REQUEST FOR ORDER (Sample Packet)

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REQUEST FOR ORDER

(Sample Packet)

HELPFUL WEBSITES

www.courts.ca.gov

- State Court - forms, etc.

www.kern.courts.ca.gov -

Kern Court Website

www.kclawlib.org

– Kern County Law Library

www.findlaw.com

– Case Law

www.leginfo.ca.gov

- Legislation/Codes

www.accesslaw.com

– Forms, Cases, Codes

1. What is a Request for Order?

The Request for Order (FL-300) form is a new Judicial Council as of July 1, 2012 and it replaces the

old Notice of Motion and Order to Show Cause forms. You use the Request for Order form to ask for

court orders in your family law case. See attached FL-300-INFO sheet for additional information.

2. How do I get custody, visitation, child support, or spousal support orders?

You must have an existing court file or you must open a new case. You cannot file a Request for Order

without an open case.

3. If I do not have an open case in the court, how do I open one?

a)

If you are married to the other parent, you can file a Petition for Dissolution of Marriage,

Legal Separation, Nullity or Petition for Custody and Support (separate handout).

b)

If you are not married to the other parent, you can file a Petition to Establish Parental

Relationship

(Paternity),

or

Petition

for Custody and Support (separate handout).

4. If I have a case with the Local Child Support Agency can I file the Request for Order in that

file?

Yes, as long as a child support judgment was entered and the other parent is listed as a party.

5. What is Physical and Legal custody of child(ren)?

Attached is Child Custody Information Sheet (FL-314-INFO) that explains these terms and more. Go

to this helpful website for more information:

www.courts.ca.gov/selfhelp

6. How do I get a Temporary Order?

There are two ways to get a temporary order – without a hearing or with a hearing.

a) Without a hearing: Temporary orders signed without an ex parte hearing are usually based on

status quo (what’s been going on already), or for urgent matter (but not if you, your property, or

your children will suffer irreparable harm or danger). Your reasons for a temporary order must be

stated in Request for Order under #10, FACTS IN SUPPORT.

b) With a hearing (Ex Parte hearing): Temporary orders signed with an ex parte hearing are based

on a factual showing, containing competent testimony based on personal knowledge of irreparable

harm, immediate danger, or other statutory basis for granting relief ex parte. Your reasons for a

temporary order must be stated in Request for Order under #10, FACTS IN SUPPORT.

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1. What is an Ex Parte Hearing?

Answer: An Ex Parte Hearing is an “Emergency” hearing scheduled prior to a regular hearing in

order to ask the Judge for “temporary” orders.

2. When would I need an Ex Parte Hearing?

Answer: Ex Parte Hearings may be requested when:

(a) One party wants the other party removed from the home. (“Kick-out”);

(b) Parent without court ordered primary physical custody is seeking a temporary order to

change custody immediately and prior to a hearing on the matter;

(c) No existing orders are on file, and parent requesting temporary custody has had the

child for the last 30 days;

(d) When non-custodial parent has recently taken the child from the custodial parent and

will not give the child back;

(e) Custodial parent is requesting that court ordered visitation be terminated or requests a

substantial change from current visitation be ordered pending regular hearing because

of imminent harm to the child; and

(f) Any other reason that the Judge requires an Ex Parte Hearing.

(g) Information about Ex Parte Hearings can be found in Local Rule 6.4 or CRC 3.1200 –

3.1207,

www.kern.courts.ca.gov

.

3. How long does it take to get into court for an Ex Parte Hearing?

Answer: Generally, it takes approximately 1 to 3 days for an Ex Parte Hearing date.

4. Is there a fee for the Ex Parte Hearing?

Answer: Yes. A non-waivable fee of $60.00, plus regular Request for Order filing fee.

Ex Parte Hearing Process:



Get Ex Parte Hearing date from the Family Law Clerk. The Clerk will also give you

an Ex Parte Checklist and Request for Temporary Orders; Notice to Other Party

(goldenrod form).



The forms may be handwritten with black or blue ink. READ THE FORMS

CAREFULLY.



Complete the Request for Order (FL-300) with Temporary Orders (FL-305).



Complete the “Request for Temporary Orders; Notice to Other Party” form. (golden

colored paper)



Take the Request for Order and fees or Fee Waiver (separate handout), with the Ex

Parte Notice to the Family Law Clerk by NOON on the date specified on the Ex Parte

Checklist. There is a mandatory non-waivable fee for the Ex Parte Hearing that must

be paid at that time.



Go to the Ex Parte Hearing.

5. What happens after the Ex Parte Hearing?

Answer: Whether the Judge grants your request or denies your request for emergency orders, you

will need to pick up your Request for Order from the Family Law Clerk after 3:00 p.m.,

following the Ex Parte hearing. Then you must have the other party served with the

Request for Order and any attachments, then continue to the mediation date and next

hearing date.

REMEMBER: THE EX PARTE PROCESS IS ALWAYS DONE ALONG WITH A REQUEST

FOR ORDER.

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FORMS LIST:

Mandatory forms:

Optional form (use as needed, based on request):

 Request for Order, FL-300

 Child Custody and Visitation Attachment,

FL-311

 Declaration under UCCJEA, FL-105

 Temporary Orders, FL-305 with Request for

Temporary Orders

(Kern County local goldenrod form)

 Attachment to Declaration under UCCJEA,

FL-105a

(use when there are more than 2 children

involved)

 Attachment 2e(4)

 Income and Expense Declaration, FL-150

(use with child support, spousal support,

request for attorney fees and costs, and

hardship cases)

 Request for Child Abduction Prevention,

FL-312

 Proof of Personal Service, FL-330

 Child Abduction Prevention Order

Attachment to Temporary Order, FL-341(b)

 Declaration Regarding Address Verification

– Postjudgment, FL-334

 Holiday Schedule, FL-341(c)

 Blank Responsive forms for the Other Party

 Additional Provisions – Physical Custody

Attachment, FL-341(e)

 Spousal or Partner Support Declaration

Attachment, FL-157

 Witnesses List, FL-321

(use when you plan on having witnesses

testify at your hearing)

You determine which attachments, if any, you will need.

