PARTY WITHOUT ATTORNEY OR ATTORNEY (NAME AND ADDRESS): TELEPHONE NO.: FOR COURT USE ONLY ATTORNEY FOR (Name): SELF REPRESENTED SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA BARBARA STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PETITIONER: RESPONDENT: CASE NUMBER: FAMILY LAW INFORMATION STATEMENT ASSIGNED JUDGE: First Case Management Conference (CMC) Statement Supplemental CMC Statement Hearing Date: Hearing Time: Hearing Dept.: Mandatory Settlement Conference Statement Trial Statement _________________________ _________________________ _________________________ Represented by: _________________________ Represented by: _________________________ Represented by: _________________________ 1. PARTIES and REPRESENTATION: Petitioner: Self-represented, or Respondent: Self-represented, or Other: ___________________________ 2. NEED FOR INTERPRETER: a. Petitioner needs an interpreter. b. Respondent needs an interpreter. Language: ______________________________ Language: ______________________________ 3. NATURE OF PETITION THAT STARTED THIS CASE: a. Petition for Dissolution, Legal Separation or Nullity (FL-100) i. Response (FL-120) filed on: _______________________________ b. Petition to Establish Parental Relationship (FL-200) i. Response (FL-220) filed on: _______________________________ c. Petition for Custody and Support of Minor Child (FL-260) i. Response (FL-270) filed on: _______________________________ 4. PROOF OF SERVICE OF SUMMONS (FL-115) filed on: ____________________________ a. Date of service: _______________________________ DEFAULT (FL-165) entered on: _______________________________ (date) or 6. 7. EXTENSION OF TIME: Petitioner and Respondent have agreed to an extension of time for Response. RECONCILIATION: We are in the process of trying to reconcile our marriage. Page 1 of 5 5. Optional SC-4026 [New January 1, 2016] FAMILY LAW INFORMATION STATEMENT American LegalNet, Inc. www.FormsWorkFlow.com Insert Case Name: Case Number: 8. MARRIAGE INFORMATION: (Dissolution (divorce), legal separation and nullity cases): a. Date of marriage: _________________________ b. Date of separation: _________________________ 9. MINOR CHILDREN of this relationship: a. NONE, or NAME OF MINOR CHILD DATE OF BIRTH (mm/dd/yyyy) AGE SEX Male Male Male Male Female Female Female Female 10. OTHER RELATED FAMILY LAW CASES (such as other state or out-of-county or other Santa Barbara County cases for domestic violence restraining orders, divorce cases, orders for custody or support) (complete all that applies): a. NONE, or NATURE OF CASE (Ex. divorce, restraining order, parentage action) CASE NUMBER LOCATION OF CASE (Name of court, city, state) 11. DISCLOSURE DOCUMENTS (Divorce, legal separation and nullity cases only. Check the boxes to show documents that have been filed and include dates): NAME OF DOCUMENT: Preliminary: Declaration re Service of Declaration of Disclosure (FL-141) Final: Declaration re Service of Declaration of Disclosure (FL-141) Income and Expense Declaration (FL-150) (most recent) Petitioner / Date filed Respondent / Date filed NOTE: In cases where there is an issue of child support, spousal support and/or property division, if a party's filed Income and Expense Declaration is more than 3 months old, or if there have been significant changes since filing the most recent Income and Expense Declaration, then a new Income and Expense Declaration must be prepared, served and filed with this document. 12. ISSUES (Check all that apply and complete as appropriate): a. PARENTING PLAN (Custody and Visitation) (Must check if you have a minor child or children of this relationship): i. PEACE CLASS: 1. Petitioner attended 2. Respondent attended 3. Waiver of class for Petitioner Respondent Page 2 of 5 Optional SC-4026 [New January 1, 2016] FAMILY LAW INFORMATION STATEMENT American LegalNet, Inc. www.FormsWorkFlow.com Insert Case Name: Case Number: ii. iii. YES, this issue has been resolved: 1. We have attended Family Court Services (FCS) mediation. 2. We have reached a written agreement that is acceptable to us. (Attach a copy of the agreement.) 3. We have an agreement, but it is not yet in writing and ordered by the court. NO, this issue has NOT been resolved: a. We have never attended FCS mediation. b. We attended FCS mediation on ______________ (date), and we did NOT reach an agreement. c. FCS mediation was attempted on ______________ (date), but the mediation did not take place because: _________________________________________________ d. Other: ___________________________________________________________ b. CHILD SUPPORT (Must check if you have a minor child or children of this relationship): i. YES, this issue has been resolved: 1. We have a written agreement about child support that is acceptable to us. (Attach a copy of the agreement.) 2. We have an agreement, but it is not yet in writing and ordered by the court. 3. We have a prior child support order: Date of order Name of Court Case Number Is the Dept of Child SupIs this order acport Services involved? ceptable to you? Yes No Yes No ii. NO, this issue has not been resolved: 1. We cannot agree on the amount of child support. 2. We have a current order, but I want a different amount. 3. Other: _____________________________________________________________ 4. A proposed child support guideline calculation: a. is attached b. is not attached because: _________________________________________ 5. We have gone to mediation to discuss this issue. c. PARENTAGE: (Check here if this is an issue. Must check if a Petition to Establish Parental Relationship (FL-200) was filed): i. YES, this issue has been resolved: We have signed a voluntary Declaration of Paternity. (Attach a copy.) 1. 2. We have signed/are willing to sign a Stipulation for Entry of Judgment re: Establishment of Parental Relationship (FL-240) and the Advisement and Waiver of Rights re: Establishment of Parental Rights (FL-235) 3. Parentage has been determined in another court case: Name of Case Name of Court Case Number Is the Dept of Child Support Services involved? Yes No ii. NO, this issue has not been resolved: 1. I want an order for genetic testing. 2. Genetic testing has been done, and I want an order of non-parentage. 3. Genetic testing has been ordered, but the other parent is not cooperating. 4. Other: ________________________________________________ 5. We have gone to mediation to discuss this issue. Page 3 of 5 Optional SC-4026 [New January 1, 2016] FAMIL