Page 1 of 2 FAM 104 (New 2/1) GESTATIONAL SURROGACY COVER SHEET SUBJECT MATTER JURISDICTION AND VENUE 1)Subject Matter Jurisdiction: Pursuant to FamilyCode Section 7620, if a child is conceived pursuant to an assisted reproduction agreement for gestationalcarriers, as defined in Section 7960 and as describedin Section 7962, this court shall have jurisdiction over a proceeding to determine parentage of the child ifany of the following conditions is satisfied:a.7620(a) A person205who enters into an assistedreproduction agreement in this state therebysubmits to the jurisdiction of the courts of thisstate205as to an action brought under this partwith respect to a child205who may have beenconceived as a result of that assistedreproduction agreement (i.e., writtengestational carrier agreement was entered intoin this state.)b.7620(b)(1) resides inthis state, or resided in this state at the time theassisted reproduction agreement for gestationalcarriers was executed.c.7620(b)(2) The medical procedures leading toconception, including in vitro fertilization orembryo transfer, or both, were carried out in this state.d.7620(b)(3) The child is/children are born in thisstate.2)Venue: Venue is proper before the Los AngelesSuperior Court pursuant to the following sections ofthe Family Code because Los Angeles County is the county where: a.7620(c)(1): The child resides or is found.b.7620(c)(5) and 7962(e):1.child is anticipated to be born.2.intended parent(s) reside.3.gestational carrier resides.4.gestational carrier agreement was executed.5.medical procedures pursuant to theagreement were performed. COMPLIANCE WITH FAMILY CODE 7962 3)If a case does not technically meet all of therequirements of Family Code Section 7962, thenunder Family Code Section 7962(f)(2), the courtis not prevented from entering a parentageorder, so long as the parties have providedsufficient proof entitling them to the reliefsought. However, in this case, the parties havecomplied with all the requirements of FamilyCode Section 7962 for the reasons stated below:4)7962(a)(1) The parties signed the writtengestational carrier agreement on .5)7962(a)(2) The child was/children were createdthrough in vitro fertilization using Ova fromand Sperm from. NAME, ADDRESS AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT ATTORNEY: STATE BAR NUMBER Reserved for Clerk222s File Stamp ATTORNEY FOR (NAME): EMAIL: SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES COURT HOUSE ADDRESS: PETITIONER / PLAINTIFF RESPONDENT / DEFENDANT OTHER GESTATIONAL SURROGACY COVER SHEET CASE NUMBER: DEPT. NUMBER: DATE PETITIONED: American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 FAM 104 (New 2/1) GESTATIONAL SURROGACY COVER SHEET 6)7962(a)(3) The gestational carrier agreementidentifies the Intended Parent(s);7)7962(a)(4) The gestational carrier agreementdiscloses how the intended parents will coverthe medical expenses of the gestational carrierand of the newborn or newborns;8)7962(b) Before signing the gestational carrieragreement, the parties to the agreement wererepresented by separate independent licensedattorneys of their choosing;9)7962(c) The gestational carrier agreement wassigned in the presence of a notary or witnessesby the equivalent method of affirmation in thejurisdiction where executed on;10)7962(d) The parties to the gestational carrieragreement did not undergo an embryo transferor commence injectable medication inpreparation for an embryo transfer until afterthe agreement was fully executed as required by Family Code Sections 7962(b) and 7962(c); 11)7962(e) A copy of the gestational carrieragreement has been lodged with this court;12)7962(e) The parties have attested, underpenalty of perjury and to the best of theirknowledge and belief, as to their compliancewith Family Code Section 7962 in entering intothe assisted reproduction agreement;13)Criminal Background Check completed andsubmitted to Court?14)Are the parties requesting a hearing?15)Are there any scheduling requests or issues(such as a need for an expedited hearing orreview date) that the Court should be aware of? I declare under penalty of perjury of the law of the Status of California that the foregoing is true and correct. / Signature Date , Esq. Attorney for Petitioners CA Bar #: American LegalNet, Inc. www.FormsWorkFlow.com