Forms are available from the Clerk or Facilitator or online at

www.courts.ca.gov

or

www.kern.courts.ca.gov

There is a FEE for filing the papers. If you cannot afford the filing fee, Fee

Waiver forms are available. See current fee schedule for list of fees. Ex parte

hearing fee cannot be waived.

Lets get started:

Step #1.

Complete your selected forms and have fees ready or complete a fee waiver application and

order;

Step #2.

Make at least 2 copies of your completed forms (1 original + 2 copies);

Step #3.

Take your completed forms and copies with the fee or a completed fee waiver application

and order to Family Law Clerk to set the hearing date;

Step #4.

Go to Family Court Services and get a mediation date if you are requesting custody and

visitation;

Step #5.

Go back to the Family Law Clerk (step #3) so you can turn in your completed forms and

have it filed and endorsed by the Clerk;

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Step #6.

Serve the Request for Order after you get your endorsed copies back from the Family Law

Clerks:

 One copy of the Request for Order is for you;

 You MUST have a 3

rd

person, 18 years or older, and not a party to the case serve one

copy of the Request for Order with the blank Responsive Declaration (FL-320) and

other blank responsive forms on the opposing party, attorney, and other interested

parties (such as Department of Child Support Services);

 If by personal service, At Least 16 COURT days (do not count holidays or weekends)

before the hearing date;

 Service by mail is limited depending on your case situation. Most requests with issues

of child custody and child visitation requires personal service method and if it an initial

requests and the other party has not been served or appear in your case or a Temporary

Order is being requested, you MUST use personal service.

 If by mail, service date MUST be at least the following :

 Within State: 16 “court” days + 5 “calendar” days;

 Outside CA: 16 “court” days + 10 “calendar” days;

 Outside US: 16 “court” days + 20 “calendar” days;

 Service on other parent for Child Support by and through the Department of Child

Support Services is 35 “calendar” days from the date the documents are mailed to

the other parties.

*NOTE: Court days = Monday – Friday, excluding court holidays;

Calendar days = Sunday – Saturday (all days of the week); and

 Server completes the Proof of Service (personal service form FL-330, mail service form

FL-335) for each person served;

Step #7.

You file the Proof of Service with the Family Law Clerk PRIOR to the hearing, preferably

5 days before the hearing;

Step #8.

Attend Mediation at the appointed time, if any child custody or visitation issue. Sanctions

may apply for failure to appear at mediation. All children 8 years and older must go to the

mediation hearing;

Step #9.

Attend the Court Hearing at the appointed time;

Step #10.

Complete a Findings and Order After Hearing (FL-340) following the Court hearing.

 Minute Order prepared by the Courtroom Clerk are ready in about 2 – 3 business days.

Use the Minute Order to prepare Findings and Order After Hearing.

 Make sufficient number of copies for all parties.

 If attorney are involved, make more copies of the unsigned unstamped Findings and

Order After Hearing and have a SERVER mail a copy to all parties. The SERVER

completes a Proof of Service by Mail (Fl-335). File the original Findings and Order

After Hearing and copies with the original Proof of Service by Mail with the Family

Law Clerk.

 If you want your copies to be returned to you by mail, you must supply a

self-addressed-stamped-envelope.

Step #11.

Pick up Signed and Stamped Findings and Order After Hearing in about 3 – 5 business

days from the Clerk or if you provided a self-addressed-stamped-envelope you will get

your copies by mail.

These materials have been compiled through a grant from the Judicial Council of California. The opinions and findings in this publication are those of the author and not necessarily those of the Judicial Council of California. All rights reserved, April 2009, rev. 11/28/2012.

SUPERIOR COURT OF CALIFORNIA, COUNTY OF KERN, FAMILY LAW FACILITATOR, 1215 TRUXTUN AVE., BAKERSFIELD CA 93301; [email protected]

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FAMILY LAW COURTHOUSE IN KERN COUNTY

Kern County Superior Court

1215 Truxtun Avenue

Bakersfield, CA 93301

Branch Name: Metro-Justice Building

(661) 868-5393

Kern County Superior Court

132 East Coso Street

Ridgecrest, CA 93555

Branch Name: East Kern Division – Ridgecrest Branch

(760) 384-5900

Kern County Superior Court

325 Central Valley Highway

Shafter, CA 93263

Branch Name: North Kern Division – Shafter/ Wasco Branch

(661) 746-7500

Kern County Superior Court

1773 Highway 58

Mojave, CA 93501

Branch Name: East Kern Division – Mojave Branch

(661) 824-7100

Kern County Superior Court

1122 Jefferson Street

Delano, CA 93215

Branch Name: North Kern Division – Delano Branch

(661) 720-5800

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FL-314-INFO

Child Custody Information Sheet-Child Custody Mediation

Parents who come to court about child custody

and parenting time (visitation) face decisions

about parenting plans for their children. This

information sheet provides general information

about child custody and parenting time matters,

how to get help resolving a custody dispute or

making a parenting plan, where to find an

attorney, and where to find other resources.

Judicial Council of California, www.courts.ca.gov FL-314-INFO, Page 1 of 2

Child Custody Information

Sheet-What is a parenting plan?

A parenting plan describes how the parents will

divide their responsibilities for taking care of their

child.

The plan may include a general or specific

schedule of days, times, weekends, holidays,

vacations, transportation, pick-up/drop-off, limits

on travel, counseling and treatment services, and

other details.

What are legal and physical custody?

A parenting plan usually includes:

Legal custody: how parents make major

decisions about the child’s health, education,

and welfare;

Physical custody: where the child lives; and

Parenting time, time-share, or visitation:

when the child spends time with each parent.

Legal custody and physical custody may

each be specified as joint (both parents have

certain responsibilities) or sole (one parent has

the responsibility alone).

Can we make our own parenting plan?

Yes. You have a right to make a parenting plan

agreement on your own. This agreement may be

called a stipulation, time-share plan, or parenting

plan.

If both parents can agree on a parenting plan, the

judge will probably approve it. The agreement

becomes a court order after it is signed by both

parents and the judge, and filed with the court.

What if there is domestic violence or a

protective order?

If there is domestic violence or a protective

order, talk with an attorney, counselor, or

mediator before making a parenting plan.

For domestic violence help, call the National

Domestic Violence Hotline at 1-800-799-7233

(TDD:1-800-787-3224) or call 211 if available

in your area.

