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TABLE OF FORMS
Sample Form Number
and Brief Description Page
9A: Stages of Dissolution Flow Chart. . . . . . . . . . . . . . . . . . . . . . . 9-3
9B: Legal Steps for a Divorce or Legal Separation (FL-107-INFO) . . . . . . . . 9-5
9C: Family Law Case Cover Sheet (LA-20/FAM020). . . . . . . . . . . . . . . 9-7
9D: Summons (Family Law) and Standard Restraining Orders (FL-110) . . . . . 9-9
9E:
Proof of Service of Summons (Family Law – Uniform Parentage –
Custody and Support) (FL-115). . . . . . . . . . . . . . . . . . . . . . . . 9-11
9F: Petition — Marriage/Domestic Partnership (Family Law) (FL-100). . . . . . 9-13
9G-1: Child Custody and Visitation Application Attachment (FL-311) . . . . . . . 9-17
9G-2: Additional Provisions — Physical Custody Attachment (FL-341(D)) . . . . . 9-19
9H-1: Joint Legal Custody Attachment (FL-341(E)). . . . . . . . . . . . . . . . . 9-21
9H-2: Children’s Holiday Schedule Attachment (FL-341(C)) . . . . . . . . . . . . 9-23
9H-3: Request for Child Abduction Prevention Orders (FL-312) . . . . . . . . . . 9-25
9I-1: Attachment 11c – Health Care Coverage for Spouse. . . . . . . . . . . . 9-27
9I-2: Attachment 11c – Consolidation Attachment. . . . . . . . . . . . . . . . . 9-29
9I-3: Children’s Health Care Attachment. . . . . . . . . . . . . . . . . . . . . . 9-30
9J:
Declaration Under Uniform Child Custody Jurisdiction and
Enforcement Act (UCCJEA) . . . . . . . . . . . . . . . . . . . . . . . . . 9-31
9K: Response — Marriage, Domestic Partnership (Family Law) (FL-120) . . . . 9-33
9L: Letter to Litigation Coordinator. . . . . . . . . . . . . . . . . . . . . . . . 9-37
9M:
Letter to Sheriff (Out-of-County or Out-of-State Personal Service
by Sheriff). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-39
9N: Schedule of Assets and Debts . . . . . . . . . . . . . . . . . . . . . . . . 9-43
9O:
Letter to Client Advising of Need to Discover Information and
Join Pension Plan (also available in Spanish). . . . . . . . . . . . . . . . . 9-47
9Q: Dissolution I Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-49
9R: RFO Checklist. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-51
9S: House Checklist. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-53
9T: Pension Checklist. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-55
9U:
Letter to Other Party’s Employer Seeking Pension/Retirement
Plan Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-56
9V: Custody and Visitation Handout (also available in Spanish). . . . . . . . . 9-57
9W: Assets & Debts Chart. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-59
Disso 1 Response
(Start your case) (Other party already
served you)
Temporary orders
needed?
Response Filed
No Response Filed (Contested)
(Default)
Disso 2 - Contested PDD
(Prelim Financial Disclosure)
Disso 2 - Default
(Financial Disclosures/
Default Request) Discovery
(Gather evidence/ Research)
Discovery
(Gather evidence/ Disso 2 - Contested FDD
Research) (Final Financial Disclosure)
Trial Prep
Disso 3 - Disso 3 - (Request Trial/Brief/Lists)
Default Default with
(Judgment Prep/ Agreement
Supporting docs) (Judgment Prep)
Trial Setting Conference
Default
Hearing? Trial
Disso 3 - Disso 3 -
Contested Uncontested
(Judgment Prep) (Stip Judgment Prep)
HBCFL Appointment
Non-appointment
Process
Judgment
Sample Form 9B: Legal Steps for a Divorce or Legal Separation (FL-107-INFO)
IMPORTANT NOTICES
The earliest you can be divorced is six months and one day from one of these three dates (whichever occurs first):
(1) the date Respondent was served with the Summons (form FL-110) and Petition (form FL-100), (2) the date the
Response (form FL-120) was filed, or (3) the date Appearance, Stipulations, and Waivers (form FL-130) was filed.
Legal separation has no waiting period. You are NOT divorced or legally separated until the court enters a Judgment in
your case.
If you need court orders for child support, custody, parenting time (visitation), spousal or partner support, restraining
orders, or other issues, file a Request for Order (form FL-300) asking for temporary orders. See “Request for Order
Information” at courts.ca.gov/divorcerequests for more information.
