Sample Form Number and Brief Description 9A Stages of Dissolution Flow Chart... 281

DISSOLUTION I FORMS 9 TABLE OF FORMS Sample Form Number and Brief Description 9A Stages of Dissolution Flow Chart....................... 281 9C Family Law Case Cover Sheet (LA-20/FAM020)............... 283 9D Summons (Family Law) and Standard Restraining Orders.......... 285 9E Page Proof of Service of Summons (Family Law, Uniform Parentage, Custody and Support) (FL-115)........................ 287 9F Petition (Family Law)..............................289 9G-1 Child Custody and Visitation Application Attachment (FL-311)........291 9G-2 Additional Provisions Physical Custody Attachment (FL-341(D))..... 293 9H-1 Joint Legal Custody Attachment (FL-341(E))................. 295 9H-2 Children s Holiday Schedule Attachment (FL-341(C)).............297 9H-3 Request for Child Abduction Prevention Orders (FL-312)...........299 9I-1 Attachment 7j Health Care Coverage for Spouse..............301 9I-2 Attachment 7j Consolidation Attachment.................. 303 9I-3 Children s Health Care Attachment...................... 304 9J Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA)..........................305 9K Response................................... 307 9L Letter to Litigation Coordinator........................ 309 9M Letter to Sheriff (Out-of-County or Out-of-State Personal Service by Sheriff)................................... 311 9N Schedule of Assets and Debts........................ 315 9O Letter to Client Advising of Need to Discover Information and Join Pension Plan (also available in Spanish)................. 319 9Q Dissolution I Checklist.............................321 9R RFO Checklist................................. 323 9S House Checklist................................ 325 9T Pension Checklist............................... 327 9U Letter to Other Party s Employer Seeking Pension/Retirement Plan Information................................ 328 9V Custody and Visitation Handout (also available in Spanish)..........329 9W Assets & Debts Chart............................. 331 25th Edition 279

9 DISSOLUTION I FORMS 280 25th Edition

Sample Form 9A: Stages of Dissolution Flow Chart DISSOLUTION I FORMS 9 Harriett Buhai Center For Family Law Dissolution of Marriage Flow Chart Disso 1 (Start your case) Response (Other party already served you) Temporary orders needed? File Disso 1 File Response Serve other party. Wait 30 days. Check court file for Response after 30 days. No Response Filed (Default) Disso 2 - Default (Financial Disclosures/ Default Request) Response Filed (Contested) Disso 2 - Contested PDD (Prelim Financial Disclosure) Discovery (Gather evidence/ Research) Discovery (Gather evidence/ Research) Disso 2 - Contested FDD (Final Financial Disclosure) Disso 3 - Default (Judgment Prep/ Supporting docs) Disso 3 - Default with Agreement (Judgment Prep) Trial Prep (Request Trial/Brief/Lists) Trial Setting Conference Default Hearing? Trial HBCFL Appointment Non-appointment Process Judgment Disso 3 - Contested (Judgment Prep) Disso 3 - Uncontested (Stip Judgment Prep) F:\Document\Publications\Volunteer Manual\2013\2013 Manual Forms\Chapter 9\9A Stages of Dissolution Flow Chart.doc 25th Edition 281

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Sample Form 9C: Family Law Case Cover Sheet (LA-20/FAM020) DISSOLUTION I FORMS 9 NAME, ADDRESS, AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT ATTORNEY: 433 1st Street Los Angeles, CA 90008 STATE BAR NUMBER Reserved for Clerk's File Stamp (213)222-5555 ATTORNEY FOR (Name): Petitioner In Pro Per SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES COURTHOUSE ADDRESS: 111 N. Hill Street Los Angeles, CA 90012 PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: Jose Smith HBCFL FAMILY LAW CASE COVER SHEET CERTIFICATE OF GROUNDS FOR ASSIGNMENT TO DISTRICT CASE NUMBER: Case Filing Instructions This cover sheet is required so that the court can assign your case to the correct court 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(d) and 14.2. 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 County Superior Court. This form is not required in Abandonment & Emancipation cases, which are to be filed at Children s Court. I. Fill in the requested information. a) Enter address of Petitioner ADDRESS: CITY: STATE ZIP CODE 433 1st Street Los Angeles CA 90008 ADDRESS: b) Enter address of Respondent. DO NOT COMPLETE THIS ITEM IF THIS IS A MINOR S CONTRACT CASE CITY: STATE MINOR CHILDREN INVOLVED? X YES HOW MANY? 2 NO II. Select the correct district: ZIP CODE 3749 Pine Avenue Los Angeles CA 90008 a. b. Under Column 1 below, check the one type of action which best describes the nature of this case. In Column 2 below, circle the reason for your choice of district that applies to the type of action you have checked. Applicable Reason for Choosing District (See Column 2 below) 1. May be filed in Central District. 2. District where one or more of the parties reside. 3. Child resides within the district. 4. District where Petitioner resides. 1 TYPE OF ACTION (Check only one) (Continued) 2 X A5520 Dissolution of Marriage 1. 2 A5525 A5521 A5530 A5531 Summary Dissolution of Marriage Dissolution of Domestic Partnership Nullity of Void or Voidable Marriage Nullity of Void or Voidable Domestic 1. 2 1. 2 1. 2 1. 2 Partnership APPLICABLE REASONS (See above) FAM 020 FAMILY LAW CASE COVER SHEET Page 1 of 2 (Rev 11/11) CERTIFICATE OF GROUNDS FOR ASSIGNMENT TO DISTRICT LASC RULE 5.2 LA-F020 25th Edition 283