What if we don't have a parenting plan?

If you can’t reach an agreement, the court will refer

you to mediation with family court services (FCS) to

try to work out a parenting plan.

What is mediation with family court services?

Family court services (FCS) provides mediation to

help parents resolve disagreements about the care of

their child. The mediator will meet with you and the

other parent to try to help you both make a parenting

plan. An orientation may be provided that offers

additional information about the process.

If you are concerned about meeting with the other

parent in mediation, or there is a domestic violence

issue or a protective order involving the other parent,

you may ask to meet alone with the mediator without

the other parent. You may also request to have a

support person with you at mediation. The support

person may not speak for you.

Do we have to agree to a parenting plan in

mediation?

No. You do not have to come to an agreement in

mediation. When the parents can’t agree, the judge

will decide. For legal advice, contact an attorney.

For other information, ask the self-help center or

family court services about how the process works in

your court.

Revised January 1, 2012, Optional Form

Child Custody Mediation

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FL-314-INFO

Are there other ways to resolve our dispute?

2. Settlement Conference: In some courts, parents

may meet with a judge, neutral evaluators, or family

law attorneys not involved in the case to discuss

settlement. Check with the local court to find out if this

is an option. If there is a protective order, the settlement

discussion can be through attorneys or a mediator in

separate sessions.

Child Custody Information Sheet-Child Custody Mediation

This information sheet gives only basic information

on the child custody process and is not legal advice.

If you want legal advice, ask an attorney for

assistance. For other information, you may want to:

Where can I get help?

1. Contact family court services.

Court Hearing

When the parents cannot agree to a parenting plan

on their own, in mediation, or in any other ADR

process, the judge will decide.

If there is domestic violence or a protective order, a

parent may be able to bring a support person with

him or her to the court hearing, but the support

person may not speak for that person.

FL-314-INFO, Page 2 of 2

Child Custody Information

Sheet-Revised January 1, 2012

Yes. You may try other alternative dispute

resolution (ADR) options, including:

1. Meet and Confer: Parents and their attorneys (if

any) may meet at any time and as often as necessary to

work out a parenting plan without a court hearing. If

there is a protective order limiting the contact between

the parents, then the “meet and confer” can be through

attorneys or a mediator in separate sessions.

3. Private Mediation: Parents may hire a private

mediator to help them resolve their dispute.

4. Collaborative Law Process: Each parent hires a

lawyer and agrees to resolve the dispute without going

to court. The parents may also hire other experts.

2. Contact the family law facilitator or self-help

center for information, local rules and court forms,

and referrals to local legal services providers.

3. Find an attorney through your local bar

association, the State Bar of California at

http://calbar.ca.gov, or the Lawyer Referral Service

at 1-866-442-2529.

4. Hire a private mediator for help with your

parenting agreement. A mediator may be an attorney

or counselor. Contact your local bar association,

court ADR program, or family court services for a

referral to local resources.

5. Find information on the Online Self-Help Center

website at www.courts.ca.gov/selfhelp.

6. For free and low-cost legal help (if you qualify),

go to: www.lawhelpcalifornia.org.

7. Find information at your local law library or ask

at your public library.

8. Ask for a court hearing and let the judge decide

what is best for your child.

Requests for Accommodations

Assistive listening systems, computer-assisted real-time captioning, or sign language interpreter services are available if you ask at least five days before the proceeding. Contact the clerk's office or go to www.courts.ca.gov/forms for

Request for Accommodations by Persons with Disabilities and Response (form MC-410). (Civil Code, § 54.8.)

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Form Approved for Optional Use

Page 1 of 2

Judicial Council of California

Information Sheet for Request for Order

FL-300-INFO,

FL-300-INFO

Information Sheet for Request for Order

General Instructions

1. Asking the court for temporary orders to go into

effect before the hearing; or

Asking that the court order the other person in

your case to come to court; or

7. The Request for Order (FL-300) form replaces the old

Notice of Motion and Order to Show Cause forms. Use

the Request for Order form to ask for court orders in

your family law case.

You must complete the top portion of page 1, including

your name and address, the court address, case name,

and number.

2. Check all the boxes that apply to the orders you are

requesting. Check the Modification box if you are

requesting a change to an existing order. Check the

Temporary Emergency Court Order box if you are

requesting that the court issue emergency orders that

will be effective before the hearing date.

3. List the name of the other person in your case in item 1.

4. Leave item 2 blank. The court clerk will fill in the date,

time, and location of the hearing.

5. In item 3 list all of the forms that you have completed

and filed with the court. These are the forms that you

will have to provide to the other party.

6. Check the box in front of “Court Order” on page 1 only

when you are:

Need an order that allows you to give notice of

the hearing after the deadline for giving notice

has passed.

Leave items 5 – 9 blank. The court clerk will fill in the

information.

Complete the sections on pages 2 and 3 that apply to the

orders that you are asking the court to make.

8. Date and sign on pages 1 and 3 of the form.

9. Complete any additional forms that you will need to file

with your Request for Order.

10. File your completed Request for Order and other forms

with the court clerk. (You may have to pay a filing fee.

If you can't afford to pay the filing fee, you can ask the

court to waive the fee by completing and filing a

Request to Waive Court Fees (form FW-001)).

For example:

If you are asking the court to make child

custody orders, check the box marked Child

Custody in the box just above item 1 on the

first page and complete item 1 on page 2.

Other forms to file with this Request for Order:

If you are asking the court to make custody orders that

go into effect before the hearing date, check the box “To

be ordered pending the hearing” in item 1 on page 2 and

check the box marked Temporary Emergency Court

Order in the box just above number 1 on page 1.

Complete the Temporary Emergency Court Orders

(form FL-305) and file it with the Request for Order.

Ask the family law facilitator or the self-help center

staff to explain the procedures for requesting temporary

emergency court orders at your court and follow those

procedures.

If you are asking the court to make temporary orders

that which will go into effect before the hearing date: a

completed Temporary Emergency Court Orders (form

FL-305).

If you are asking the court to order spousal support: a

completed Income and Expense Declaration (form

FL-150).

If you are asking the court to order child support: A

completed Income and Expense Declaration (form

FL-150) or a completed Financial Statement

(Simplified) (form Fl-155).

