FL-110
SUMMONS (Family Law) CITACIÓN (Derecho familiar)
FOR COURT USE ONLY
(SOLO PARA USO DE LA CORTE)
NOTICE TO RESPONDENT (Name):
AVISO AL DEMANDADO (Nombre):
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 is:
Nombre del demandante:
CASE NUMBER (NÚMERO DE CASO):
You have 30 calendar days after this Summons and
Petition are served on you to file a Response (form
FL-120
) at the court and have a copy served on the
petitioner. A letter, phone call, or court appearance
will not protect you.
Tiene 30 días de calendario después de haber recibido la
entrega legal de esta Citación y Petición para presentar una
Respuesta (formulario FL-120
) 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.
If you do not file your Response on time, the court
may make orders affecting your marriage or domestic
partnership, your property, and custody of your
children. You may be ordered to pay support and
attorney fees and costs.
Si no presenta su Respuesta a tiempo, la corte puede dar
órdenes que afecten su matrimonio o pareja de hecho, sus
bienes y la custodia de sus hijos. La corte también le puede
ordenar que pague manutención, y honorarios y costos legales.
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 county bar association.
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.
Form Adopted for Mandatory Use
SUMMONS
Page 1 of 2
Family Code, §§ 232, 233, 2024.7, 2040, 7700;
(Family Law)
www.courts.ca.gov
Code of Civil Procedure, §§ 412.20, 416.60–416.90
NOTICE—RESTRAINING ORDERS ARE ON PAGE 2:
These restraining orders are effective against both
spouses or domestic partners until the petition is
dismissed, a judgment is entered, or the court makes
further orders. They are enforceable anywhere in
California by any law enforcement officer who has
received or seen a copy of them.
AVISO—LAS ÓRDENES DE RESTRICCIÓN SE
ENCUENTRAN EN LA PÁGINA 2: Las órdenes de restricción
están en vigencia en cuanto a ambos cónyuges o miembros de
la pareja de hecho hasta que se despida la petición, se emita un
fallo o la corte dé otras órdenes. Cualquier agencia del orden
público que haya recibido o visto una copia de estas órdenes
puede hacerlas acatar en cualquier lugar de California.
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.
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.
[SEAL]
1. The name and address of the court are (El nombre y dirección de la corte son):
2. The name, address, and telephone number of the petitioner’s attorney, or the petitioner without an
attorney, are: (El nombre, dirección y número de teléfono del abogado del demandante, o del
demandante si no tiene abogado, son):
Clerk , by (Secretario, por) , Deputy (Asistente)Date (Fecha):
Judicial Council of California
FL-110 [Rev. January 1, 2015]
FL-110 [Rev. January 1, 2015].
SUMMONS
Page 2 of 2
(Family Law)
STANDARD FAMILY LAW RESTRAINING ORDERS ÓRDENES DE RESTRICCIÓN ESTÁNDAR DE DERECHO
FAMILIAR
Starting immediately, you and your spouse or domestic
partner are restrained from:
1. removing the minor children of the parties from the state
or applying for a new or replacement passport for those
minor children without the prior written consent of the
other party or an order of the court;
2. cashing, borrowing against, canceling, transferring,
disposing of, or changing the beneficiaries of any
insurance or other coverage, including life, health,
automobile, and disability, held for the benefit of the
parties and their minor children;
3. transferring, encumbering, hypothecating, concealing, or in
any way disposing of any property, real or personal,
whether community, quasi-community, or separate, without
the written consent of the other party or an order of the
court, except in the usual course of business or for the
necessities of life; and
4. creating a nonprobate transfer or modifying a nonprobate
transfer in a manner that affects the disposition of property
subject to the transfer, without the written consent of the
other party or an order of the court. Before revocation of a
nonprobate transfer can take effect or a right of
survivorship to property can be eliminated, notice of the
change must be filed and served on the other party.
You must notify each other of any proposed extraordinary
expenditures at least five business days prior to incurring these
extraordinary expenditures and account to the court for all
extraordinary expenditures made after these restraining orders
are effective. However, you may use community property,
quasi-community property, or your own separate property to
pay an attorney to help you or to pay court costs.