Annulments: See courts.ca.gov/annulment for information about annulments.
You must keep the court and the other party informed of any change in your mailing address or other contact
information. File and serve a Notice of Change of Address or Other Contact Information (form MC-040) on the other
party or his or her attorney to let them know about the change in your contact information.
FL-107-INFO, Page 1 of 2
Legal Steps for a Divorce or Legal Separation
Judicial Council of California, www.courts.ca.gov
Revise January 1, 2015, Optional Form
Cal. Rules of Court, rule 5.83
Sample Form 9B: Legal Steps for a Divorce or Legal Separation (FL-107-INFO)
NAME, ADDRESS, AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT ATTORNEY: STATE BAR NUMBER Reserved for Clerk's File Stamp
Maria Smith
433 1st Street
Los Angeles, CA 90008
(213)222-5555
ATTORNEY FOR (Name): Petitioner In Pro Per
a. Under Column 1 below, check the one type of action which best describes the nature of this case.
b. In Column 2 below, circle the reason for your choice of district that applies to the type of action you have checked.
1 TYPE OF ACTION (Check only one) (Continued) 2 APPLICABLE REASONS (See above)
BD354789
III. Enter address of minor child if known. (DO NOT COMPLETE UNLESS YOU HAVE CIRCLED ITEM 3 AS AN APPLICABLE REASON
ADDRESS: Do not complete if this case falls under Family Code §6751 CITY: STATE ZIP CODE
Certificate / Declaration of Assignment: The undersigned hereby certifies and declares that the above entitled matter is properly filed for
assignment to the Central 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.
Sample Form 9D: Summons (Family Law) and Standard Restraining Orders (FL-110)
FL-110
SUMMONS (Family Law) CITACIÓN (Derecho familiar)
NOTICE TO RESPONDENT (Name): Jose Smith FOR COURT USE ONLY
(SOLO PARA USO DE LA CORTE)
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.
You have 30 calendar days after this Summons and Tiene 30 días de calendario después de haber recibido la
Petition are served on you to file a Response (form entrega legal de esta Citación y Petición para presentar una
FL-120) at the court and have a copy served on the Respuesta (formulario FL-120) ante la corte y efectuar la
petitioner. A letter, phone call, or court appearance entrega legal de una copia al demandante. Una carta o llamada
will not protect you. telefónica o una audiencia de la corte no basta para protegerlo.
If you do not file your Response on time, the court Si no presenta su Respuesta a tiempo, la corte puede dar
may make orders affecting your marriage or domestic órdenes que afecten su matrimonio o pareja de hecho, sus
partnership, your property, and custody of your bienes y la custodia de sus hijos. La corte también le puede
children. You may be ordered to pay support and ordenar que pague manutención, y honorarios y costos legales.
attorney fees and costs.
For legal advice, contact a lawyer immediately. Get Para asesoramiento legal, póngase en contacto de inmediato
help finding a lawyer at the California Courts Online con un abogado. Puede obtener información para encontrar un
Self-Help Center (www.courts.ca.gov/selfhelp), at the abogado en el Centro de Ayuda de las Cortes de California
(www.sucorte.ca.gov), en el sitio web de los Servicios Legales
California Legal Services website (www.lawhelpca.org),
de California (www.lawhelpca.org) o poniéndose en contacto
or by contacting your local county bar association.
con el colegio de abogados de su condado.