If you are asking the court for child custody orders:

See item 1e on page 2 of the Request for Order (form

FL-300) for the list of forms that you may have to

complete.

If you plan on having witnesses testify at your hearing:

a completed Witness List (form FL-321).

Note: Do not use Request for Order (FL-300) if you are

filing a motion or order to show cause:

For a contempt action in a family law case (use Order

to Show Cause and Affidavit for Contempt (see form

FL-410))

To set aside a child support order (see form FL-361 or

FL-640) or a voluntary declaration of paternity (see

form FL-280)

For a domestic violence protective order under the

Domestic Violence Protection Act (see form DV-100).

Note: You can use the Request for Order (form

FL-300) in a domestic violence protective order case,

but only if you have child custody, visitation, or

support orders that you need modified.

Other types of cases for which there are other Judicial

Council forms just for those cases.

If you have a question about whether this is the right

form for your situation or whether you need to complete

additional forms, ask the family law facilitator, self-help

center, or the clerk’s office at the court.

FL-300-INFO [New July 1, 2012]

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FL-300-INFO

Information Sheet for Request for Order

[New July 1, 2012]

Page 2 of 2

FL-300-INFO,

Instructions for Giving the Other Party

Notice (Service)

Service by Personal Delivery

After you file the Request for Order and other forms

with the court clerk, you will get them back with a court

date and time stamped on the first page of the Request

for Order. You must make sure that the other party

receives a copy of the Request for Order and all the

other forms so that he or she has notice of the date,

time, and location of the hearing and of the orders that

you are asking the court to make. This means that you

must “serve” a copy of the Request for Order and all

the other documents on the other party. If you

completed and filed an Income and Expense

Declaration (form FL-150) or a completed Financial

Statement (Simplified) (form FL-155), you must include

a blank copy of these forms for the other party to

complete and file.

In general, the other party must be served with the

Request for Order and other forms at least 16 court

days prior to the hearing. If service is by mail, you

must add 5 days. The court may order that the time for

service on the other party can be shorter (See item 9 on

the Request for Order (form FL-300)).

Service by Personal Delivery

If you have asked the court for temporary emergency

court orders or other orders that will go into effect

before the hearing, or you have asked the court to order

the other party to attend the hearing and the judicial

officer has signed the “Court Order” portion of the

Request for Hearing form:

Have someone else (who is at least 18) personally

give a copy the Request for Order with the other

forms and blank responsive forms to the other party.

After the person gives the forms to the other party, he

or she should complete a Proof of Personal Service

(form FL-330). Information Sheet for Proof of

Personal Service (form FL-330-INFO) has instructions

to help the person complete the form.

You then file the Proof of Personal Service with the

clerk of the court 5 court days before the hearing date.

You can ask another person (who is at least 18) to mail

the Request for Order with the appropriate attachments

and blank responsive forms to the other party.

If you filed the Request for Order asking for orders after

the judgment was entered in your case or after

permanent orders were made in your case, you will need

to verify the address of the person who is being served

and file proof of the verification with the court.

Service by Mail

If you have not asked the court for orders that will go

into effect before the hearing, or you have not asked the

court to order the other party to attend the hearing and

the “Court Order” portion on page 1 of the Request for

Order has not been completed or signed by the judicial

officer:

After the person mails the forms, he or she should

complete a Proof of Service by Mail (form FL-335).

Information Sheet for Proof of Service by Mail (form

FL-335-INFO) has instructions to help the person

complete the form.

You then file the completed Proof of Service by Mail

(form FL-335) with the clerk of the court 5 court days

before the hearing date.

If you have questions about service or need additional

assistance, contact the family law facilitator or

self-help center in your county.

For more information about giving notice, see

Information Sheet for Proof of Personal Service

(FL-330-INFO) or Information Sheet for Proof of

Service by Mail (FL-335-INFO).

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FL-300

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY

TELEPHONE NO.: FAX NO. (Optional): E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS:

MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:

PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT:

REQUEST FOR ORDER MODIFICATION CASE NUMBER:

Child Custody Visitation

Temporary Emergency Court Order

Child Support Spousal Support Other (specify): Attorney Fees and Costs

1. TO (name):

2. A hearing on this Request for Order will be held as follows: If child custody or visitation is an issue in this proceeding, Family

a. Date: Time: Dept.: Room:

b. Address of court same as noted above other (specify):

Page 1 of 4 Form Adopted for Mandatory Use REQUEST FOR ORDER Family Code, §§ 2045, 2107, 6224,

Judicial Council of California

Government Code, § 26826 FL-300 [Rev. July 1, 2012]

www.courts.ca.gov

3. Attachments to be served with this Request for Order: a. A blank Responsive Declaration (form FL-320)

b. Completed Income and Expense Declaration (form FL-150) and a blank Income and Expense

Declaration

c. Completed Financial Statement (Simplified) (form FL-155) and a blank Financial Statement (Simplified) d. Points and authorities

e. Other (specify): Date:

(SIGNATURE) (TYPE OR PRINT NAME)

COURT ORDER

4. YOU ARE ORDERED TO APPEAR IN COURT AT THE DATE AND TIME LISTED IN ITEM 2 TO GIVE ANY LEGAL REASON WHY THE ORDERS REQUESTED SHOULD NOT BE GRANTED.

5. Time for service hearing is shortened. Service must be on or before (date): 6. Any responsive declaration must be served on or before (date):

7. The parties are ordered to attend mandatory custody services as follows:

8. You are ordered to comply with the Temporary Emergency Court Orders (form FL-305) attached. 9. Other (specify):

Date:

JUDICIAL OFFICER

To the person who received this Request for Order: If you wish to respond to this Request for Order, you must file a

Responsive Declaration to Request for Order (form FL-320) and serve a copy on the other parties at least nine court days

before the hearing date unless the court has ordered a shorter period of time. You do not have to pay a filing fee to file the

Responsive Declaration to Request for Order (form FL-320) or any other declaration including an Income and Expense Declaration (form FL-150) or Financial Statement (Simplified) (form FL-155).

6226, 6320–6326, 6380–6383

OTHER PARENT/PARTY:

Code section 3170 requires mediation before or at the same time as the hearing (see item 7.)