9 DISSOLUTION I FORMS Sample Form 9C: Family Law Case Cover Sheet (LA-20/FAM090) Short Title Smith and Smith Case Number BD354789 A5510 Legal Separation 1. 2 A5511 Legal Separation of Domestic Partnership 1. 2 A6126 A6131 A6139 A6136 Petition for Custody and Support of Minor Child Support Services Department (CSSD) Parentage/Support Foreign Support Order Foreign Custody Order 1. 2. 3 1. 1. 2. 3 1. 2. 3 A6138 Uniform Interstate Family Support Act (UIFSA) Responding Petition A6122 Domestic Violence Restraining Order (Civil Harassment use Civil Cover Sheet) 1. 2. 3 (Any Court Jurisdiction DV's only) A6600 Habeas Corpus Petition Child Custody 1. 3 A6080 A6111 Petition to Establish Parentage / Paternity (Non- 1. 2. 3 governmental) Approval of Minor s Contract (6751 Family Code) 1 A6130 A6101 A6102 A6104 Other Family Complaint or Petition (Specify): Agency Adoption Independent Adoption Stepparent Adoption 1. 2. 3 1. 4 1. 4 1. 4 A6103 Adult Adoption 1. 4 A6106 Sole Custody Petition 1. 4 III. Enter address of minor child if known. (DO NOT COMPLETE UNLESS YOU HAVE CIRCLED ITEM 3 AS AN APPLICABLE REASON ADDRESS: Do not complete if this case falls under Family Code 6751 CITY: STATE ZIP CODE IV. Enter the information below and sign the certificate. Certificate / 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 Angles Superior Court under Code of Civil Procedure 392 et seq., 2300 et seq. of the Family Code, and Rule 2(b), (c), and (d) of this court for reason checked above. I certify and declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: 6/5/07 Central. (SIGNATURE OF ATTORNEY/PARTY WITHOUT ATTORNEY), Petitioner in Pro Per FAM 020 FAMILY LAW CASE COVER SHEET Page 2 of 2 (Rev 11/11) CERTIFICATE OF GROUNDS FOR ASSIGNMENT TO DISTRICT LASC RULE 5.2 284 25th Edition