1. The name and address of the court are (El nombre y dirección de la corte son):
[SEAL]
Superior Court of California
111 N. Hill Street
111 N. Hill Street
Los Angeles, CA 90012
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):
Maria Smith
433 First St
Los Angeles, CA 90008
213-222-5555
Date (Fecha): Clerk, by (Secretario, por) , Deputy (Asistente)
Page 1 of 2
Sample Form 9D: Summons (Family Law) and Standard Restraining Orders (FL-110)
FL-110
STANDARD FAMILY LAW RESTRAINING ORDERS ÓRDENES DE RESTRICCIÓN ESTÁNDAR DE DERECHO
FAMILIAR
Starting immediately, you and your spouse or domestic En forma inmediata, usted y su cónyuge o pareja de hecho
partner are restrained from: tienen prohibido:
1. removing the minor children of the parties from the state 1. llevarse del estado de California a los hijos menores de las
or applying for a new or replacement passport for those partes, o solicitar un pasaporte nuevo o de repuesto para los
minor children without the prior written consent of the hijos menores, sin el consentimiento previo por escrito de la
other party or an order of the court; otra parte o sin una orden de la corte;
2. cashing, borrowing against, canceling, transferring, 2. cobrar, pedir prestado, cancelar, transferir, deshacerse o
disposing of, or changing the beneficiaries of any cambiar el nombre de los beneficiarios de cualquier seguro u
insurance or other coverage, including life, health, otro tipo de cobertura, como de vida, salud, vehículo y
automobile, and disability, held for the benefit of the discapacidad, que tenga como beneficiario(s) a las partes y
parties and their minor children; su(s) hijo(s) menor(es);
3. transferring, encumbering, hypothecating, concealing, or in 3. transferir, gravar, hipotecar, ocultar o deshacerse de
any way disposing of any property, real or personal, cualquier manera de cualquier propiedad, inmueble o
whether community, quasi-community, or separate, without personal, ya sea comunitaria, cuasicomunitaria o separada,
the written consent of the other party or an order of the sin el consentimiento escrito de la otra parte o una orden de
court, except in the usual course of business or for the la corte, excepto en el curso habitual de actividades
necessities of life; and personales y comerciales o para satisfacer las necesidades
de la vida; y
4. creating a nonprobate transfer or modifying a nonprobate 4. crear o modificar una transferencia no testamentaria de
transfer in a manner that affects the disposition of property manera que afecte la asignación de una propiedad sujeta a
subject to the transfer, without the written consent of the transferencia, sin el consentimiento por escrito de la otra
other party or an order of the court. Before revocation of a parte o una orden de la corte. Antes de que se pueda
nonprobate transfer can take effect or a right of eliminar la revocación de una transferencia no
survivorship to property can be eliminated, notice of the testamentaria, se debe presentar ante la corte un aviso del
change must be filed and served on the other party. cambio y hacer una entrega legal de dicho aviso a la otra
parte.
You must notify each other of any proposed extraordinary Cada parte tiene que notificar a la otra sobre cualquier gasto
expenditures at least five business days prior to incurring these extraordinario propuesto por lo menos cinco días hábiles antes
extraordinary expenditures and account to the court for all de realizarlo, y rendir cuenta a la corte de todos los gastos
extraordinary expenditures made after these restraining orders extraordinarios realizados después de que estas órdenes de
are effective. However, you may use community property, restricción hayan entrado en vigencia. No obstante, puede usar
quasi-community property, or your own separate property to propiedad comunitaria, cuasicomunitaria o suya separada para
pay an attorney to help you or to pay court costs. pagar a un abogado que lo ayude o para pagar los costos de la
corte.
(Family Law)
Sample Form 9E: Proof of Service of Summons (Family Law – Uniform Parentage –
Custody and Support) (FL-115)
FL-115
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY
Maria Smith
433 First St
Los Angeles, CA 90008
TELEPHONE NO.: 213-222-5555 FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (Name): In Pro Per
SUPERIOR COURT OF CALIFORNIA, COUNTY OF Los Angeles
STREET ADDRESS: 111 N. Hill Street
MAILING ADDRESS: 111 N. Hill Street
CITY AND ZIP CODE: Los Angeles, CA 90012
BRANCH NAME: Central District HBCFL
PETITIONER: Maria Smith
RESPONDENT: Jose Smith
CASE NUMBER:
1. 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:
a. X 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)
–or–
b. 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)
–or–
c. 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)
and
d. X (1) X Completed and blank Declaration Under (5) Completed and blank Financial Statement
Uniform Child Custody Jurisdiction and (Simplified) (form FL-155)
Enforcement Act (form FL-105)
(6) Completed and blank Property
(2) Completed and blank Declaration of Declaration (form FL-160)
Disclosure (form FL-140) (7) Request for Order (form FL-300), and blank
(3) Completed and blank Schedule of Assets Responsive Declaration to Request for Order (form
and Debts (form FL-142) FL-320)
(4) Completed and blank Income and (8) Other (specify):
Expense Declaration (form FL-150)
2. Address where respondent was served: Indicate address, date, and time
the Respondent was served.
Sample Form 9E: Proof of Service of Summons (Family Law – Uniform Parentage –
Custody and Support) (FL-115)
FL-115
PETITIONER: Maria Smith CASE NUMBER:
3. c. Mail and acknowledgment service. I mailed the copies to the respondent, addressed as shown in item 2, by
first-class mail, postage prepaid, on (date): from (city):
(1) 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.)
(2) 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.)
d. Other (specify code section):
Continued on Attachment 3d.
