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DISSOLUTION I – FORMS • 9
25th Edition 279
TABLE OF FORMS
Sample Form Numberand Brief Description Page
9A Stages of Dissolution Flow Chart . . . . . . . . . . . . . . . . . . . . . . . 281
9C Family Law Case Cover Sheet (LA-20/FAM020) . . . . . . . . . . . . . . . 283
9D Summons (Family Law) and Standard Restraining Orders . . . . . . . . . . 285
9E Proof of Service of Summons (Family Law, Uniform Parentage, Custody and Support) (FL-115) . . . . . . . . . . . . . . . . . . . . . . . . 287
9F Petition (Family Law) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
9G-1 Child Custody and Visitation Application Attachment (FL-311) . . . . . . . 291
9G-2 Additional Provisions — Physical Custody Attachment (FL-341(D)) . . . . . 293
9H-1 Joint Legal Custody Attachment (FL-341(E)) . . . . . . . . . . . . . . . . . 295
9H-2 Children’s Holiday Schedule Attachment (FL-341(C)) . . . . . . . . . . . . 297
9H-3 Request for Child Abduction Prevention Orders (FL-312) . . . . . . . . . . 299
9I-1 Attachment 7j – Health Care Coverage for Spouse . . . . . . . . . . . . . 301
9I-2 Attachment 7j – Consolidation Attachment . . . . . . . . . . . . . . . . . . 303
9I-3 Children’s Health Care Attachment . . . . . . . . . . . . . . . . . . . . . . 304
9J Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) . . . . . . . . . . . . . . . . . . . . . . . . . 305
9K Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
9L Letter to Litigation Coordinator . . . . . . . . . . . . . . . . . . . . . . . . 309
9M Letter to Sheriff (Out-of-County or Out-of-State Personal Service by Sheriff) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
9N Schedule of Assets and Debts . . . . . . . . . . . . . . . . . . . . . . . . 315
9O Letter to Client Advising of Need to Discover Information and Join Pension Plan (also available in Spanish) . . . . . . . . . . . . . . . . . 319
9Q Dissolution I Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
9R RFO Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
9S House Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
9T Pension Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
9U Letter to Other Party’s Employer Seeking Pension/Retirement Plan Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328
9V Custody and Visitation Handout (also available in Spanish) . . . . . . . . . 329
9W Assets & Debts Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
9 • DISSOLUTION I – FORMS
25th Edition280
DISSOLUTION I – FORMS • 9
25th Edition 281
Sample Form 9A: Stages of Dissolution Flow Chart
Harriett Buhai Center For Family Law Dissolution of Marriage Flow Chart
F:\Document\Publications\Volunteer Manual\2013\2013 Manual Forms\Chapter 9\9A Stages of Dissolution Flow Chart.doc
Disso 1 (Start your case)
Serve other party. Wait 30 days.
Check court file for Response after 30 days.
Disso 2 - Default (Financial Disclosures/
Default Request)
Disso 2 - Contested PDD (Prelim Financial Disclosure)
Response (Other party already
served you)
Disso 3 - Default
(Judgment Prep/ Supporting docs)
No Response Filed (Default)
Response Filed (Contested)
Trial Setting Conference
Disso 2 - Contested FDD (Final Financial Disclosure)
Trial
Disso 3 - Contested
(Judgment Prep)
Process Judgment
Disso 3 - Uncontested
(Stip Judgment Prep)
Temporary orders needed?
File Response
Discovery (Gather evidence/
Research)
Discovery (Gather evidence/ Research)
HBCFL Appointment
Non-appointment
File Disso 1
Trial Prep (Request Trial/Brief/Lists)
Default Hearing?
Disso 3 - Default with Agreement
(Judgment Prep)
9 • DISSOLUTION I – FORMS
25th Edition282
This page was intentionally left blank.
DISSOLUTION I – FORMS • 9
25th Edition 283
Sample Form 9C: Family Law Case Cover Sheet (LA-20/FAM020)
2
ZIP CODESTATECITY:ADDRESS:
b) Enter address of Respondent. DO NOT COMPLETE THIS ITEM IF THIS IS A MINOR S CONTRACT CASE
SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES
CASE NUMBER:FAMILY LAW CASE COVER SHEET
I. Fill in the requested information.
MINOR CHILDREN INVOLVED? YES NOHOW MANY?