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 towards high quality affordable health care. For
more information, visit www.coveredca.com. Or call Covered
California at 1-800-300-1506.
En forma inmediata, usted y su cónyuge o pareja de hecho
tienen prohibido:
1.
2. cobrar, pedir prestado, cancelar, transferir, deshacerse o
cambiar el nombre de los beneficiarios de cualquier seguro u
otro tipo de cobertura, como de vida, salud, vehículo y
discapacidad, que tenga como beneficiario(s) a las partes y
su(s) hijo(s) menor(es);
llevarse del estado de California a los hijos menores de las
partes, o solicitar un pasaporte nuevo o de repuesto para los
hijos menores, sin el consentimiento previo por escrito de la
otra parte o sin una orden de la corte;
3. transferir, gravar, hipotecar, ocultar o deshacerse de
cualquier manera de cualquier propiedad, inmueble o
personal, ya sea comunitaria, cuasicomunitaria o separada,
sin el consentimiento escrito de la otra parte o una orden de
la corte, excepto en el curso habitual de actividades
personales y comerciales o para satisfacer las necesidades
de la vida; y
4. crear o modificar una transferencia no testamentaria de
manera que afecte la asignación de una propiedad sujeta a
transferencia, sin el consentimiento por escrito de la otra
parte o una orden de la corte. Antes de que se pueda
eliminar la revocación de una transferencia no
testamentaria, se debe presentar ante la corte un aviso del
cambio y hacer una entrega legal de dicho aviso a la otra
parte.
Cada parte tiene que notificar a la otra sobre cualquier gasto
extraordinario propuesto por lo menos cinco días hábiles antes
de realizarlo, y rendir cuenta a la corte de todos los gastos
extraordinarios realizados después de que estas órdenes de
restricción hayan entrado en vigencia. No obstante, puede usar
propiedad comunitaria, cuasicomunitaria o suya separada para
pagar a un abogado que lo ayude o para pagar los costos de la
corte.
AVISO—ACCESO A SEGURO DE SALUD MÁS ECONÓMICO:
¿Necesita seguro de salud a un costo asequible, ya sea para usted
o alguien en su hogar? Si es así, puede presentar una solicitud con
Covered California. Covered California lo puede ayudar a reducir el
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.
WARNING—IMPORTANT INFORMATION
California law provides that, for purposes of division of
property upon dissolution of a marriage or domestic
partnership or upon legal separation, property acquired
by the parties during marriage or domestic partnership in
joint form is presumed to be community property. If either
party to this action should die before the jointly held
community property is divided, the language in the deed
that characterizes how title is held (i.e., joint tenancy,
tenants in common, or community property) will be
controlling, and not the community property
presumption. You should consult your attorney if you
want the community property presumption to be written
into the recorded title to the property.
De acuerdo a la ley de California, las propiedades adquiridas
por las partes durante su matrimonio o pareja de hecho en
forma conjunta se consideran propiedad comunitaria para
fines de la división de bienes que ocurre cuando se produce
una disolución o separación legal del matrimonio o pareja de
hecho. Si cualquiera de las partes de este caso llega a
fallecer antes de que se divida la propiedad comunitaria de
tenencia conjunta, el destino de la misma quedará
determinado por las cláusulas de la escritura
correspondiente que describen su tenencia (por ej., tenencia
conjunta, tenencia en común o propiedad comunitaria) y no
por la presunción de propiedad comunitaria. Si quiere que la
presunción comunitaria quede registrada en la escritura de
la propiedad, debería consultar con un abogado.
ADVERTENCIA—INFORMACIÓN IMPORTANTE
FL-110
FL-100
PARTY WITHOUT ATTORNEY OR ATTORNEY STATE BAR NO.: FOR COURT USE ONLY
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name)::
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER:
RESPONDENT:
CASE NUMBER:
PETITION FOR
Dissolution (Divorce) of:
Legal Separation of:
Nullity of:
Marriage
1. LEGAL RELATIONSHIP (check all that apply):
Page 1 of 3
Form Adopted for Mandatory Use
PETITION—MARRIAGE/DOMESTIC PARTNERSHIP
Family Code, §§ 297, 299, 2320, 2330, 3409;
Judicial Council of California www.courts.ca.gov
FL-100 [Rev. July 1, 2016]
(Family Law)
Domestic Partnership
Marriage Domestic Partnership
Marriage Domestic Partnership
AMENDED
a. We are married.
b. We are domestic partners and our domestic partnership was established in California.
c. We are domestic partners and our domestic partnership was NOT established in California.
2.
a. Petitioner
RESIDENCE REQUIREMENTS (check all that apply):
Respondent has been a resident of this state for at least six months and of this county for at least
three months immediately preceding the filing of this Petition. (For a divorce, at least one person in the legal relationship
described in items 1a and 1c must comply with this requirement.)
b. Our domestic partnership was established in California. Neither of us has to be a resident or have a domicile in California
to dissolve our partnership here.
Petitioner lives in (specify): Respondent lives in (specify):
c. We are the same sex, were married in California, but currently live in a jurisdiction that does not recognize, and will not
dissolve, our marriage.This Petition is filed in the county where we married.
3.
a. (1)
STATISTICAL FACTS
Date of marriage (specify): (2) Date of separation (specify):
(3) Time from date of marriage to date of separation (specify): Years Months
b. (1) Registration date of domestic partnership with the California Secretary of State or other state equivalent (specify below):
(2) Date of separation (specify):
(3) Time from date of registration of domestic partnership to date of separation (specify): Years Months
4. MINOR CHILDREN
a. There are no minor children.
b. The minor children are:
Child's name
Birthdate Age Sex
(1) continued on Attachment 4b. (2) a child who is not yet born.
c. If any children listed above were born before the marriage or domestic partnership, the court has the authority to determine
those children to be children of the marriage or domestic partnership.
e. Petitioner and Respondent signed a voluntary declaration of paternity. A copy is is not attached.
NAME:
FIRM NAME:
STREET ADDRESS:
CITY: STATE: ZIP CODE:
If there are minor children of Petitioner and Respondent, a completed Declaration Under Uniform Child Custody Jurisdiction
and Enforcement Act (UCCJEA) (form FL-105
) must be attached.
d.
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PETITIONER:
CASE NUMBER:
5. LEGAL GROUNDS (Family Code sections 2200–2210, 2310–2312)
a. Divorce
RESPONDENT:
Petitioner requests that the court make the following orders:
or Legal separation of the marriage or domestic partnership based on (check one):
(1) irreconcilable differences. (2) permanent legal incapacity to make decisions.
b.
(1)
Nullity of void marriage or domestic partnership based on
incest. (2) bigamy.
c. Nullity of voidable marriage or domestic partnership based on
(1) petitioner’s age at time of registration of domestic
partnership or marriage.
(2) prior existing marriage or domestic partnership.
(3) unsound mind.
(4)
(5)
(6) physical incapacity.
force.
fraud.
6. CHILD CUSTODY AND VISITATION (PARENTING TIME)
Petitioner Respondent Joint Other
a. Legal custody of children to..............................................................
b. Physical custody of children to.........................................................
c. Child visitation (parenting time) be granted to .............................
As requested in: form FL-311
form FL-341(D)
form FL-312
form FL-341(E)
form FL-341(C)
Attachment 6c(1)
7. CHILD SUPPORT
a. If there are minor children born to or adopted by Petitioner and Respondent before or during this marriage or domestic
partnership, the court will make orders for the support of the children upon request and submission of financial forms by the
requesting party.
b. An earnings assignment may be issued without further notice.
c. Any party required to pay support must pay interest on overdue amounts at the "legal" rate, which is currently 10 percent.
d. Other (specify):
FL-100 [Rev. July 1, 2016]
(Family Law)
PETITION—MARRIAGE/DOMESTIC PARTNERSHIP
Page 2 of 3
8. SPOUSAL OR DOMESTIC PARTNER SUPPORT
a. Spousal or domestic partner support payable to Petitioner Respondent
b. Terminate (end) the court's ability to award support to Petitioner Respondent
c. Reserve for future determination the issue of support payable to Petitioner Respondent
d. Other (specify):
9.
a.
SEPARATE PROPERTY
There are no such assets or debts that I know of to be confirmed by the court.
Property Declaration (form FL-160
).b. Confirm as separate property the assets and debts in Attachment 9b.
the following list. Item Confirm to
FL-100
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12.
Date:
NOTICE—CANCELLATION OF RIGHTS: Dissolution or legal separation may automatically cancel the rights of a domestic partner
or spouse under the other domestic partner’s or spouse’s will, trust, retirement plan, power of attorney, pay-on-death bank account,
survivorship rights to any property owned in joint tenancy, and any other similar thing. It does not automatically cancel the right of a
domestic partner or spouse as beneficiary of the other partner’s or spouse’s life insurance policy. You should review these matters,
as well as any credit cards, other credit accounts, insurance polices, retirement plans, and credit reports, to determine whether they
should be changed or whether you should take any other actions. Some changes may require the agreement of your partner or
spouse or a court order.
(TYPE OR PRINT NAME)
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
(SIGNATURE OF PETITIONER)
I HAVE READ THE RESTRAINING ORDERS ON THE BACK OF THE SUMMONS, AND I UNDERSTAND THAT THEY APPLY
TO ME WHEN THIS PETITION IS FILED.
(SIGNATURE OF ATTORNEY FOR PETITIONER)
10.
a.
PETITIONER:
RESPONDENT:
There are no such assets or debts that I know of to be divided by the court.
COMMUNITY AND QUASI-COMMUNITY PROPERTY
CASE NUMBER:
b. Determine rights to community and quasi-community assets and debts. All such assets and debts are listed
in Property Declaration (form FL-160
) in Attachment 10b.
as follows (specify):
a.
b.
OTHER REQUESTS
Attorney's fees and costs payable by
Petitioner's former name be restored to (specify):
11.
Petitioner Respondent
c. Other (specify):
Continued on Attachment 11c.
Date:
(TYPE OR PRINT NAME)
NOTICE:
FL-100 [Rev. July 1, 2016]
(Family Law)
PETITION—MARRIAGE/DOMESTIC PARTNERSHIP
Page 3 of 3
FL-100
FOR MORE INFORMATION: Read Legal Steps for a Divorce or Legal Separation (form FL-107-INFO) and visit "Families Change"
at www.familieschange.ca.gov
an online guide for parents and children going through divorce or separation.
You may redact (black out) social security numbers from any written material filed with the court in this case other than a
form used to collect child, spousal or partner support.
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FL-105/GC-120
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY
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:
PETITIONER:
RESPONDENT:
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.
3. There are (specify number): minor children who are subject to this proceeding, as follows:
(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 Person child lived with (name and complete current address) Relationship
to present
Confidential
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.
Period of residence Address Relationship
to present
Confidential
to
to
to
c. Additional residence information for a child listed in item a or b is continued on attachment 3c.
Page 1 of 2
Form Adopted for Mandatory Use
DECLARATION UNDER UNIFORM CHILD CUSTODY
Family Code, § 3400 et seq.;
Judicial Council of California Probate Code, §§ 1510(f), 1512
FL-105/GC-120 [Rev. January 1, 2009]
JURISDICTION AND ENFORCEMENT ACT (UCCJEA)
www.courtinfo.ca.gov
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.
Confidential
Child's residence (City, State)
Child's residence (City, State)
Child's residence (City, State)
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)
(If NOT the same, provide the information below.)
Child's residence (City, State)
Child's residence (City, State)
Child's residence (City, State)
Person child lived with (name and complete current address)
Person child lived with (name and complete current address)
Confidential
Person child lived with (name and complete current address)
Person child lived with (name and complete current address)
d. Additional children are listed on form FL-105(A)/GC-120(A).(Provide all requested information for additional children.)
OTHER PARTY:
(This section applies only to family law cases.)
(
This section applies only to guardianship cases.)