YOUR NAME

YOUR ADDRESS

CITY, STATE , and ZIP CODE

PHONE NUMBER

IN PRO PER

KERN

(SEE ATTACHED LIST OF

KERN COURT'S ADDRESSES)

PETITIONER'S NAME

RESPONDENT'S NAME

CASE NUMBER

X

(LIST THE ISSUE)

PUT THE OTHER PARTY'S NAME (and DCSS - if DCSS case and child support is an issue or requested)

LEAVE BLANK

X

(LIST ALL OTHER FORMS YOU

ARE ATTACHING (e.g. "UCCJEA)

DATE YOU SIGN

PRINT YOUR NAME

SIGN YOUR NAME

X

SAMPLES

See attached Information

Sheet, Request for Order

FL-300-INFO for more

information about this form.

(LEAVE #s 5 - 9

BLANK)

(CHECK ALL FORMS THAT'S BEING ATTACHED) CHECK ALL BOXES YOU'RE REQUESTING ORDERS FOR

CHECK “COURT ORDER” & #4 WHEN YOU'RE ASKING FOR TEMPORARY ORDERS, ASKING THAT THE COURT ORDER THE OTHER PERSON IN YOUR CASE TO COME TO COURT, OR NEED AN ORDER THAT ALLOW YOU TO GIVE NOTICE OF THE HEARING AFTER DEADLINE

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PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT:

OTHER PARENT/PARTY:

CASE NUMBER:

REQUEST FOR ORDER AND SUPPORTING DECLARATION

Petitioner Respondent Other Parent/Party requests the following orders: 1. CHILD CUSTODY

a. Child's name and age

To be ordered pending the hearing b. Legal custody to (name of person who

makes decisions about health, education, etc.)

c. Physical custody to (name of person with whom child will live)

d. As requested in form Child Custody and Visitation Application Attachment (form FL-311) Request for Child Abduction Prevention Orders (form FL-312)

Additional Provisions—Physical Custody Attachment (form FL-341(D)) Children's Holiday Schedule Attachment (form FL-341(C))

Other (Attachment 1d)

Joint Legal Custody Attachment (form FL-341(E))

e. Modify existing order (1) filed on (date): (2) ordering (specify):

2. CHILD VISITATION (PARENTING TIME) a. As requested in:

To be ordered pending the hearing

(1) Attachment 2a (2) Child Custody and Visitation Application Attachment (form FL-311)

(3) Other (specify): b. Modify existing order

(1) filed on (date): (2) ordering (specify):

c. One or more domestic violence restraining/protective orders are now in effect. (Attach a copy of the orders if you

have one.) The orders are from the following court or courts (specify county and state):

(1) Criminal: County/state: Case No. (if known):

(3) Juvenile: County/state: Case No. (if known): (2) Family: County/state:

Case No. (if known):

(4) Other: County/state: Case No. (if known): 3. CHILD SUPPORT (An earnings assignment order may be issued.)

a. Child's name and age b. I request support based on the child support guidelines

c. Monthly amount requested (if not by guideline) $

d. Modify existing order (1) filed on (date): (2) ordering (specify):

Notice: The court is required to order child support based on the income of both parents. It normally continues until the child is 18. You must supply the court with information about your finances by filing an Income and Expense Declaration (form FL-150) or a Financial Statement (Simplified) (form FL-155). Otherwise, the child support order will be based on information about your income that the court receives from other sources, including the other parent.

FL-300

Page 2 of 4

REQUEST FOR ORDER

FL-300 [Rev. July 1, 2012]

PETITIONER'S NAME

RESPONDENT'S NAME

CASE NUMBER

X

CHILD'S NAME & AGE

SOLE or JOINT

NAME OF PARENT(S)

X

CHILD'S NAME AGE

(CHECK ONE TO SHOW WHICH PARTY YOU ARE TO THE CASE)

(CHECK IF YOU ARE ATTACHING ANY FORM)

(CHECK AND COMPLETE SECTION 1e ONLY IF THERE IS AN EXISTING

ORDER REGARDING CHILD CUSTODY AND YOU ARE REQUESTING TO

CHANGE IT. IF SO, COMPLETE (1) AND LIST THE FILED DATE OF THAT

EXISTING ORDER AND (2) SPECIFY THE EXISTING ORDER)

(CHECK THE BOX THAT APPLY TO THE REQUEST YOU WANT THE COURT TO MAKE ORDERS FOR)

(CHECK AND COMPLETE SECTION 2b ONLY IF THERE IS AN EXISTING ORDER REGARDING CHILD VISITATION AND YOU ARE REQUESTING TO CHANGE IT. IF SO, COMPLETE (1) AND LIST THE FILED DATE OF THAT EXISTING ORDER AND (2) SPECIFY THE EXISTING ORDER)

(CHECK AND COMPLETE SECTION 3d ONLY IF THERE IS AN EXISTING

ORDER REGARDING CHILD SUPPORT AND YOU ARE REQUESTING

TO CHANGE IT. IF SO, COMPLETE (1) AND LIST THE FILED DATE OF

THAT EXISTING ORDER AND (2) SPECIFY THE EXISTING ORDER)

(IF YOU ARE REQUESTING CHILD SUPPORT COMPLETE THIS SECTION AND CHECK "b" or COMPLETE "c")

(12)

Page 3 of 4

REQUEST FOR ORDER

FL-300 [Rev. July 1, 2012]

4. SPOUSAL OR PARTNER SUPPORT (An earnings assignment order may be issued.)

a. Amount requested (monthly): $ c. Modify existing order (1) filed on (date): (2) ordering (specify): b. Terminate existing order

(1) filed on (date): (2) ordering (specify):

d. The Spousal or Partner Support Declaration Attachment (form FL-157) is attached (for modification of spousal or

partner support after judgment only)

e. An Income and Expense Declaration (form FL-150) must be attached

5. ATTORNEY FEES AND COSTS are requested on Request for Attorney Fees and Costs Order Attachment (form FL-319) or a declaration that addresses the factors covered in that form. An Income and Expense Declaration (form FL-150) must be attached. A Supporting Declaration for Attorney Fees and Costs Order Attachment (form FL-158) or a declaration that addresses the factors covered in that form must also be attached.