II. Select the correct district:
Applicable Reason for Choosing District (See Column 2 below)
1.2.
3.May be filed in Central District.District where one or more of the parties reside.
Child resides within the district.
FAMILY LAW CASE COVER SHEETFAM 020
TYPE OF ACTION (Check only one) (Continued) APPLICABLE REASONS (See above)
A5520
A5525
A5521
A5530
A5531
Dissolution of Marriage 1. 2
In Column 2 below, circle the reason for your choice of district that applies to the type of action you have checked.Under Column 1 below, check the one type of action which best describes the nature of this case.
LA-F020
Summary Dissolution of Marriage
Dissolution of Domestic Partnership
Nullity of Void or Voidable Marriage
Nullity of Void or Voidable Domestic
1. 2
1. 2
1. 2
1. 2
Page 1 of 2
a.b.
COURTHOUSE ADDRESS:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
ATTORNEY FOR (Name):
NAME, ADDRESS, AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT ATTORNEY: Reserved for Clerk's File StampSTATE BAR NUMBER
1
District where Petitioner resides.4.
Case Filing InstructionsThis cover sheet is required so that the court can assign your case to the correct court district for filing and hearing. Itsatisfies the requirement for a certificate authorizing filing in the district, as set forth in Los Angeles Superior CourtRules 2(d) and 14.2. It must be completed and submitted to the court along with the original Complaint or Petition inALL Family cases filed in any district of the Los Angeles County Superior Court. This form is not required inAbandonment & Emancipation cases, which are to be filed at Children s Court.
Enter address of Petitionera)ADDRESS: CITY: STATE ZIP CODE
(Rev 11/11) LASC RULE 5.2
Maria Smith433 1st StreetLos Angeles, CA 90008
(213)222-5555Petitioner In Pro Per
111 N. Hill StreetLos Angeles, CA 90012
Maria Smith
Jose Smith
433 1st Street Los Angeles CA 90008
3749 Pine Avenue Los Angeles CA 90008
X 2
X
CERTIFICATE OF GROUNDS FOR ASSIGNMENT TO DISTRICT
CERTIFICATE OF GROUNDS FOR ASSIGNMENT TO DISTRICT
Partnership
HBCFL
9 • DISSOLUTION I – FORMS
25th Edition284
Sample Form 9C: Family Law Case Cover Sheet (LA-20/FAM090)
Short Title Case Number
IV.
Certificate / 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 Angles Superior Court under Code of Civil Procedure §392 et seq., 2300 et
seq. of the Family Code, and Rule 2(b), (c), and (d) 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.
(SIGNATURE OF ATTORNEY/PARTY WITHOUT ATTORNEY)
Date:
FAM 020 Page 2 of 2
Enter the information below and sign the certificate.
A6080
A6111
A6130
A6101
A6102
A6104
A6106
Petition to Establish Parentage / Paternity (Non- 1. 2. 3
Approval of Minor s Contract (6751 Family Code)
Other Family Complaint or Petition (Specify):
Agency Adoption
Independent Adoption
Stepparent Adoption
Sole Custody Petition
1
1. 2. 3
1. 4
1. 4
1. 4
1. 4
A6103 Adult Adoption 1. 4
Enter address of minor child if known. (DO NOT COMPLETE UNLESS YOU HAVE CIRCLED ITEM 3 AS AN APPLICABLE REASONIII.
ADDRESS: Do not complete if this case falls under Family Code §6751 CITY: STATE ZIP CODE
A5510
A6126
A6131
A6139
A6136
Legal Separation
Petition for Custody and Support of Minor
Child Support Services Department (CSSD)
Foreign Support Order
Foreign Custody Order
1. 2
1. 2. 3
1.
1. 2. 3
1. 2. 3
A5511 Legal Separation of Domestic Partnership 1. 2
A6138 Uniform Interstate Family Support Act (UIFSA)
A6122 Domestic Violence Restraining Order (Civil
A6600 Habeas Corpus Petition Child Custody
1. 2. 3
(Any Court Jurisdiction DV's only)
1. 3
(Rev 11/11) LASC RULE 5.2
Smith and Smith
BD354789
Central
6/5/07
Maria Smith, Petitioner in Pro Per
FAMILY LAW CASE COVER SHEETCERTIFICATE OF GROUNDS FOR ASSIGNMENT TO DISTRICT
Parentage/Support
Responding Petition
Harassment use Civil Cover Sheet)
governmental)
. Maria Smith
DISSOLUTION I – FORMS • 9
25th Edition 285
Sample Form 9D: Summons (Family Law) and Standard Restraining Orders
SUMMONS (Family Law) CITACIÓN (Derecho familiar)
NOTICE TO RESPONDENT (Name):AVISO AL DEMANDADO (Nombre):
You are being sued. Lo están demandando.