G
UARDIANSHIP OF (Name):
M
inor
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SHORT TITLE:
CASE NUMBER:
4.
Yes No (If yes, attach a copy of the orders (if you have one) and provide the following information):
6. 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? Yes No (If yes, provide the following information) :
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
proceeding in a California court or any other court concerning a child subject to this proceeding.
FL-105/GC-120 [Rev. January 1, 2009]
DECLARATION UNDER UNIFORM CHILD CUSTODY
Page 2 of 2
JURISDICTION AND ENFORCEMENT ACT (UCCJEA)
FL-105/GC-120
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?
Proceeding Case number
Court
(name, state, location)
Court order
or judgment
(date)
Name of each child
Your
connection to
the case
Case status
a. Family
b. Guardianship
c. Other
d.
e.
Juvenile Delinquency/
Proceeding
Adoption
Court (name, state, location)Case Number
Juvenile Dependency
5. One or more domestic violence restraining/protective orders are now in effect. (Attach a copy of the orders if you have one
and provide the following information):
c.
d.
Court
Other
Juvenile Delinquency/
Juvenile Dependency
County Case number (if known)
a. Criminal
b. Family
State Orders expire (date)
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FAMILY LAW CASE COVER SHEET
AND CERTIFICATE OF GROUNDS FOR ASSIGNMENT TO DISTRICT
FAM 020
(Rev 7/17)
Page 1 of 3
LASC Rule 2.3 & 5.2
NAME, ADDRESS, AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT ATTORNEY:
STATE BAR NUMBER
Reserved for Clerks File Stamp
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES
COURTHOUSE ADDRESS:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
FAMILY LAW CASE COVER
SHEET AND
CERTIFICATE OF GROUNDS FOR ASSIGNMENT TO
DISTRICT
CASE NUMBER:
This form is required for all new Family Law cases filed in the Los Angeles Superior Court
This case cover sheet is required so that the court can assign your case to the correct district for filing and hearing. It satisfies the
requirement for a certificate authorizing filing in the district, as set forth in Los Angeles Superior Court Rules 2.3 and 5.2. It must
be completed and submitted to the court along with the original Complaint or Petition in all Family cases filed in any district of the
Los Angeles Superior Court.
I. Consent to Electronic Notification (optional)
I agree to accept information electronically from the court at the following email address and/or cell phone number
Email Address
Cell Phone
II. Address of Petitioner
Street (including Apt. #)
City
State
Zip Code
III. Address of Respondent / Joint Petitioner (Do not complete this item if filing a Minor’s contract case)
Street (including Apt. #)
City
State
Zip Code
IV. Case Information
Date of Marriage/Domestic Partnership
(if applicable)
Date of Separation
(if applicable)
Are there Minor Children
Involved?
Yes No
If yes, indicate how many:
Parties agree to mediate:
(check one, if applicable)
Property and Support
Parties intend to proceed by:
(check one, if applicable)
Default
Property Only
Stipulated Judgment
Support Only
Use of private dispute resolution judge
Collaborative Law process
Do you need an interpreter?
Yes No
Do other parties need to be joined to the action to resolve the case?
Yes No
If yes, indicate language:
FAMILY LAW CASE COVER SHEET
AND CERTIFICATE OF GROUNDS FOR ASSIGNMENT TO DISTRICT
FAM 020
(Rev 7/17)
Page 2 of 3
LASC Rule 2.3 & 5.2
V. District Assignment
Step 1. In the “Type of Action” column below, select one type of action which best describes the nature of this case. For dissolution, nullity,
and legal separation cases select one option each in sections A, B, and C.
Step 2. Across from the Type of Action you selected, place an “X” in the column that corresponds to the reason for your choice of district.
Note that you may only select from the boxes that are not shaded.