6. PROPERTY RESTRAINT To be ordered pending the hearing

a. The petitioner respondent claimant is restrained from transferring, encumbering, hypothecating, concealing, or in any way disposing of any property, real or personal, whether community, quasi-community, or separate, except in the usual course of business or for the necessities of life.

The applicant will be notified at least five business days before any proposed extraordinary expenditures, and an accounting of such will be made to the court.

Both parties are restrained and enjoined from cashing, borrowing against, canceling, transferring, disposing of, or changing the beneficiaries of any insurance or other coverage, including life, health, automobile, and disability, held for the benefit of the parties or their minor children.

b.

c. Neither party may incur any debts or liabilities for which the other may be held responsible, other than in the ordinary course of business or for the necessities of life.

7. PROPERTY CONTROL To be ordered pending the hearing

a. The petitioner respondent is given the exclusive temporary use, possession, and control of the following property that we own or are buying (specify):

b. The petitioner respondent is ordered to make the following payments on liens and encumbrances coming due while the order is in effect:

Debt Amount of payment Pay to

8. OTHER RELIEF (specify):

NOTE: To obtain domestic violence restraining orders, you must use the forms Request for Order

(Domestic Violence Prevention) (form DV-100), Temporary Restraining Order (Domestic Violence) (form

DV-110), and Notice of Court Hearing (Domestic Violence) (form DV-109). PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT/PARTY: CASE NUMBER: FL-300

PETITIONER'S NAME

RESPONDENT'S NAME

CASE NUMBER

X

GUIDELINE

X

SAMPLES

(COMPLETE SECTION 4b or 4c ONLY IF

THERE IS AN EXISTING ORDER RE SPOUSAL OR PARTNER SUPPORT AND YOU ARE REQUESTING TO CHANGE IT)

#8 "OTHER RELIEF": CHECK IF IT APPLIES, COMPLETE IF YOU HAVE ANY OTHER

REQUEST THAT IS NOT ALREADY SPECIFIED IN THE PREVIOUS SECTIONS, e.g.

SET ASIDE JUDGMENT/ORDER OF _; VACATE JUDGMENT/ORDER OF __;

VACATE TRO/DV ISSUED ON __; CHANGE OF VENUE TO _; CLERK OF THE

COURT TO EXECUTE TRANSFER DOCUMENT INSTEAD OF ___; DECLARATORY

RELIEF; DIVIDE OMITTED ASSET OR DEBT; ENFORCE JUDGMENT ORDER OF ___;

LEAVE TO AMEND PETITION/RESPONSE; RECONSIDER ORDERS OF ___;

REQUEST FOR CHILD'S NAME CHANGE; REQUEST FOR DNA TEST; STAY AWAY

ORDERS; SANCTIONS; REQUEST FOR JUDGMENT OF NON-PARENTAGE; ISSUE

WRIT OF EXECUTION; PERSONAL CONDUCT ORDERS; QUASH SUMMONS AND

PETITION; STATEMENT OF DECISION; etc.)

(13)

Requests for Accommodations

Assistive listening systems, computer-assisted real-time captioning, or sign language interpreter services are available if you ask at least five days before the proceeding. Contact the clerk’s office or go to www.courts.ca.gov/forms for

Request for Accommodations by Persons With Disabilities and Response (form MC-410). (Civil Code, § 54.8.)

9. I request that time for service of the Request for Order and accompanying papers be shortened so that these documents may be served no less than (specify number): days before the time set for the hearing. I need to have this order shortening time because of the facts specified in item 10 or the attached declaration.

10. FACTS IN SUPPORT of orders requested and change of circumstances for any modification are (specify): Contained in the attached declaration. (You may use Attached Declaration (form MC-031) for this purpose.

The attached declaration must not exceed 10 pages in length unless permission to file a longer declaration has been obtained from the court.)

FL-300 [Rev. July 1, 2012] REQUEST FOR ORDER Page 4 of 4

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 APPLICANT)

PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT/PARTY: CASE NUMBER: FL-300

PETITIONER'S NAME

RESPONDENT'S NAME

CASE NUMBER

X

EXPLAIN HERE WHY YOU WANT EACH ORDER REQUESTED or ATTACH A SEPARATE

DECLARATION. IF YOU ARE USING AN ATTACHED DECLARATION, YOU MUST NOT

EXCEED 10 PAGES IN LENGTH (SINGLE-SIDED).

***IF YOU WANT MORE SPECIFIC CUSTODY/VISITATION SCHEDULE, YOU MAY USE

FORMS FL-311; FL-312; FL-341(C); FL-341(D); FL-341(E); OR ATTACHMENT 2A (BLANK

FORM MC-020).***

***IF YOU ARE REQUESTING ORDERS PENDING THE HEARING FOR ANY OF THE ABOVE

ITEMS, YOU WILL NEED TO ADD A TEMPORARY ORDER (FORM FL-305). YOU MUST ALSO

INCLUDE THE REQUEST FOR TEMPORARY ORDERS; NOTICE TO THE OTHER PARTY

(GOLDENROD LOCAL FORM).***

DATE YOU SIGN

(14)

FL-311

PETITIONER/PLAINTIFF: CASE NUMBER:

RESPONDENT/DEFENDANT:

CHILD CUSTODY AND VISITATION APPLICATION ATTACHMENT

TO Petition, Response, Application for Order or Responsive Declaration Other (specify): To be ordered now and effective until the hearing

1. Custody. Custody of the minor children of the parties is requested as follows:

Child's Name Date of Birth Legal Custody to Physical Custody to

(person who makes decisions about (person with whom the child lives)

health, education, etc.)

2. Visitation.

a. Reasonable right of visitation to the party without physical custody (not appropriate in cases involving domestic violence)

b. See the attached -page document dated (specify date): c. The parties will go to mediation at (specify location):

d. No visitation

e. Visitation for the petitioner respondent will be as follows: (1) Weekends starting (date):

(The first weekend of the month is the first weekend with a Saturday.)

1st 2nd 3rd 4th 5th weekend of the month

from at a.m. p.m.

(day of week) (time)

to at a.m. p.m.

(a) The parents will alternate the fifth weekends, with the petitioner respondent having the initial fifth weekend, which starts (date):

(b) The petitioner will have fifth weekends in odd even months. (2) Alternate weekends starting (date) :

The petitioner respondent will have the children with him or her during the period

from at a.m. p.m.

to at a.m. p.m.

