders; or if the court has not specified a period of time, you
must make payment (1) within 30 days from the time you were
given notice of the amount due, (2) according to any payment
schedule set by the health-care provider, (3) according to a
schedule agreed to in writing by you and the other parent, or
(4) according to a schedule adopted by the court.
Preferred health providers.
If the court-ordered coverage
designates a preferred health-care provider, that provider
must be used at all times consistent with the terms of the
health insurance policy. When any party uses a health-care
provider other than the preferred provider, any health-care
costs that would have been paid by the preferred health
provider if that provider had been used must be the sole
responsibility of the party incurring those costs.
Disputed charges.
If you dispute a charge, you may file a
motion in court to resolve the dispute, but only if you pay that
charge before filing your motion. If you claim that the other
party has failed to reimburse you for a payment, or the other
party has failed to make a payment to the provider after proper
notice has been given, you may file a motion in court to resolve
the dispute. The court will presume that if uninsured costs have
been paid, those costs were reasonable. The court may award
attorney fees and costs against a party who has been
unreasonable.
FL-192
Form Approved for Optional Use
Judicial Council of California
FL-192 [Rev. January 1, 2015]
Family Code, §§ 4062, 4063
www.courts.ca.gov
NOTICE OF RIGHTS AND RESPONSIBILITIES
Health-Care Costs and Reimbursement Procedures
Page 1 of 2
1.
2.
3.
4.
5.
6.
7.
b.
FL-192 [Rev. January 1, 2015]
NOTICE OF RIGHTS AND RESPONSIBILITES
Health-Care Costs and Reimbursement Procedures
INFORMATION SHEET ON CHANGING A CHILD SUPPORT ORDER
General Information
The court has just made a child support order in your case. This order will remain the same unless a party to the action requests that
the support be changed (modified). An order for child support can be modified only by filing a motion to change child support and
serving each party involved in your case. If both parents and the local child support agency (if it is involved) agree on a new child
support amount, you can complete, have all parties sign, and file with the court a
Stipulation to Establish or Modify Child Support and
Order
(form FL-350) or
Stipulation and Order (Governmental)
(form FL-625).
When a Child Support Order May Be Modified
The court takes several things into account when ordering the payment of child support. First, the number of children is considered.
Next, the net incomes of both parents are determined, along with the percentage of time each parent has physical custody of the
children. The court considers both parties
’
tax filing status and may consider hardships, such as a child of another relationship. An
existing order for child support may be modified when the net income of one of the parents changes significantly, the parenting
schedule changes significantly, or a new child is born.
Examples
You have been ordered to pay $500 per month in child support. You lose your job. You will continue to owe $500 per month, plus
10 percent interest on any unpaid support, unless you file a motion to modify your child support to a lower amount and the court
orders a reduction.
You are currently receiving $300 per month in child support from the other parent, whose net income has just increased
substantially. You will continue to receive $300 per month unless you file a motion to modify your child support to a higher amount
and the court orders an increase.
You are paying child support based upon having physical custody of your children 30 percent of the time. After several months it turns
out that you actually have physical custody of the children 50 percent of the time. You may file a motion to modify child support to a
lower amount.
How to Change a Child Support Order
To change a child support order, you must file papers with the court.
Remember:
You must follow the order you have now.
What forms do I need?
If you are asking to change a child support order open with the local child support agency, you must fill out one of these forms:
FL-680,
Notice of Motion (Governmental)
or
FL-683
Order to Show Cause (Governmental)
and
FL-684,
Request for Order and Supporting Declaration (Governmental)
If you are asking to change a child support order that is
not
open with the local child support agency, you must fill out one of these
forms:
FL-300,
Request for Order
or
FL-390,
Notice of Motion and Motion for Simplified Modification of Order for Child, Spousal, or Family Support
You must also fill out one of these forms:
FL-150,
Income and Expense Declaration
or
FL-155,
Financial Statement (Simplified)
What if I am not sure which forms to fill out?
Talk to the family law facilitator at your court.
After you fill out the forms,
file them with the court clerk and ask for a hearing date. Write the hearing date on the form.
The clerk will ask you to pay a filing fee. If you cannot afford the fee, fill out these forms, too:
Form FW-001,
Request to Waive Court Fees
Form FW-003,
Order on Court Fee Waiver (Superior Court)
You must serve the other parent.
If the local child support agency is involved, serve it too.
This means someone 18 or over—
not you—
must serve the other parent copies of your filed court forms at least
16 court days
before
the hearing. Add
5 calendar days
if you serve by mail within California (see Code of Civil Procedure section 1005 for other situations).
Court days
are weekdays when the court is open for business (Monday through Friday except court holidays).
Calendar days
include
all days of the month, including weekends and holidays. To find court holidays, go to
www.courts.ca.gov/holidays.htm.
Go to your hearing and ask the judge to change the support.
Bring your tax returns from the last two years and your last two
months' pay stubs. The judge will look at your information, listen to both parents, and make an order. After the hearing, fill out:
FL-340,
Findings and Order After Hearing
and
FL-342,
Child Support Information and Order Attachment
Need help?
Contact the family law facilitator in your county or call your county's bar association and ask for an experienced family lawyer.
The server must also serve blank copies of these forms:
FL-320,
Responsive Declaration to Request for Order
and
FL-150,
Income and Expense Declaration,
or
FL-155,
Financial Statement (Simplified)
Then the server fills out and signs a
Proof of Service
(form FL-330 or FL-335). Take this form to the clerk and file it.
Page 2 of 2
FL-192
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Petition to Establish Parental Relationship September 4, 2018 (California)

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Completed 13 June 2021

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