Petitioner's name is:Nombre del demandante:
CASE NUMBER (NÚMERO DE CASO):
FOR COURT USE ONLY(SÓLO PARA USO DE LA CORTE)
You have 30 calendar days after this Summons andPetition are served on you to file a Response (formFL-120 or FL-123) at the court and have a copyserved on the petitioner. A letter or phone call will notprotect you.
If you do not file your Response on time, the courtmay make orders affecting your marriage or domesticpartnership, your property, and custody of yourchildren. You may be ordered to pay support andattorney fees and costs. If you cannot pay the filingfee, ask the clerk for a fee waiver form.
If you want legal advice, contact a lawyer immediately.You can get information about finding lawyers at the
Tiene 30 días corridos después de haber recibido la entrega legalde esta Citación y Petición para presentar una Respuesta(formulario FL-120 ó FL-123) ante la corte y efectuar la entregalegal de una copia al demandante. Una carta o llamada telefónicano basta para protegerlo.
Si no presenta su Respuesta a tiempo, la corte puede dar órdenesque afecten su matrimonio o pareja de hecho, sus bienes y lacustodia de sus hijos. La corte también le puede ordenar que paguemanutención, y honorarios y costos legales. Si no puede pagar lacuota de presentación, pida al secretario un formulario de exenciónde cuotas.
inmediato con un abogado. Puede obtener información para
NOTICE: The restraining orders on page 2 are effective against both spouses or domestic partners until the petition is dismissed, ajudgment is entered, or the court makes further orders. These orders are enforceable anywhere in California by any lawenforcement officer who has received or seen a copy of them.AVISO: Las órdenes de restricción que figuran en la página 2 valen para ambos cónyuges o pareja de hecho hasta que se despidala petición, se emita un fallo o la corte dé otras órdenes. Cualquier autoridad de la ley que haya recibido o visto una copia de estasórdenes puede hacerlas acatar en cualquier lugar de California.
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 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):
[SEAL]
Date (Fecha): Clerk, by (Secretario, por) , Deputy (Asistente)NOTICE TO THE PERSON SERVED: You are served
a. as an individual. (a usted como individuo.)b. on behalf of respondent who is a (en nombre de un demandado que es):
minor (menor de edad)ward or conservatee (dependiente de la corte o pupilo)other (specify) (otro � especifique):
(Read the reverse for important information.) (Lea importante información al dorso.)Form Adopted for Mandatory Use
Judicial Council of CaliforniaFL-110 [Rev. July 1, 2009]
SUMMONS(Family Law)
Family Code §§ 232, 233, 2040, 7700;
FL-110
Code of Civil Procedure, §§ 412.20, 416.60-416.90
Page 1 of 2
(www.courtinfo.ca.gov/selfhelp), at the California LegalCalifornia Courts Online Self-Help Center
contacting your local county bar association.Services Web site (www.lawhelpcalifornia.org), or by
encontrar a un abogado en el Centro de Ayuda de las Cortes deCalifornia (www.sucorte.ca.gov), en el sitio Web de los Servicios
contacto con el colegio de abogados de su condado.Legales de California (www.lawhelpcalifornia.org) o poniéndose en
Si desea obtener asesoramiento legal, póngase en contacto de
AVISO A LA PERSONA QUE RECIBIÓ LA ENTREGA: Esta entrega se realiza
(1)(2)(3)
NOTE: If a judgment or support order is entered, the court may order you to pay all or part of the fees and costs that the court waivedfor yourself or for the other party. If this happens, the party ordered to pay fees shall be given notice and an opportunity to request ahearing to set aside the order to pay waived court fees.AVISO: Si se emite un fallo u orden de manutención, la corte puede ordenar que usted pague parte de, o todas las cuotas y costos dela corte previamente exentas a petición de usted o de la otra parte. Si esto ocurre, la parte ordenada a pagar estas cuotas debe recibiraviso y la oportunidad de solicitar una audiencia para anular la orden de pagar las cuotas exentas.