(3) Weekdays starting (date) :

The petitioner respondent will have the children with him or her during the period

from at a.m. p.m.

to at a.m. p.m.

(4) Other (specify days and times as well as any additional restrictions) :

See Attachment 2e(4).

Page 1 of 2 Form Approved for Optional Use CHILD CUSTODY AND VISITATION APPLICATION ATTACHMENT Family Code, § 6200 et seq. Judicial Council of California www.courtinfo.ca.gov

FL-311 [Rev. July 1, 2005]

PETITIONER'S NAME

CASE NUMBER

RESPONDENT'S NAME

X

CHILD'S NAME

DATE OF BIRTH MOTHER/FATHER'S NAME OR JOINT MOTHER/FATHER'S NAME OR JOINT

X

SPECIFY STARTING DATE

X

FRIDAY

6:00

X

SUNDAY

6:00

X

SPECIFY STARTING DATE

X

TUESDAY

5:00

X

TUESDAY

9:00

X

LIST/SPECIFY DAYS, TIMES, OR RESTRICTIONS HERE

-OR- USE FORM MC-020 AND TITLE IT AS "ATTACHMENT 2e(4)"

SAMPLES

(COMPLETE ONLY THE SECTION YOU ARE REQUESTING AN ORDER FOR)

(15)

PETITIONER: CASE NUMBER:

RESPONDENT:

3. Supervised visitation.

I request that (name) : have supervised visitation with the minor children according to the schedule set out on page 1 and that the visits be supervised by (name) :

who is a professional nonprofessional supervisor. The supervisor's phone number is (specify) :

I request that the costs of supervision be paid as follows: petitioner: percent;

respondent:

percent. If item 3 is checked, you must attach a declaration that shows why unsupervised visitation would be bad for your children. The judge is required to consider supervised visitation if one parent is alleging domestic violence and is protected by a restraining order.

4. Transportation for visitation and place of exchange.

a. Transportation to the visits will be provided by (name) : b. Transportation from the visits will be provided by (name) : c. Drop-off of the children will be at (address) :

d. Pick-up of the children will be at (address) :

e. The children will be driven only by a licensed and insured driver. The car or truck must have legal child restraint devices.

f. During the exchanges, the parent driving the children will wait in the car and the other parent will wait in his or her home while the children go between the car and the home.

g. Other (specify) :

5. Travel with children. The petitioner respondent other (name) : must have written permission from the other parent or a court order to take the children out of a. the state of California.

b. the following counties (specify) : c. other places (specify) :

6. Child abduction prevention. There is a risk that one of the parents will take the children out of California without the other parent's permission. I request the orders set out on attached form FL-312.

7. Children's holiday schedule. I request the holiday and visitation schedule set out on the attached form FL-341(C) other (specify):

8. Additional custody provisions. I request the additional orders regarding custody set out on the attached form FL-341(D) other (specify):

9. Joint legal custody provisions. I request joint legal custody and want the additional orders set out on the attached form FL-341(E) other (specify):

10. Other. I request the following additional orders (specify) :

FL-311 [Rev. July 1, 2005] CHILD CUSTODY AND VISITATION APPLICATION ATTACHMENT Page 2 of 2

PETITIONER'S NAME

CASE NUMBER

RESPONDENT'S NAME

SAMPLES

(COMPLETE ONLY THE SECTION YOU

ARE REQUESTING AN ORDER FOR)

(COMPLETE ONLY THE SECTION YOU

ARE REQUESTING AN ORDER FOR)

(16)

FL-105/GC-120

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY

TELEPHONE NO.: FAX NO.(Optional): E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:

PETITIONER: RESPONDENT:

CASE NUMBER:

DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA)

1. I am a party to this proceeding to determine custody of a child. 2.

3. There are (specify number): minor children who are subject to this proceeding, as follows:

(Insert the information requested below. The residence information must be given for the last FIVE years.)

a. Child's name Place of birth Date of birth Sex

Period of residence Address Person child lived with (name and complete current address) Relationship

to present Confidential

to

b. Child's name Place of birth Date of birth Sex

Residence information is the same as given above for child a.

Period of residence Address Relationship

to

c. Additional residence information for a child listed in item a or b is continued on attachment 3c.

Page 1 of 2 Form Adopted for Mandatory Use DECLARATION UNDER UNIFORM CHILD CUSTODY Family Code, § 3400 et seq.;

Judicial Council of California Probate Code, §§ 1510(f), 1512 FL-105/GC-120 [Rev. January 1, 2009] JURISDICTION AND ENFORCEMENT ACT (UCCJEA) www.courtinfo.ca.gov

My present address and the present address of each child residing with me is confidential under Family Code section 3429 as I have indicated in item 3.

Confidential

Child's residence (City, State)

Person child lived with (name and complete current address)

(If NOT the same, provide the information below.)

Confidential

d. Additional children are listed on form FL-105(A)/GC-120(A).(Provide all requested information for additional children.)

OTHER PARTY:

(This section applies only to family law cases.)

(This section applies only to guardianship cases.)

GUARDIANSHIP OF (Name): Minor

YOUR NAME

YOUR ADDRESS

CITY, STATE , and ZIP CODE

PHONE NUMBER

IN PRO PER

KERN

(SEE ATTACHED LIST OF

KERN COURT'S ADDRESSES)

PETITIONER'S NAME

RESPONDENT'S NAME

LEAVE BLANK

2

CHILD'S NAME (oldest child if more than 1 child)

CITY, STATE

DATE OF BIRTH

M or F

DATE

ADDRESS, CITY & STATE

PERSON CHILD IS LIVING WITH

MOM, DAD, or

PARENTS ADDRESS, CITY & STATE

CHILD'S NAME (if more than 1 child)

CITY, STATE

DATE OF BIRTH

M or F

X

SAMPLES

(MUST GIVE RESIDENCE INFORMATION FOR LAST 5 YEARS or IF

CHILD IS LESS THAN 5 YEARS OLD, MUST GIVE RESIDENCE FROM

BIRTH TO PRESENT).