Telephone number:
This person is
a. exempt from registration under Business and Professions Code section 22350(b).
b. X not a registered California process server.
c. a registered California process server: an employee or an independent contractor
(1) Registration no.:
(2) County:
d. The fee for service was (specify): $
5. X I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
–or–
6. I am a California sheriff, marshal, or constable, and I certify that the foregoing is true and correct.
Date:
Maria Smith
x x
x x
x 6/24/2001 12/15/2014
13 6
Maria Smith
Jose Smith
x
x
x
x
x
x x
x
x x
x x
x
x
1995 Toyota Camry Petitioner
Maria Smith
Jose Smith
x
Bank of America Savings Account #1234, 1999 Nissan Truck, Target credit card
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.
x x
x Maria Rodriguez
x
1. Consolidation of DVPA case; 2. Health Care for Minor Children;
3. Health Care for Spouse.
x 1, 11c2, 11c3.
3/5/2015
Maria Smith Maria Smith
Sample Form 9G-1: Child Custody and Visitation Application Attachment (FL-311)
Maria Smith
Jose Smith BD132789
Ana Smith 1/19/00 Maria Smith & Jose Smith Maria Smith
Paul Smith 12/30/10 Maria Smith & Jose Smith Maria Smith
x
x
x Immediately after hearing
x x
Saturday 10 x
Sunday 5 x
x
Wednesday 4 x
Wednesday 8 x
Sample Form 9G-1: Child Custody and Visitation Application Attachment (FL-311)
Maria Smith
Jose Smith BD132789
Jose Smith
x Jose Smith
x Jose Smith
x 65 Oak St., LA, CA 90012 or future home of Petitioner
x 65 Oak St., LA, CA 90012 or future home of Petitioner
x x
x Los Angeles
x x
x
x
x
x
Maria Smith
Jose Smith
x
x x
7
x x x
x x x
x
x
x
x
x
30
x
x x
Maria Smith
Jose Smith
x x
12
x
In emergency situations, each parent is authorized to take any and all
actions necessary to protect the health and welfare of the children,
including but not limited to the consent to emergency surgical procedures
or treatment. The parent authorizing such emergency treatment must notify
the other parent as soon as possible, within 3 hours, of such emergency and
of all procedures or treatment administered to the children.
Maria Smith
Jose Smith
BD354789
x x
x
x
x
x
x
x
x
x
children's primary care physician.
x
x
Maria Smith
Jose Smith
BD354789
8
8
Petitioner
Respondent
Petitioner Respondent
Respondent Petitioner
3/3/83 Petitioner
11/1/82 Respondent
Maria Smith
Jose Smith
BD354789
Sample Form 9H-3: Request for Child Abduction Prevention Orders (FL-312)
Maria Smith
Jose Smith BD354789
Maria Smith
x
x
x
x
The Respondent's mother, father, four brothers, two sisters, and
numerous aunts and uncles live in Mexico.
x
x x
x
x
x
x x
x
The Respondent on many occasions has threatened to take our children away
from me so that I will never see them again if I were to leave him. On or
about 1/1/14, I tried to separate from Respondent. He took the kids to
Mexico and did not return until I agreed to take him back.
x
On or about February 2015, the Respondent was arrested and convicted for
spousal battery against me.
Sample Form 9H-3: Request for Child Abduction Prevention Orders (FL-312)
Maria Smith
Jose Smith BD354789
x
x
x
x
x
x
x
x
x
Mexico
15
x
Sample Form 9I-1: Attachment 11c – Health Care Coverage for Spouse
4 Petitioner respectfully requests that this Court order the following relief so that (s/he ) ma y ha ve health
5 care coverage:
8 1. By direct payment each month to the Petitioner payable by wage assignment for the
11 coverage available through state and federal laws and thereafter to provide payment for
15 4. Any amount so ordered may be increased annually by not more than 10% without
16 further hearing or order of the Court, based upon the actual cost of said coverage for the
17 year.
18 5. The Respondent shall pay 50% of all un-reimbursed health care expense s of the
19 Petitioner within 30 days of request made by the Petitioner submitted with written
21 □ 6.
22
23
24
25
26
27
28
HEALTH CARE ATTACHMENT
F:\Document\Publications\Volunteer Manual\2013\2013 Manual Forms\Chapter 9\9I-1 Health Care Coverage for Spouse.wpd rev.June 1, 2000
Page ______
Attachment 11 C 1:
1 Consolidation Request
2 x 1. Domestic Violence Prevention Act (DVPA) Case number BQ456789 be
3 consolidated and merged into this case, and this action should be ordered the lead case.
