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