COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): -against- FL-103 FOR COURT USE ONLY : Calendar No. : Plaintiff(s) TELEPHONE NO. : Index No. JUDICIAL SUBPOENA : FAX NO. (Optional): E-MAIL ADDRESS (Optional): : ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF : STREET ADDRESS: MAILING ADDRESS: Defendant(s) : ...................................................... CITY AND ZIP CODE: BRANCH NAME: DOMESTIC PARTNERSHIP OF PETITIONER: THE PEOPLE OF THE STATE OF NEW YORK RESPONDENT: PETITION FOR TO CASE NUMBER: Dissolution of Domestic Partnership Legal Separation of Domestic Partnership Nullity of Domestic Partnership AMENDED GREETINGS: 1. STATISTICAL FACTS a. Date of registration of domestic partnership or equivalent: b. Date of separation: WE COMMAND YOU, that all business and excuses being laid aside, c. the Honorable of registration of domestic partnership to at the separation (specify): Time from date date of Court you and each of you attend before Years Months located at County of 2. RESIDENCE (Partnerships established out of state only) on the day of , 20 , at o'clock in the noon, and at any recessed Our a. in room domestic,partnership was established in another state (specify state): b. or adjourned date, to testify and give evidence as a witness state of action on for at least six months and of this county for Petitioner Respondent has been a resident of this in this California the part of the at least three months immediately preceding the filing of this Petition for Dissolution of Domestic Partnership. 3. DECLARATION REGARDING MINOR CHILDREN (include children of this relationship born prior to or during this domestic partnership or adopted during this domestic partnership): Your failure to comply with this subpoena is punishable as a contempt of court and will make you a. b. liable to the party on are no minor children. There whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. The minor children are: Child’s name Witness, Honorable Court in County, Birthdate Age Sex , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Continued on Attachment 3b. c. If there are minor children of the petitioner and respondent, a completed Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) (form FL-105) must be attached. 4. SEPARATE PROPERTY Petitioner requests that the assets and debts listed below be confirmed as separate property. Item Attorney(s) for in Property Declaration (form FL-160) in Attachment 4 Confirm to Office and P.O. Address NOTICE: You may redact (black out) social security numbers from any written material filed with the court in this case Telephone No.: other than a form used to collect child or partner support. Form Adopted for Mandatory Use Judicial Council of California FL-103 [New January 1, 2005] Facsimile No.: E-Mail Address: PETITION—DOMESTIC PARTNERSHIP (Family Law) Mobile Tel. No.: Page 1 of 2 Family Code, §§ 299, 2330; Cal. Rules of Court, rule 5.28 www.courtinfo.ca.gov American LegalNet, Inc. www.USCourtForms.com , DOMESTIC PARTNERSHIP OF (Last name, first name of each party): CASE NUMBER: 5. DECLARATION REGARDING COMMUNITY AND QUASI-COMMUNITY ASSETS AND DEBTS AS CURRENTLY KNOWN a. There are no such assets or debts subject to disposition by the court in this proceeding. All such assets and debts are listed in Property Declaration (form FL-160) in Attachment 5b. b. below (specify): 6. Petitioner requests a. dissolution of the domestic partnership based on d. irreconcilable differences. (Fam. Code, § 2310(a).) (1) incurable insanity. (Fam. Code, § 2310(b).) (2) legal separation of the domestic partnership based on b. irreconcilable differences. (Fam. Code, § 2310(a).) (1) incurable insanity. (Fam. Code, § 2310(b).) (2) nullity of void domestic partnership based on c. incest. (Fam. Code, § 2200.) (1) bigamy. (Fam. Code, § 2201.) (2) nullity of voidable domestic partnership based on (1) petitioner’s age at time of registration of domestic partnership. (Fam. Code, § 2210(a).) prior existing marriage or domestic (2) partnership. (Fam. Code, § 2210(b).) unsound mind. (Fam. Code, § 2210(c).) (3) (4) fraud. (Fam. Code, § 2210(d).) force. (Fam. Code, § 2210(e).) (5) physical incapacity. (Fam. Code, § 2210(f).) (6) 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 granted to ................................................................................. Attachment 7c. As requested in form: FL-311 FL-312 FL-341(C) FL-341(E) FL-341(D) d. Determination of parentage of any children born to the Petitioner and Respondent prior to the domestic partnership. e. Attorney fees and costs payable by .................................................................... f. Partner support payable to ................................................................................ g. Terminate court's jurisdiction (ability) to award partner support to respondent. h. Property rights be determined. i. Petitioner’s former name be restored to (specify): j. Other (specify): Continued on Attachment 7j. 8. Child support–If there are minor children who were born to or adopted by the petitioner and respondent before or during this domestic partnership, the court will make orders for the support of the children upon request and submission of financial forms by the requesting party. An earnings assignment may be issued without further notice. Any party required to pay support must pay interest on overdue amounts at the "legal" rate, which is currently 10 percent. 9. 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. 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 PETITIONER) (TYPE OR PRINT NAME) (SIGNATURE OF ATTORNEY FOR PETITIONER) Date: NOTICE: Dissolution or legal separation may automatically cancel the rights of a domestic partner under the other domestic partner’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 as beneficiary of the other partner'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. However, some changes may require the agreement of your partner or a court order (see Fam. Code, §§ 231–235). FL-103 [New January 1, 2005] PETITION—DOMESTIC PARTNERSHIP (Family Law) Page 2 of 2