(CHECK THIS BOX IF RESIDENCE INFORMATION FOR THIS CHILD IS SAME

AS CHILD "a" AND LEAVE THIS CHILD'S RESIDENCE INFORMATION BLANK).

(CHECK C or D IF NEEDED)

(17)

SHORT TITLE: CASE NUMBER:

4.

Yes No (If yes, attach a copy of the orders (if you have one) and provide the following information):

6. Do you know of any person who is not a party to this proceeding who has physical custody or claims to have custody of or visitation rights with any child in this case? Yes No (If yes, provide the following information) :

a. Name and address of person b. Name and address of person c. Name and address of person

Has physical custody Has physical custody Has physical custody Claims custody rights Claims custody rights Claims custody rights Claims visitation rights Claims visitation rights Claims visitation rights

Name of each child Name of each child Name of each child

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 DECLARANT)

7. Number of pages attached:

NOTICE TO DECLARANT: You have a continuing duty to inform this court if you obtain any information about a custody proceeding in a California court or any other court concerning a child subject to this proceeding.

FL-105/GC-120 [Rev. January 1, 2009] DECLARATION UNDER UNIFORM CHILD CUSTODY Page 2 of 2

JURISDICTION AND ENFORCEMENT ACT (UCCJEA)

FL-105/GC-120

Do you have information about, or have you participated as a party or as a witness or in some other capacity in, another court case or custody or visitation proceeding, in California or elsewhere, concerning a child subject to this proceeding?

Proceeding Case number

Court

(name, state, location)

Court order or judgment

(date)

Name of each child

Your connection to the case Case status a. Family b. Guardianship c. Other d. e. Juvenile Delinquency/ Proceeding Adoption

Court (name, state, location) Case Number

Juvenile Dependency

5. One or more domestic violence restraining/protective orders are now in effect. (Attach a copy of the orders if you have one

and provide the following information):

c. d. Court Other Juvenile Delinquency/ Juvenile Dependency

County Case number (if known)

a. Criminal

b. Family

State Orders expire (date)

PETITIONER'S NAME VS. RESPONDENT'S NAME

X

DATE YOU SIGN

PRINT YOUR NAME

SIGN YOUR NAME

(IF YES IS CHECKED, COMPLETE BELOW)

(18)

Child's name Place of birth Date of birth Sex Residence information is the same as given on form

Period of residence Present address Person child lived with (name and complete current address) Relationship

to

ATTACHMENT TO Family Code, § 3400 et seq.;

DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION

FL-105(A)/GC-120(A)

Confidential

Child's name

to present Confidential Confidential

Child's residence (City, State) Person child lived with (name and complete current address)

to

Place of birth Date of birth Sex

Place of birth Date of birth Sex Child's name

to present Confidential Confidential

to

CASE NAME: CASE NUMBER:

ATTACHMENT TO

DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA)

Form Adopted for Mandatory Use Judicial Council of California

FL-105(A)/GC-120(A) [New January 1, 2009]

Probate Code, §§ 1510(f), 1512

www.courtinfo.ca.gov

AND ENFORCEMENT ACT (UCCJEA)

FL-105/GC-120 for child a. (If NOT the same, provide the

information below.)

FL-105/GC-120 for child a. (If NOT the same, provide the Residence information is the same as given on form

information below.)

Residence information is the same as given on form FL-105/GC-120 for child a. (If NOT the same, provide the

Page of

PETITIONER'S NAME VS. RESPONDENT'S NAME

CASE NUMBER

c.

CHILD'S NAME

CITY & STATE OF BIRTH

DATE OF BIRTH

M or F

X

SAMPLES

(19)

FL-150

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address) : FOR COURT USE ONLY

TELEPHONE NO.: E-MAIL ADDRESS (Optional) : ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:

PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT/CLAIMANT:

CASE NUMBER:

INCOME AND EXPENSE DECLARATION

1. Employment (Give information on your current job or, if you're unemployed, your most recent job.) Attach copies a. Employer:

of your pay b. Employer's address: stubs for last c. Employer's phone number: two months d. Occupation:

(black out e. Date job started:

social f. If unemployed, date job ended:

security g. I work about hours per week.

numbers). h. I get paid $ gross (before taxes) per month per week per hour. (If you have more than one job, attach an 8 1/2-by-11-inch sheet of paper and list the same information as above for your other jobs. Write "Question 1 - Other Jobs" at the top.)

2. Age and education a. My age is (specify):

b. I have completed high school or the equivalent: Yes No If no, highest grade completed (specify): c. Number of years of college completed (specify): Degree(s) obtained (specify):

d. Number of years of graduate school completed (specify): Degree(s) obtained (specify): e. I have: professional/occupational license(s) (specify):

vocational training (specify): 3. Tax information

a. I last filed taxes for tax year (specify year):

b. My tax filing status is single head of household married, filing separately married, filing jointly with (specify name):

c. I file state tax returns in California other (specify state):

d. I claim the following number of exemptions (including myself) on my taxes (specify):

4. Other party's income. I estimate the gross monthly income (before taxes) of the other party in this case at (specify): $ This estimate is based on (explain):

(If you need more space to answer any questions on this form, attach an 8 1/2-by-11-inch sheet of paper and write the question number before your answer.) Number of pages attached:

I declare under penalty of perjury under the laws of the State of California that the information contained on all pages of this form and any attachments is true and correct.

Date:

(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)

Page 1 of 4 Form Adopted for Mandatory Use _{INCOME AND EXPENSE DECLARATION} Family Code, §§ 2030-2032,

Judicial Council of California 2100-2113, 3552, 3620-3634, FL-150 [Rev. January 1, 2007] 4050-4076, 4300-4339 www.courtinfo.ca.gov

YOUR NAME

YOUR ADDRESS

CITY, STATE , and ZIP CODE

PHONE NUMBER

IN PRO PER

KERN

(SEE ATTACHED LIST OF

KERN COURT'S ADDRESSES)

PETITIONER'S NAME

RESPONDENT'S NAME

CASE NUMBER

BAKERSFIELD HOSPITAL

124 HOSPITAL ROW, BAKERSFIELD, CA 93301

(661) 555-5555

AD, OTTOMG, G, ERL

01/2004

(COMPLETE THIS IF YOU ARE NO LONGER WORKING)