Sample Form 9D: Summons (Family Law) and Standard Restraining Orders DISSOLUTION I FORMS 9 SUMMONS (Family Law) NOTICE TO RESPONDENT (Name): Jose Smith AVISO AL DEMANDADO (Nombre): FL-110 CITACIÓN (Derecho familiar) FOR COURT USE ONLY (SÓLO PARA USO DE LA CORTE) You are being sued. Lo están demandando. Petitioner's name is: Nombre del demandante: (NÚMERO DE CASO): BD 345678 30 calendar days Summons Tiene 30 días corridos después de haber recibido la entrega legal Petition Response de esta y para presentar una (formulario FL-120 ó FL-123) ante la corte y efectuar la entrega legal de una copia al demandante. Una carta o llamada telefónica no basta para protegerlo. Response Si no presenta su a tiempo, la corte puede dar órdenes que afecten su matrimonio o pareja de hecho, sus bienes y la custodia de sus hijos. La corte también le puede ordenar que pague manutención, y honorarios y costos legales. Si no puede pagar la cuota de presentación, pida al secretario un formulario de exención de cuotas. Si desea obtener asesoramiento legal, póngase en contacto de inmediato con un abogado. Puede obtener información para encontrar a un abogado en el Centro de Ayuda de las Cortes de (www.courtinfo.ca.gov/selfhelp) California (www.sucorte.ca.gov), en el sitio Web de los Servicios (www.lawhelpcalifornia.org) Legales de California (www.lawhelpcalifornia.org) o poniéndose en contacto con el colegio de abogados de su condado. NOTICE: AVISO: Las órdenes de restricción que figuran en la página 2 valen para ambos cónyuges o pareja de hecho hasta que se despida la petición, se emita un fallo o la corte dé otras órdenes. Cualquier autoridad de la ley que haya recibido o visto una copia de estas órdenes puede hacerlas acatar en cualquier lugar de California. NOTE: AVISO: Si se emite un fallo u orden de manutención, la corte puede ordenar que usted pague parte de, o todas las cuotas y costos de la corte previamente exentas a petición de usted o de la otra parte. Si esto ocurre, la parte ordenada a pagar estas cuotas debe recibir aviso y la oportunidad de solicitar una audiencia para anular la orden de pagar las cuotas exentas. (El nombre y dirección de la corte son): Los Angeles Superior Court 111 N. Hill Street Los Angeles, CA 90012 (El nombre, dirección y número de teléfono del abogado del demandante, o del demandante si no tiene abogado, son): (323) 298-3224 105 W. Beverly Blvd. Los Angeles, CA 90042 (Fecha): (Secretario, por) (Asistente) NOTICE TO THE PERSON SERVED: AVISO A LA PERSONA QUE RECIBIÓ LA ENTREGA: Esta entrega se realiza x (a usted como individuo.) (en nombre de un demandado que es): (menor de edad) (dependiente de la corte o pupilo) (specify) (otro especifique): (Read the reverse for important information.) (Lea importante información al dorso.) SUMMONS (Family Law) Page 1 of 2 25th Edition 285

9 DISSOLUTION I FORMS Sample Form 9D: Summons (Family Law) and Standard Restraining Orders WARNING IMPORTANT INFORMATION WARNING: California law provides that, for purposes of division of property upon dissolution of a marriage or domestic partnership or upon legal separation, property acquired by the parties during marriage or domestic partnership in joint form is presumed to be community property. If either party to this action should die before the jointly held community property is divided, the language in the deed that characterizes how title is held (i.e., joint tenancy, tenants in common, or community property) will be controlling, and not the community property presumption. You should consult your attorney if you want the community property presumption to be written into the recorded title to the property. STANDARD FAMILY LAW RESTRAINING ORDERS Starting immediately, you and your spouse or domestic partner are restrained from ADVERTENCIA INFORMACIÓN IMPORTANTE ADVERTENCIA: De acuerdo a la ley de California, las propiedades adquiridas por las partes durante su matrimonio o pareja de hecho en forma conjunta se consideran propiedad comunitaria para los fines de la división de bienes que ocurre cuando se produce una disolución o separación legal del matrimonio o pareja de hecho. Si cualquiera de las partes de este caso llega a fallecer antes de que se divida la propiedad comunitaria de tenencia conjunta, el destino de la misma quedará determinado por las cláusulas de la escritura correspondiente que describen su tenencia (por ej., tenencia conjunta, tenencia en común o propiedad comunitaria) y no por la presunción de propiedad comunitaria. Si quiere que la presunción comunitaria quede registrada en la escritura de la propiedad, debería consultar con un abogado. ÓRDENES DE RESTRICCIÓN NORMALES DE DERECHO FAMILIAR En forma inmediata, usted y su cónyuge o pareja de hecho tienen prohibido: Llevarse del estado de California a los hijos menores de las partes, si los hubiere, sin el consentimiento previo por escrito de la otra parte o una orden de la corte; Cobrar, pedir prestado, cancelar, transferir, deshacerse o cambiar el nombre de los beneficiarios de cualquier seguro u otro tipo de cobertura, tal como de vida, salud, vehículo y discapacidad, que tenga como beneficiario(s) a las partes y su(s) hijo(s) menor(es); Transferir, gravar, hipotecar, ocultar o deshacerse de cualquier manera de cualquier propiedad, inmueble o personal, ya sea comunitaria, cuasicomunitaria o separada, sin el consentimiento escrito de la otra parte o una orden de la corte, con excepción las operaciones realizadas en el curso normal de actividades o para satisfacer las necesidades de la vida; y Crear o modificar una transferencia no testamentaria de manera que afecte el destino de una propiedad sujeta a transferencia, sin el consentimiento por escrito de la otra parte o una orden de la corte. Antes de que se pueda eliminar la revocación de una transferencia no testamentaria, se debe presentar ante la corte un aviso del cambio y hacer una entrega legal de dicho aviso a la otra parte. Cada parte tiene que notificar a la otra sobre cualquier gasto extraordinario propuesto, por lo menos cinco días laborales antes de realizarlo, y rendir cuenta a la corte de todos los gastos extraordinarios realizados después de que estas órdenes de restricción hayan entrado en vigencia. No obstante, puede usar propiedad comunitaria, cuasicomunitaria o suya separada para pagar a un abogado o para ayudarle a pagar los costos de la corte. SUMMONS (Family Law) Page 2 of 2 286 25th Edition