TYPE OF ACTION
(check one)
May be filed in
Central
District
District where one
or more of the
parties resides
Child resides within
the county
District where the
Petitioner resides
Any court location
Dissolution, Nullity, and Legal Separation (required: select one option each in sections A, B, and C below)
Section A
(check one)
Dissolution
Nullity
Legal Separation
Section B
(check one)
With Minor Children
Without Minor Children
Section C
(check one)
Domestic Partnership
Marriage
Dept. of Child Support Services (DCSS)
DSU Summons and Complaint [4814]
DSU Statement Registration of California Support Order [4811]
DSU Petition Uniform Support [4810]
DSU Statement Registration Out-of-State Support Order [4812]
Establish Parental Relationship
Petition Establish Parental Relationship [4040]
Petition Special Immigrant Juvenile [4068]
Petition Request Set Aside Voluntary Dec. of Paternity [4054]
Joint Petition for Summary Dissolution
Marriage [4041]
Domestic Partnership [4042]
Surrogacy (if selected, also complete Section VII, “Surrogacy Case Jurisdiction”, on page 3 of this form)
Surrogacy Stipulation and Order [4324]
Other Family Law
Petition Custody and Support of Minor Child [4032]
Registration of Out-of-State Custody Order [4052]
Statement Registration of California Support Order [4190]
Petition Grandparent/Third Party Visitation [4327]
Request Release Confidential License/Certificate [4384]
Petition Minor’s Contract (FC § 6751) [4047]
Petition Habeas Corpus Family Law [4011]
Custody Order - Juvenile Final Judgment - Closing Order [174]
Petition Elder/Dependent Adult Abuse [226]
Order Register Out-of-State/Tribal Court Restraining Order [4325]
Petition Family Law Other [4329]
Emancipation: FL (FAM) [5340AS]
Consent for Minor to Marry/Establish Domestic Partnership
Marriage [4031]
Domestic Partnership [4030]
Restraining Orders/Domestic Violence (DV) Prevention (Note: Use Civil Case Cover Sheet [LA CIV109] for all Civil Restraining Orders)
DV Prevention with Minor Children [4038]
DV Prevention without Minor Children [4039]
FAMILY LAW CASE COVER SHEET
AND CERTIFICATE OF GROUNDS FOR ASSIGNMENT TO DISTRICT
FAM 020
(Rev 7/17)
Page 3 of 3
LASC Rule 2.3 & 5.2
TYPE OF ACTION
(check one)
May be filed in
Central District
District where one
or more of the
parties resides
Child resides within
the county
District where the
Petitioner resides
Any court location
Adoptions Filed Only at Edmund D. Edelman Children’s Court
Adoption: FL Adult (FAM) [5323AS]
Adoption: FL Independent (FAM) [5300AS]
Adoption: FL Agency Domestic (FAM) [5300AS]
Adoption: FL Agency International IR-3/IH-3 (FAM) [5300AS]
Adoption: FL Agency International IR-4/IH-4 (FAM) [5300AS]
Adoption: FL Step-Parent (FAM) [5300AS]
Non-Adoption: FL - Abandonment (FC § 7662 and FC § 7820) [5137AS]
VI. Address of Minor Child(ren) (if known)
Complete this section only if you have selected “Child Resides within the County” as an applicable reason for case assignment in Section V above.
Do not complete this section if this case falls under Family Code § 6751.
Street (including Apt. #)
City
State
Zip Code
VII. Surrogacy Case Jurisdiction Required only for Surrogacy actions (Family Code § 7962)
Please select the appropriate grounds
for jurisdiction in Los Angeles County:
Child is anticipated to be born in Los Angeles County
Intended parent or intended parents reside in Los Angeles County
Surrogate resides in Los Angeles County
Assisted reproduction agreement for gestational carriers was executed in Los Angeles County
Medical procedures pursuant to the agreement are to be performed in Los Angeles County
VIII. Certification / Declaration of Assignment
The undersigned hereby certifies and declares that the above entitled matter is properly filed for assignment to the ___________________
District of the Los Angeles Superior Court under Code of Civil Procedure § 392 et seq., 2300 et seq. of the Family Code, and Local Rules 2.3
and 5.2 of this court for reason checked above. I certify and declare under penalty of perjury under the laws of the State of California that the
foregoing is true and correct.
Date:
.
(SIGNATURE OF
ATTORNEY/PARTY
WITHOUT ATTORNEY)