4 x 2. All orders previously set forth in the aforementioned DVPA case, including but not
5 limited to CLETS orders, custody and visitation orders, support orders, and property control
6 orders, shall be incorporated and shall remain in full force and effect unless explicitly
7 modified by other terms of the Findings and Order After Hearing Judgment.
8 //
9 //
10 //
11 //
12 //
13 //
14 //
15 //
16 //
17 //
18 //
19 //
20 //
21 //
22 //
23 //
24
25
26
27
28
CONSOLIDATION ATTACHMENT
Page ____
Sample Form 9J: Declaration Under Uniform Child Custody Jurisdiction and
Enforcement Act (UCCJEA)
FL-105/GC-120
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY
Mary Smith
105 W. Beverly Blvd.
Los Angeles, CA 90042
GUARDIANSHIP OF (Name):
Minor
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): 2 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
Ana Smith Portland, OR 1/19/96 F
Period of residence Address Person child lived with (name and complete current address) Relationship
105 W. Beverly Blvd Mary Smith Mother
Los Angeles, CA 90042 Same
4/11/09 to present Confidential Confidential
Child's residence (City, State) Person child lived with (name and complete current address)
210 NE 18th Street Mary Smith / Jose Smith Mother/
1/19/05 to 4/10/09 Portland, OR 97311 105 W. Beverly Blvd / 82 W. 9th St Father
Child's residence (City, State) Person child lived with (name and complete current address)
to
Child's residence (City, State) Person child lived with (name and complete current address)
to
b. Child's name Place of birth Date of birth Sex
Paul Smith Los Angeles, CA 12/30/03 M
x Residence information is the same as given above for child a.
(If NOT the same, provide the information below.)
Period of residence Address Person child lived with (name and complete current address) Relationship
to
Child's residence (City, State) Person child lived with (name and complete current address)
to
Child's residence (City, State) Person child lived with (name and complete current address)
to
c. Additional residence information for a child listed in item a or b is continued on attachment 3c.
d. Additional children are listed on form FL-105(A)/GC-120(A). (Provide all requested information for additional children.) Page 1 of 2
Form Adopted for Mandatory Use Family Code, § 3400 et seq.;
Judicial Council of California DECLARATION UNDER UNIFORM CHILD CUSTODY Probate Code, §§ 1510(f), 1512
FL-105/GC-120 [Rev. January 1, 2009] JURISDICTION AND ENFORCEMENT ACT (UCCJEA)
Sample Form 9J: Declaration Under Uniform Child Custody Jurisdiction and
Enforcement Act (UCCJEA)
FL-105/GC-120
SHORT TITLE: Smith and Smith CASE NUMBER:
4. 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?
x Yes No (If yes, attach a copy of the orders (if you have one) and provide the following information):
Court order Your
Proceeding Case number Court or judgment Name of each child connection to Case status
(name, state, location) (date) the case
a. Family
b. Guardianship
c. Other
e. Adoption
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):
Court County State Case number (if known) Orders expire (date)
a. Criminal
b. Family
Juvenile Delinquency/
c. Juvenile Dependency
d. Other
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 x 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
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date: 01/01/09
Mary Smith
(TYPE OR PRINT NAME)
Mary Smith
(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
Sample Form 9K: Response — Marriage, Domestic Partnership (Family Law) (FL-120)
Sample Form 9K: Response — Marriage, Domestic Partnership (Family Law) (FL-120)
Sample Form 9K: Response — Marriage, Domestic Partnership (Family Law) (FL-120)
X
X
X
X
J. Volunteer
3/1/2015
Sheriff’s Office
1401 Lakeside Drive, 12th Floor
Seattle, WA 22017
Dear Sheriff:
We are assisting Maria Smith, who is representing himself/herself in a family law case. The
attached pleadings are sent to you for personal service on: Jose Smith, for whom there is a full
description at the end of this letter.
After serving, please complete the enclosed proof of service. For your convenience we have
indicated the sections you need to complete by affixing stick-on colored dots These include
sections:
Please return the completed proof of service in the enclosed self-addressed stamped envelope
addressed to our office at Harriett Buhai Center for Family Law, 3250 Wilshire Blvd., Suite
710, Los Angeles, CA 90010 within 10 days of receipt of this letter.