Sample Form 9E: Proof of Service of Summons (Family Law, Uniform Parentage, Custody and Support) (FL-115) ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): 433 1st Street Los Angeles, CA 90008 DISSOLUTION I FORMS 9 FOR COURT USE ONLY FL-115 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: RESPONDENT: (323)222-5555 FAX NO. (Optional): Petitioner In Pro Per Los Angeles 111 N. Hill Street 111 N. Hill Street Los Angeles, CA 90012 Central District Jose Smith HBCFL PROOF OF SERVICE OF SUMMONS CASE NUMBER: 1. At the time of service I was at least 18 years of age and not a party to this action. I served the respondent with copies of: a. X Family Law Marriage: Petition Marriage (form FL-100), Summons (form FL-110), and blank Response Marriage (form FL-120) or b. Family Law Domestic Partnership: Petition Domestic Partnership (form FL-103), Summons (form FL-110), and blank Response Domestic Partnership (form FL-123) or c. Uniform Parentage: Petition to Establish Parental Relationship (form FL-200), Summons (form FL-210), and blank Response to Petition to Establish Parental Relationship (form FL-220) or d. Custody and Support: Petition for Custody and Support of Minor Children (form FL-260), Summons (form FL-210), and blank Response to Petition for Custody and Support of Minor Children (form FL-270) e. X (1) (2) (3) (4) X and Completed and blank Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act (form FL-105) Completed and blank Declaration of Disclosure (form FL-140) Completed and blank Schedule of Assets and Debts (form FL-142) Completed and blank Income and Expense Declaration (form FL-150) (5) (6) (7) Completed and blank Financial Statement (Simplified) (form FL-155) Completed and blank Property Declaration (form FL-160) Request for Order (form FL-300), and blank Responsive Declaration to Request for Order (form FL-320) (8) Other (specify): 2. Address where respondent was served: Indicate address, date, and time the Respondent was served. 3. I served the respondent by the following means (check proper box): a. X Personal service. I personally delivered the copies to the respondent (Code Civ. Proc., 415.10) on (date): at (time): b. Substituted service. I left the copies with or in the presence of (name): who is (specify title or relationship to respondent): (1) (2) Form Approved for Optional Use Judicial Council of California FL-115 [Rev. July 1, 2012] (Business) a person at least 18 years of age who was apparently in charge at the office or usual place of business of the respondent. I informed him or her of the general nature of the papers. (Home) a competent member of the household (at least 18 years of age) at the home of the respondent. I informed him or her of the general nature of the papers. PROOF OF SERVICE OF SUMMONS (Family Law Uniform Parentage Custody and Support) Page 1 of 2 Code of Civil Procedure, 417.10 25th Edition 287

9 DISSOLUTION I FORMS Sample Form 9E: Proof of Service of Summons (Family Law, Uniform Parentage, Custody and Support) (FL-115) PETITIONER: CASE NUMBER: RESPONDENT: Jose Smith 3. b. (cont.) on (date): at (time): I thereafter mailed additional copies (by first class, postage prepaid) to the respondent at the place where the copies were left (Code Civ. Proc., 415.20b) on (date): A declaration of diligence is attached, stating the actions taken to first attempt personal service. c. Mail and acknowledgment service. I mailed the copies to the respondent, addressed as shown in item 2, by first-class mail, postage prepaid, on (date): from (city): (1) with two copies of the Notice and Acknowledgment of Receipt (form FL-117) and a postage-paid return envelope addressed to me. (Attach completed Notice and Acknowledgment of Receipt (form FL-117).) (Code Civ. Proc., 415.30.) (2) to an address outside California (by registered or certified mail with return receipt requested). (Attach signed return receipt or other evidence of actual delivery to the respondent.) (Code Civ. Proc., 415.40.) d. Other (specify code section): Continued on Attachment 3d. 4. The "NOTICE TO THE PERSON SERVED" on the Summons was completed as follows (Code Civ. