NAME, ADDRESS, AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT ATTORNEY: STATE BAR NUMBER Reserved for Clerk's File Stamp ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES COURTHOUSE ADDRESS: PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: FAMILY LAW CASE COVER SHEET AND CERTIFICATE OF GROUNDS FOR ASSIGNMENT TO DISTRICT CASE NUMBER: This form is required for all new Family Law cases filed in the Los Angeles Superior Court This case cover sheet is required so that the court can assign your case to the correct district for filing and hearing. It satisfies the requirement for a certificate authorizing filing in the district, as set forth in Los Angeles Superior Court Rules 2.3 and 5.2. It must be completed and submitted to the court along with the original Complaint or Petition in all Family cases filed in any district of the Los Angeles Superior Court. I. Consent to Electronic Notification (optional) I agree to accept information electronically from the court at the following email address and/or cell phone number Email Address Cell Phone II. Case Information Date of Marriage/Domestic Partnership (if applicable) Date of Separation (if applicable) Are there Minor Children Involved? If yes, indicate how many: Yes No Parties agree to mediate: (check one, if applicable) Property and Support Property Only Support Only Yes No Parties intend to proceed by: (check one, if applicable) Default Stipulated Judgment Use of private dispute resolution judge Collaborative Law process Yes No Do you need an interpreter? If yes, indicate language: Do other parties need to be joined to the action to resolve the case? FAM 020 (Rev 5/17) FAMILY LAW CASE COVER SHEET AND CERTIFICATE OF GROUNDS FOR ASSIGNMENT TO DISTRICT Page 1 of 3 LASC Rule 2.3 & 5.2 American LegalNet, Inc. www.FormsWorkFlow.com III. District Assignment Step 1. In the "Type of Action" column below, select one type of action which best describes the nature of this case. For dissolution, nullity, and legal separation cases select one option each in sections A, B, and C. Step 2. Across from the "Type of Action" you selected, place an "X" in the column that corresponds to the reason for your choice of district. Note that you may only select from the boxes that are not shaded. Child resides within the county District where one or more of the parties resides TYPE OF ACTION (check one) Dissolution, Nullity, and Legal Separation (required: select one option each in sections A, B, and C below) (check one) (check one) (check one) Section A Section B Dept. of Child Support Services (DCSS) DSU ­ Summons and Complaint [4814] DSU ­ Statement ­ Registration of California Support Order [4811] DSU ­ Petition ­ Uniform Support [4810] DSU ­ Statement ­ Registration Out-of-State Support Order [4812] Establish Parental Relationship Petition ­ Establish Parental Relationship [4040] For Establish Parental Relationship actions, the child must reside within Los Angeles County. Check either "May be filed in Central District" or "District where one or more of the parties resides" to indicate your district choice. Petition ­ Special Immigrant Juvenile [4068] Petition ­ Request ­ Set Aside Voluntary Dec. of Paternity [4054] Joint Petition for Summary Dissolution Marriage [4041] Domestic Partnership [4042] Surrogacy (if selected, also complete Section V, "Surrogacy Case Jurisdiction", on page 3 of this form) Surrogacy ­ Stipulation and Order [4324] Other Family Law Petition ­ Custody and Support of Minor Child [4032] Registration of Out-of-State Custody Order [4052] Statement ­ Registration of California Support Order [4190] Petition ­ Grandparent/Third Party Visitation [4327] Request ­ Release Confidential License/Certificate [4384] Petition ­ Minor's Contract (FC § 6751) [4047] Petition ­ Habeas Corpus ­ Family Law [4011] Custody Order ­ Juvenile ­ Final Judgment [4202] Petition ­ Elder/Dependent Adult Abuse [226] Order ­ Register Out-of-State/Tribal Court Restraining Order [4325] Petition ­ Family Law Other [4329] Emancipation: FL (FAM) [5340AS] Consent for Minor to Marry/Establish Domestic Partnership Marriage [4031] Domestic Partnership [4030] Restraining Orders/Domestic Violence (DV) Prevention (Note: Use Civil Case Cover Sheet [LA CIV109] for all Civil Restraining Orders) DV Prevention with Minor Children [4038] DV Prevention without Minor Children [4039] FAM 020 (Rev 5/17) Section C Dissolution Nullity Legal Separation With Minor Children Without Minor Children Domestic Partnership Marriage X FAMILY LAW CASE COVER SHEET AND CERTIFICATE OF GROUNDS FOR ASSIGNMENT TO DISTRICT Page 2 of 3 LASC Rule 2.3 & 5.2 American LegalNet, Inc. www.FormsWorkFlow.com Any court location District where the Petitioner resides May be filed in Central District Child resides within the county District where one or more of the parties resides TYPE OF ACTION (check one) Adoptions ­ Filed Only at Edmund D. Edelman Children's Court Adoption: FL ­ Adult (FAM) [5323AS] Adoption: FL ­ Independent (FAM) [5300AS] Adoption: FL ­ Agency ­ Domestic (FAM) [5300AS] Adoption: FL ­ Agency ­ International IR-3/IH-3 (FAM) [5300AS] Adoption: FL ­ Agency ­ International IR-4/IH-4 (FAM) [5300AS] Adoption: FL ­ Step-Parent (FAM) [5300AS] Non-Adoption: FL - Abandonment (FC § 7662 and FC § 7820) [5137AS] IV. Address of Minor Child(ren) (if known) Complete this section only if you have selected "Child Resides within the County" as an applicable reason for case assignment in Section III above. Do not complete this information if there is a Protective Order under Family Code § 6751. Street (including Apt. #) City State Zip Code V. Surrogacy Case Jurisdiction ­ Required only for Surrogacy actions (Family Code § 7962) Child is anticipated to be born in Los Angeles County Intended parent or intended parents reside in Los Angeles County Surrogate resides in Los Angeles County Assisted reproduction agreement for gestational carriers was executed in Los Angeles County Medical procedures pursuant to the agreement are to be performed in Los Angeles County Please select the appropriate grounds for jurisdiction in Los Angeles County: VI. Certification / 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 Angeles Superior Court under Code of Civil Procedure § 392 et seq., 2300 et seq. of the Family Code, and Local Rules 2.3 and 5.2 of this court for reason checked above. I certify and d