If you are required to use your own proof of service, please make sure to indicate the following
otherwise the proof of service will be not be valid and we will have to request you re-complete
the proof of service:
1. Please include the language: “I declare under penalty of perjury under the laws of the
State of California that the foregoing is true and correct.” before the signature of the
person who personally served the court papers. This sentence must be included for the
service to be valid in California. You may declare under penalty of perjury of the laws of
both your state and the State of California.
2. Please list all the following forms on the proof of service as having been served:
X Summons
X Pe tition
X Blank Re sponse
X UCCJEA and Blank UCCJEA
Re que st for Orde r and Supporting De claration
Me morandum of Points and Authoritie s
____ Blank Re sponsive De claration
Income & Expe nse De claration and Blank Income & Expe nse De claration
Financial State me nt (Simplified) and Blank Financial Stateme nt (Simplifie d)
Te mporary Re straining Orde r
Re straining Orde r Afte r He aring
De claration of Disclosure
Sche dule of Asse ts and De bts
Community and Quasi Community Prope rty De claration
____ Se parate Prope rty De claration
Othe r
Should you need any further assistance, please call our office at (213)388-7505/ext. _______ and
identify the case by name and our HB#. Thank you for your anticipated cooperation in this matter.
Sincerely,
J. Volunteer
_____________________
Staff/Volunteer
Page 2 of 3
9-40 27th Edition
DISSOLUTION I – FORMS • 9
Race
White ( ) Black ( ) Hispanic ( ) Asian ( )
Hair
Color: _______________ Length: _______________ Style: _______________
Facial Hair
Mustache ( ) Beard ( ) Goatee ( ) Bushy Eyebrows ( )
Page 3 of 3
27th Edition 9-41
9 • DISSOLUTION I – FORMS
X Petitioner's Respondent's
INSTRUCTIONS
List all your known community and separate assets or debts. Include assets even if they are in the possession of another person,
including your spouse. If you contend an asset or debt is separate, put P (for Petitioner) or R (for Respondent) in the first column
(separate property) to indicate to whom you contend it belongs.
All values should be as of the date of signing the declaration unless you specify a different valuation date with the description. For
additional space, use a continuation sheet numbered to show which item is being continued.
$ $
1. REAL ESTATE (Give street addresses and attach copies of
deeds with legal descriptions and latest lender's statement.)
None
Page 1 of 4
Code of Civil Procedure, §§ 2030(c), 2033.5
Form Approved for Optional Use
Judicial Council of California
SCHEDULE OF ASSETS AND DEBTS
FL-142 [Rev. January 1, 2005] (Family Law)
None
9. TAX REFUND
None
(Family Law)
9-44 27th Edition
DISSOLUTION I – FORMS • 9
$ $
11. STOCKS, BONDS, SECURED NOTES, MUTUAL FUNDS
(Give certificate number and attach copy of the certificate or
copy of latest statement.)
None
None
None
None
(Family Law)
$
19. STUDENT LOANS (Give details.)
None
20. TAXES (Give details.)
None
23. CREDIT CARDS (Give creditor's name and address and the account number. Attach
copy of latest statement.)
Target 500 01/01/97
Date:
Mary Smith
(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)
(Family Law)
Sample Form 9O: Letter to Client Advising of Need to Discover Information and
Join Pension Plan (also available in Spanish)
3250 Wilshire Boulevard, Suite 710, Los Angeles, California 90010 213.388.7514
Sponsored by Black Women Lawyers Association of Los Angeles Los Angeles County Bar Association Women Lawyers Association of Los Angeles
Date:
Dear Client :
It has come to our attention that your spouse may have rights to collect a pension at a future date.
As his/her spouse under California law you too may have valuable rights to such pension funds.
In order to protect these rights, you must bring the pension fund into the dissolution action which
you have filed or will be filing. To do this, the pension fund must be served with a special kind
of petition and summons. The action that you take will not negatively affect your spouse's rights
to his/her pension, nor will it affect his/her employment. The petition and summons merely bring
the pension fund into the case so that it can be fairly divided. For the pension fund it only
requires some paperwork. They do not have to come to court.
To protect your rights you must find out and give us the following information about your
spouse's pension:
2. Date of hire:
Sample Form 9O: Letter to Client Advising of Need to Discover Information and
Join Pension Plan (also available in Spanish)
We suggest you call the Personnel Office at your spouse's employer to get this information. If
you feel you are unable to do this on your own, try to get a friend or relative to help you. You
may also use a form letter to the employer that the Center has prepared for this purpose. You can
ask the staff attorney for a copy of it.
Please provide us with the information requested (numbers 1-7) in writing no later than
.
Please call us at (213) 388-7514 on Fridays from 10:00 a.m. to 12:00 p.m or 2:00 to 4:00 p.m if
you have any questions. Tell us your HBCFL # is .
DISSOLUTION I
Name of Client ___________________________ Date _______________
HB# _________________ Volunteer __________________
2. PETITION
a. Date of Marriage ___________ Date of Se paration ____________(date on which one or
both parties decided marriage was over and one or both acted on that decision)
b. Children? Y _______ N _______
Any born before marriage or after separation? Y _______ N _______
Any children not husband’s biological children? Y _______ N _______
If Yes to either question, do we have a copy of the Birth Certificate? If we don’t yet,
advise Client that we will need a copy before or at next appointment.
c. Custody (See Reverse)
d. Visitation (See Reverse)
e. Property - Community Property - generally all property acquired from the date of marriage until the date
of separation is community property unless by gift or inheritance. Separate Property - all property
acquired before the date of marriage and after the date of separation is separate property.
Only list: 1) property of value (monetary or sentimental) that Client believes the other
side will argue about or
2) property that Client wants to make sure gets divided/assigned.
Also, make sure the property listed is identifiable, e.g. ‘opal and gold ring’, not just ‘ring.’ When
listing bank accounts, do not list entire account number, just last 4 digits for privacy reasons.
Separate Property? Y _______ N _______
Community Property? Y _______ N _______
House? Y _______ N _______
Pension? Y _______ N _______
OTHER IMPORTANT PROPERTY ISSUES? Y _______ N _______
_______________________________________________________________
3. SUPPORT
a. Employment status of spouse: Employed ____ Self-Employed ____ Unknown ____
Incarcerated ____ Unemployed ____ Gov’t Benefits ____
b. If employed, spouse’s employer and work address: ______________________________
_________________________________________________________________
Income estimate:____________________________________________________
How can we prove income? (E.g. paystub, Client’s knowledge of spouse’s earnings)____
______________________________________________________________________
c. If unknown, explain why Client can’t estimate income:__________________________
d. Is there a Child Support (CSSD) case? Y________ N__________
If Yes, what is the case number? ________________________
If Client does not know, tell Client we will need that case number before he next
appointment - she can get the number by calling CSSD
3. SERVICE ISSUES?
Does Client need Posting (because Client has NO way to locate other side)? Y _____ N _____
Does other party live out of state? Y _____ N _____
Is other party in jail/prison? Y____ N_____
(Possible) FORMS for cases with kids: UCCJEA, Child Custody and Visitation Attachment, Holiday Schedule,
Additional Provisions, Joint Legal Attachment, Child Abduction Prevention Attachment
Please use the following questions to help you and the Client decide on the best Custody and Visitation
plan (please work with the Client to figure out what is in the best interests of the child(ren)
rather than assuming that an every other weekend plan is appropriate)
Please summarize Client’s answers on the lines below:
What’s currently happening in terms of custody and visitation and how long has this been going on?
_________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
How and why did the current schedule develop? E.g. does non-custodial parent choose not to see kids,
does custodial parent prevent him from seeing children, etc. ________________________
____________________________________________________________________________
____________________________________________________________________________
Does this arrangement work? Would Client like to make any changes?____________________
____________________________________________________________________________
Does the other party have any problems with drugs or alcohol? __________________________
_____________________________________________________________________________
If there is domestic violence, how can we minimize contact during the exchange of the children?
____________________________________________________________________________
____________________________________________________________________________
HOUSE CHECKLIST
Name of Client: HB #:
Person Completing Form: Date:
Basic Information:
1. Street Address:
City, State and Zip Code:
2. Who lives in the house? Client Spouse Both
a. What date did the client or spouse move out of the house? ___________________
3. Who is paying the mortgage? Client Spouse Other _______________________
4. No. of minor children living in the house?
5. Client wants to Stay Leave Sell
6. Spouse wants to Stay Leave Sell
7. Are any rooms being rented? Yes No By whom?
a. Monthly rental income: $
8. Are payments current and being paid? Yes No
9. Foreclosure proceeding pending? Yes No (If Yes, get referral info from Staff Atty)
Purchase Information:
1. Date of Purchase:
2. Purchase Price: $
3. Amount of down payment: $
4. What was the source of funds for the down payment?
5. Whose name/s were listed on title at time of purchase?
a. How was title taken on the deed - joint tenants, tenants in common, separate property?
6. Have changes been made to who is listed on title since the date of purchase? Yes No
a. How is titles held currently?
b. Explain:_____________________________________________________________________
7. If client not on title to the home, explain: ____________________________________________
______________________________________________________________________________
Mortgage Information:
1. Monthly payment: $
2. Does this include taxes & insurance? Yes No
3. If answer to #2 is “No” how much are property taxes __________ and (see next page)
F:\Document\Master Forms - Legal Program\Administrative\House Checklist.Rev.2012.wpd
House Checklist
Page 2
*** After Completion of Form, Ask Staff Attorney to Get a Property Profile***
CLIENT INFORMATION
Name: HBC#: LASC#: Date of Birth:
SPOUSE INFORMATION
Name: Current employment status: (please circle)
1. Does Client have any supporting documentation pertinent to spouse’s past or present employment, wages or
retirement plan? E.g. pay slips, retirement plan account statement, etc. If yes, please list and attach all
information provided by Client.
2. Does Client think spouse had or has a retirement plan (for example a pension, 401(k), 403(b) or savings
plan?)? If yes, why?
3. Does Client know the name of any potential retirement plan spouse has? If yes, please list the name(s) below.
3250 Wilshire Boulevard, Suite 710, Los Angeles, California 90010 213.388.7514
Sponsored by Black Women Lawyers Association of Los Angeles Los Angeles County Bar Association Women Lawyers Association of Los Angeles
Date:
Dear Employer:
Your help is required in providing the correct name, address and telephone number of the
pension plan. Please indicate this information below and return it to (client name and HB#)
C/O Harriett Buhai Center for Family Law 3250 Wilshire
Blvd., Ste. 710, Los Angeles, CA 90010.
Your prompt reply within five (5) days would be greatly appreciated.
Betty L. Nordwind
Executive Director
Date:_______________
Sample Form 9V: Custody and Visitation Handout (also available in Spanish)
3250 Wilshire Boulevard, Suite 710, Los Angeles, California 90010 213.388.7514
Sponsored by Black Women Lawyers Association of Los Angeles Los Angeles County Bar Association Women Lawyers Association of Los Angeles
Perhaps the most important part of your papers is the section where you tell the court what you think
the custody and visitation arrangements should be for your children.
Before you fill in this document you should think about where you want your children to live, who
you want them to live with and how much time you want the other parent to spend with the children.
Ask yourself the following questions:
As you think about these issues, you should think about what is best for your children. That is what
the court cares about most.
The words "custody" and "visitation" have very specific meanings for the court which are probably
different from what you think of when you hear "custody" and "visitation."
"Custody"
There are two kinds of custody and you must make a decision about both kinds. The first kind is
LEGAL CUSTODY. Legal custody gives a parent the authority to make decisions about the child's
education, religious upbringing, medical treatment, and other legal decisions. One parent can have
the right to make these legal decisions alone. This is called "sole" legal custody. Or both parents
could make these legal decisions on their own, with or without the other parent’s agreement. This
is called “joint” legal custody. Joint legal custody may be hard for parents if you don’t agree or
communicate well with the other parent about your children.
The second kind of custody is PHYSICAL CUSTODY. Physical custody gives a parent the
authority to live with the children. The child’s primary place of residence may be with one parent.
This is called “sole” physical custody. Or the children may live with both parents for significant
periods of time. This is called “joint” physical custody.
Sample Form 9V: Custody and Visitation Handout (also available in Spanish)
"Visitation”
If the children live with one parent most of the time, then the other parent will have the right to spend
time with the children on a regular basis. The court generally calls this time "visitation." The parent
who has the right to visitation may spend a little or a lot of time with the children. You can ask the
court for "reasonable" visitation which means that you and the other parent will work it out
yourselves or the court will decide what is reasonable after listening to you and the other parent.
If you think that there are reasons why the other parent's time with the children should be limited or
you feel that the other parent should not be alone with the children, instead of "reasonable" visitation
you can ask the court to place restrictions. Some possible restrictions are:
! No overnights
! 24 hours notice by telephone before a visit
! No drinking alcohol before or during the other parent's time with the children
! Supervised visitation where someone of your choice is present during the visitation
! A requirement that the other parent not remove the children from the city, county, or state
If you think that the other parent's visits should be monitored or supervised, you need to decide who
will be the supervisor. For example, the supervisor could be your parents, a good friend, a teacher,
someone from your church or community group. If you and the other parent do not get along, or if
the other parent has hit you, thrown things at you, threatens you or forced you to have sex against
your will, you should not be the supervisor. You should pick someone you trust and who will act
responsibly toward your children.