FL-200 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address): FOR COURT USE ONLY TELEPHONE NO. (Optional): E­MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PETITIONER: RESPONDENT: PETITION TO ESTABLISH PARENTAL RELATIONSHIP Child Support Visitation Child Custody Other (specify): CASE NUMBER: 1. Petitioner is a. the mother. b. the father. c. the child or the child's personal representative (specify court and date of appointment): d. other (specify): 2. The children are a. Child's name Date of birth Age Sex b. a child who is not yet born. 3. The court has jurisdiction over the respondent because the respondent a. resides in this state. b. had sexual intercourse in this state, which resulted in conception of the children listed in item 2. c. other (specify): 4. The action is brought in this county because (you must check one or more to file in this county): a. the child resides or is found in the county. b. a parent is deceased and proceedings for administration of the estate have been or could be started in this county. 5. Petitioner claims (check all that apply): a. respondent is the child's mother. b. respondent is the child's father. c. parentage has been established by Voluntary Declaration of Paternity (attach copy). d. respondent who is child's parent has failed to support the child. e. (name): has furnished or is furnishing the following reasonable expenses of pregnancy and birth for which the respondent as parent of the child is obligated: Amount Payable to For (specify): f. g. public assistance is being provided to the child. other (specify): 6. A completed Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA)) (form FL-105) is attached. Page 1 of 2 Form Approved for Optional Use Judicial Council of California FL-200 [Rev. January 1, 2003] PETITION TO ESTABLISH PARENTAL RELATIONSHIP (Uniform Parentage) Family Code, § 7630 www.courtinfo.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com PETITIONER: RESPONDENT: CASE NUMBER: Petitioner requests the court to make the determinations indicated below. 7. PARENT-CHILD RELATIONSHIP a. Respondent b. Petitioner c. Other (specify): is the parent of the children listed in item 2. 8. CHILD CUSTODY AND VISITATION a. Legal custody of children to b. Physical custody of children to c. Visitation of children: None (1) (2) (3) Reasonable visitation. Petitioner Respondent should have the right to visit the children as follows: Petitioner Respondent Joint Other (4) Visitation with the following restrictions (specify): d. Facts in support of the requested custody and visitation orders are (specify): Contained in the attached declaration. e. I request mediation to work out a parenting plan. 9. REASONABLE EXPENSES OF PREGNANCY AND BIRTH: Petitioner Reasonable expenses of pregnancy and birth be paid by as follows: Respondent Joint Petitioner 10. FEES AND COSTS OF LITIGATION a. Attorney fees to be paid by b. Expert fees, guardian ad litem fees, and other costs of the action or pretrial proceedings to be paid by Respondent Joint 11. NAME CHANGE Children's names be changed, according to Family Code section 7638, as follows (specify): 12. CHILD SUPPORT The court may make orders for support of the children and issue an earnings assignment without further notice to either party. 13. I have read the restraining order on the back of the Summons (FL-210) and I understand it applies 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) A blank Response to Petition to Establish Parental Relationship (form FL-220) must be served on the Respondent with this Petition. NOTICE: If you have a child from this relationship, the court is required to order child support based upon the income of both parents. Support normally continues until the child is 18. You should supply the court with information about your finances. Otherwise, the child support order will be based upon information supplied by the other parent. Any party required to pay child support must pay interest on overdue amounts at the "legal" rate, which is currently 10 percent. FL-200 [Rev. January 1, 2003] PETITION TO ESTABLISH PARENTAL RELATIONSHIP (Uniform Parentage) American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2