Government Code, § 68637
Jose Smith
Maria Smith
BD 345678
Los Angeles Superior Court111 N. Hill StreetLos Angeles, CA 90012
Maria Smith105 W. Beverly Blvd.Los Angeles, CA 90042
(323) 298-3224
x
9 • DISSOLUTION I – FORMS
25th Edition286
Sample Form 9D: Summons (Family Law) and Standard Restraining Orders
WARNING: California law provides that, for purposes of division of property upon dissolution of a marriage or domesticpartnership or upon legal separation, property acquired by the parties during marriage or domestic partnership in jointform is presumed to be community property. If either party to this action should die before the jointly held communityproperty 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 yourattorney if you want the community property presumption to be written into the recorded title to the property.
STANDARD FAMILY LAW RESTRAINING ORDERSStarting immediately, you and your spouse or domestic partner are restrained from
1. Removing the minor child or children of the parties, if any, from the state without the prior written consent of the other party oran order of the court;
2. Cashing, borrowing against, canceling, transferring, disposing of, or changing the beneficiaries of any insurance or othercoverage, including life, health, automobile, and disability, held for the benefit of the parties and their minor child or children;
3. Transferring, encumbering, hypothecating, concealing, or in any way disposing of any property, real or personal, whethercommunity, quasi-community, or separate, without the written consent of the other party or an order of the court, except in theusual course of business or for the necessities of life; and
You must notify each other of any proposed extraordinary expenditures at least five business days prior to incurring theseextraordinary expenditures and account to the court for all extraordinary expenditures made after these restraining orders areeffective. However, you may use community property, quasi-community property, or your own separate property to pay an attorneyto help you or to pay court costs.
ÓRDENES DE RESTRICCIÓN NORMALES DE DERECHO FAMILIAR
En forma inmediata, usted y su cónyuge o pareja de hecho tienen prohibido:1. Llevarse del estado de California a los hijos menores de las partes, si los hubiere, sin el consentimiento previo por escrito de
la otra parte o una orden de la corte;
2. Cobrar, pedir prestado, cancelar, transferir, deshacerse o cambiar el nombre de los beneficiarios de cualquier seguro u otrotipo de cobertura, tal como de vida, salud, vehículo y discapacidad, que tenga como beneficiario(s) a las partes y su(s)hijo(s) menor(es);
3. Transferir, gravar, hipotecar, ocultar o deshacerse de cualquier manera de cualquier propiedad, inmueble o personal, ya seacomunitaria, cuasicomunitaria o separada, sin el consentimiento escrito de la otra parte o una orden de la corte, con excepciónlas operaciones realizadas en el curso normal de actividades o para satisfacer las necesidades de la vida; y
Cada parte tiene que notificar a la otra sobre cualquier gasto extraordinario propuesto, por lo menos cinco días laborales antes derealizarlo, y rendir cuenta a la corte de todos los gastos extraordinarios realizados después de que estas órdenes de restricciónhayan entrado en vigencia. No obstante, puede usar propiedad comunitaria, cuasicomunitaria o suya separada para pagar a unabogado o para ayudarle a pagar los costos de la corte.
FL-110 [Rev. July 1, 2009] SUMMONS(Family Law)
Page 2 of 2
WARNING�IMPORTANT INFORMATION
ADVERTENCIA: De acuerdo a la ley de California, las propiedades adquiridas por las partes durante su matrimonioo pareja de hecho en forma conjunta se consideran propiedad comunitaria para los fines de la división de bienesque ocurre cuando se produce una disolución o separación legal del matrimonio o pareja de hecho. Si cualquiera delas partes de este caso llega a fallecer antes de que se divida la propiedad comunitaria de tenencia conjunta, eldestino de la misma quedará determinado por las cláusulas de la escritura correspondiente que describen sutenencia (por ej., tenencia conjunta, tenencia en común o propiedad comunitaria) y no por la presunción depropiedad comunitaria. Si quiere que la presunción comunitaria quede registrada en la escritura de la propiedad,debería consultar con un abogado.
ADVERTENCIA � INFORMACIÓN IMPORTANTE
4. Crear o modificar una transferencia no testamentaria de manera que afecte el destino 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 unatransferencia no testamentaria, se debe presentar ante la corte un aviso del cambio y hacer una entrega legal de dicho aviso ala otra parte.
4. Creating a nonprobate transfer or modifying a nonprobate transfer in a manner that affects the disposition of property subject tothe transfer, without the written consent of the other party or an order of the court. Before revocation of a nonprobate transfer cantake effect or a right of survivorship to property can be eliminated, notice of the change must be filed and served on the otherparty.
DISSOLUTION I – FORMS • 9
25th Edition 287
Sample Form 9E: Proof of Service of Summons (Family Law, Uniform Parentage, Custody and Support) (FL-115)
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 UseJudicial Council of California
Code of Civil Procedure, § 417.10
FL-115
PROOF OF SERVICE OF SUMMONS
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OFSTREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER:
RESPONDENT:
CASE NUMBER:
ATTORNEY FOR (Name):
TELEPHONE NO.: FAX NO. (Optional):
E�MAIL ADDRESS (Optional):
1.
Uniform Parentage: Petition to Establish Parental Relationship (form FL-200), Summons (form FL-210), and blankResponse to Petition to Establish Parental Relationship (form FL-220)
Family Law�Marriage: Petition�Marriage (form FL-100), Summons (form FL-110), and blank Response�Marriage
Custody and Support: Petition for Custody and Support of Minor Children (form FL-260), Summons (form FL-210), andblank Response to Petition for Custody and Support of Minor Children (form FL-270)
and
a.
(1)
(2)
(3)
Completed and blank Income andExpense Declaration (form FL-150)
(7)
c.
d.
�or�
�or�
(5)Completed and blank Declaration UnderUniform Child Custody Jurisdiction andEnforcement Act (form FL-105) (6)
Request for Order (form FL-300), and blankResponsive Declaration to Request for Order(form FL-320)
(4)
Completed and blank PropertyDeclaration (form FL-160)
2. Address where respondent was served:
a.
3. I served the respondent by the following means (check proper box):
Personal service. I personally delivered the copies to the respondent (Code Civ. Proc., § 415.10)on (date): at (time):
b.
(Business) a person at least 18 years of age who was apparently in charge at the office or usual place ofbusiness of the respondent. I informed him or her of the general nature of the papers.
(1)
(Home) a competent member of the household (at least 18 years of age) at the home of the respondent. Iinformed him or her of the general nature of the papers.
(2)
Substituted service. I left the copies with or in the presence of (name):
e.
Completed and blank Declaration ofDisclosure (form FL-140)Completed and blank Schedule of Assetsand Debts (form FL-142)
Page 1 of 2
(8) Other (specify):
Completed and blank Financial Statement(Simplified) (form FL-155)
FL-115 [Rev. July 1, 2012]
who is (specify title or relationship to respondent):
b. Family Law�Domestic Partnership: Petition�Domestic Partnership (form FL-103), Summons (form FL-110), andblank Response�Domestic Partnership (form FL-123)
�or�
Maria Smith433 1st StreetLos Angeles, CA 90008
(323)222-5555
Petitioner In Pro Per
111 N. Hill Street111 N. Hill StreetLos Angeles, CA 90012Central District
Maria Smith
Jose Smith
X
X X
X
(form FL-120)
Los Angeles
Indicate address, date, and time the Respondent was served.
HBCFL
9 • DISSOLUTION I – FORMS
25th Edition288
Sample Form 9E: Proof of Service of Summons (Family Law, Uniform Parentage, Custody and Support) (FL-115)
Person who served papers
The fee for service was (specify): $
exempt from registration under Business and Professions Code section 22350(b).not a registered California process server.a registered California process server:
a.b.c. an employee or
(1) Registration no.:County:
6. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
7.
Date:
(SIGNATURE OF PERSON WHO SERVED PAPERS)
PROOF OF SERVICE OF SUMMONS
CASE NUMBER:PETITIONER:
RESPONDENT:
5.
I am a California sheriff, marshal, or constable, and I certify that the foregoing is true and correct.
(2)
Mail and acknowledgment service. I mailed the copies to the respondent, addressed as shown in item 2, byfirst-class mail, postage prepaid, on (date):
c.from (city):
with two copies of the Notice and Acknowledgment of Receipt (form FL-117) and a postage-paid returnenvelope addressed to me. (Attach completed Notice and Acknowledgment of Receipt (form FL-117).)(Code Civ. Proc., § 415.30.)
(1)
(2)
Other (specify code section):d.
a.b.
other (specify):
minor. (Code Civ. Proc., § 416.60.)ward or conservatee. (Code Civ. Proc., § 416.70.)
to an address outside California (by registered or certified mail with return receipt requested). (Attach signedreturn receipt or other evidence of actual delivery to the respondent.) (Code Civ. Proc., § 415.40.)
Continued on Attachment 3d.
4. The "NOTICE TO THE PERSON SERVED" on the Summons was completed as follows (Code Civ. Proc., §§ 412.30, 415.10, 474):As an individual orOn behalf of respondent who is a
(NAME OF PERSON WHO SERVED PAPERS)
Name:Address:
Telephone number:
d.
on (date):
A declaration of diligence is attached, stating the actions taken to first attempt personal service.
at (time):I thereafter mailed additional copies (by first class, postage prepaid) to the respondent at the place where thecopies were left (Code Civ. Proc., § 415.20b) on (date):
3. (cont.)
This person is
Page 2 of 2FL-115 [Rev. July 1, 2012]
�or�
(Family Law�Uniform Parentage�Custody and Support)
an independent contractor
Maria Smith
Jose Smith
X
X
0.00
X
(1)(2)(3)
b.
To be completed by the person who served the Respondent.
To be completed and signed by the person who served the Respondent.
DISSOLUTION I – FORMS • 9
25th Edition 289
Sample Form 9F: Petition (Family Law)
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
TELEPHONE NO.:
FOR COURT USE ONLY
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OFSTREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
MARRIAGE OFPETITIONER:
RESPONDENT:
PETITION FORDissolution of MarriageLegal SeparationNullity of Marriage AMENDED
CASE NUMBER:
1. RESIDENCE (Dissolution only)of this county for at least three months immediately preceding the filing of this Petition for Dissolution of Marriage.
2. STATISTICAL FACTSa. Date of marriage:b. Date of separation:
c. Time from date of marriage to date of separation (specify):Years: Months:
3. DECLARATION REGARDING MINOR CHILDREN (include children of this relationship born prior to or during the marriage oradopted during the marriage):a. There are no minor children.b. The minor children are:
Child's name Birthdate Age Sex
c. If there are minor children of the Petitioner and Respondent, a completed Declaration Under Uniform Child Custody Jurisdiction
d. A completed voluntary declaration of paternity regarding minor children born to the Petitioner and Respondent prior to
4.Petitioner requests that the assets and debts listed in Attachment 4
below be confirmed as separate property.Item Confirm to
NOTICE: You may redact (black out) social security numbers from any written material filed with the court in this caseother than a form used to collect child or spousal support.
Form Adopted for Mandatory UseJudicial Council of California
FL-100 [Rev. January 1, 2005]
PETITION MARRIAGE(Family Law)
Family Code, §§ 2330, 3409
Petitioner Respondent has been a resident of this state for at least six months and
FAX NO. (Optional):
Continued on Attachment 3b.
and Enforcement Act (UCCJEA) (form FL-105) must be attached.
the marriage is attached.
FL-100
E-MAIL ADDRESS (Optional):
Page 1 of 2
SEPARATE PROPERTYin Property Declaration (form FL-160)
Mary Smith
433 1st Street
Los Angeles, CA 90008(213)222-5555
Petitioner in Pro PerLos Angeles
111 N. Hill Street111 N. Hill StreetLos Angeles, CA 90012Central District
Mary Smith
Jose Smith
X
X
06/24/200112/15/2007 6 6
X
Ana Smith 01/19/96 11 FPaul Smith 12/30/00 7 M
X
1978 Ford Mustang Petitioner1978 Ford Pick-Up Truck Petitioner
HBCFL
9 • DISSOLUTION I – FORMS
25th Edition290
Sample Form 9F: Petition (Family Law)
MARRIAGE OF (last name, first name of parties): CASE NUMBER:
5. DECLARATION REGARDING COMMUNITY AND QUASI-COMMUNITY ASSETS AND DEBTS AS CURRENTLY KNOWNa. There are no such assets or debts subject to disposition by the court in this proceeding.b. All such assets and debts are listed in Attachment 5b.
below (specify):
6. Petitioner requestsa. dissolution of the marriage based on
(1) irreconcilable differences. (Fam. Code, § 2310(a).)(2) incurable insanity. (Fam. Code, § 2310(b).)
b. legal separation of the parties based on(1) irreconcilable differences. (Fam. Code, § 2310(a).)(2) incurable insanity. (Fam. Code, § 2310(b).)
c. nullity of void marriage based on(1) incestuous marriage. (Fam. Code, § 2200.)(2) bigamous marriage. (Fam. Code, § 2201.)
d. nullity of voidable marriage based on(1) petitioner's age at time of marriage.
(Fam. Code, § 2210(a).)(2) prior existing marriage.
(3) unsound mind. (Fam. Code, § 2210(c).)(4) fraud. (Fam. Code, § 2210(d).)(5) force. (Fam. Code, § 2210(e).)(6) physical incapacity. (Fam. Code, § 2210(f).)
7. Petitioner requests that the court grant the above relief and make injunctive (including restraining) and other orders as follows:Petitioner Respondent Joint Other
a. Legal custody of children to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .b. Physical custody of children to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .c. Child visitation be granted to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
f. Spousal support payable to (earnings assignment will be issued) . . . . . . . . . . . . . . .e. Attorney fees and costs payable by . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
g. Terminate the court's jurisdiction (ability) to award spousal support to Respondent.h. Property rights be determined.i. Petitioner's former name be restored to (specify):j. Other (specify):
8. Child support If there are minor children born to or adopted by the Petitioner and Respondent before or during this marriage, thecourt will make orders for the support of the children upon request and submission of financial forms by the requesting party. An
9. I HAVE READ THE RESTRAINING ORDERS ON THE BACK OF THE SUMMONS, AND I UNDERSTAND THAT THEY APPLY
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.Date:
(SIGNATURE OF PETITIONER)
(TYPE OR PRINT NAME) (SIGNATURE OF ATTORNEY FOR PETITIONER)
NOTICE: Dissolution or legal separation may automatically cancel the rights of a spouse under the other spouse's will, trust,retirement plan, power of attorney, pay on death bank account, survivorship rights to any property owned in joint tenancy, and anyother similar thing. It does not automatically cancel the right of a spouse as beneficiary of the other spouse's life insurance policy.
FL-100 [Rev. January 1, 2005] PETITION MARRIAGE(Family Law)
Page 2 of 2
(Fam. Code, § 2210(b).)
Attachment 7c.d. Determination of parentage of any children born to the Petitioner and Respondent prior to the marriage.
Continued on Attachment 7j.(1), 7j(2) and 7j(3)
TO ME WHEN THIS PETITION IS FILED.
You should review these matters, as well as any credit cards, other credit accounts, insurance polices, retirement plans, and creditreports to determine whether they should be changed or whether you should take any other actions. However, some changes may
(TYPE OR PRINT NAME)
Date:
require the agreement of your spouse or a court order (see Family Code sections 231 235).
in Property Declaration (form FL-160)
As requested in form: FL-311 FL-312 FL-341(C) FL-341(D) FL-341(E)
earnings assignment may be issued without further notice. Any party required to pay support must pay interest on overdueamounts at the "legal" rate, which is currently 10 percent.
Smith and Smith
XX
Target credit card debt, 1999 Nissan Truck, First interstate VISA creditcard debt, any and all pension, retirement plans, 401ks or other employee benefits earned during marriage by Respondent, and other assets and debts
acquired during the marriage.
XX
XX
XX X
XX
XXX
X
01/01/11
Mary Smith Mary Smith
X
1. Consolidation of DVPA case; 2. Health Care for Minor Children; 3. Health Care for Spouse, and;4. Child support be made retroactive to the date of filing of this petition pursuant to Family Code Section 4009.
DISSOLUTION I – FORMS • 9
25th Edition 291
Sample Form 9G-1: Child Custody and Visitation Application Attachment (FL-311)
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
CASE NUMBER:
CHILD CUSTODY AND VISITATION APPLICATION ATTACHMENT
1. Custody. Custody of the minor children of the parties is requested as follows:Child's name Date of Birth Legal Custody to Physical Custody to
2. Visitation.a. Reasonable right of visitation to the party without physical custody (not appropriate in cases involving domestic
c. The parties will go to mediation at (specify location):d. No visitation
TO Petition, Response, Application for Order or Responsive Declaration Other (specify):
b.
FL-311
Visitation for the
Weekends starting (date):
Other (specify days and times as well as any additional restrictions):
(1)
(4)
Weekdays starting (date):(3)
a.m. p.m.
to a.m. p.m.
from at
petitioner will have the children with him or her during the period
e.
(2) Alternate weekends starting (date):will have the children with him or her during the period
at a.m. p.m.
to a.m. p.m.
at a.m. p.m.
to a.m. p.m.
petitioner
See Attachment 2e(4).
at
at
at
respondent
from
respondent
from
CHILD CUSTODY AND VISITATION APPLICATION ATTACHMENT Family Code, § 6200 et seq.Form Approved for Optional UseJudicial Council of CaliforniaFL-311 [Rev. July 1, 2005]
Page 1 of 2
To be ordered now and effective until the hearing
(person who makes decisions abouthealth, education, etc.)
(person with whom the child lives)
See the attached -page document dated (specify date):
petitioner respondent will be as follows:
(The first weekend of the month is the first weekend with a Saturday.)1st 2nd 3rd 4th 5th weekend of the month
(day of week) (time)
(day of week) (time)
The parents will alternate the fifth weekends, with the petitioner respondenthaving the initial fifth weekend, which starts (date):
The petitioner will have fifth weekends in odd even months.
(day of week) (time)
(day of week) (time)
(day of week) (time)
(time)(day of week)
violence)
(a)
(b)
The
The
Maria Smith
Jose Smith
X
X
Ana Smith 1/19/96 Maria Smith & Jose Smith Maria SmithPaul Smith 12/30/00 Maria Smith & Jose Smith Maria Smith
X
X X
X August 1, 2012
X XSaturday 10:00 X
Sunday 5:00 X
X August 1, 2012
XWednesday 4:00 x
Wednesday 8:00 X
9 • DISSOLUTION I – FORMS
25th Edition292
Sample Form 9G-1: Child Custody and Visitation Application Attachment (FL-311)
PETITIONER:
RESPONDENT:
CASE NUMBER:
4. Transportation for visitation and place of exchange
Transportation to the visits will be provided by (name):a.b.
Drop-off of the children will be at (address):c.
g. Other (specify):
5. Travel with children. The
the state of California.a.b. the following counties (specify):
other places (specify):c.
Transportation from the visits will be provided by (name):
CHILD CUSTODY AND VISITATION APPLICATION ATTACHMENTFL-311 [Rev. July 1, 2005] Page 2 of 2
6. Child abduction prevention. There is a risk that one of the parents will take the children out of California without the other
e. The children will be driven only by a licensed and insured driver. The car or truck must have legal child restraint
f. During the exchanges, the parent driving the children will wait in the car and the other parent will wait in his or herhome while the children go between the car and the home.
petitioner respondent other (name):must have written permission from the other parent or a court order to take the children out of
parent's permission. I request the orders set out on attached form FL-312.
7. Children's holiday schedule. I request the holiday and visitation schedule set out on the attached form FL-341(C)other (specify):
8. Additional custody provisions. I request the additional orders regarding custody set out on the attachedform FL-341(D) other (specify):
9. Joint legal custody provisions. I request joint legal custody and want the additional orders set out on the attached
form FL-341(E) other (specify):
10. Other. I request the following additional orders (specify):
3. Supervised visitation.I request that (name):schedule set out on page 1 and that the visits be supervised by (name):who is a professional nonprofessional supervisor. The supervisor's phone number is (specify):
I request that the costs for supervision be paid as follows: petitioner: percent; respondent: percent.
have supervised visitation with the minor children according to the
If item 3 is checked, you must attach a declaration that shows why unsupervised visitation would be bad for yourchildren. The judge is required to consider supervised visitation if one parent is alleging domestic violence and isprotected by a restraining order.
d. Pick-up of the children will be at (address):
devices.
Maria Smith
Jose Smith
X Jose Smith
Beth Smith or person of Petitioner's choice
X (562)722-3700
X
X 65 Oak St., L.A., CA 90012 or future home of Petitioner
X 65 Oak St., L.A., CA 90012 or future home of Petitioner
X X
X Los Angeles
X X
XX
X
X
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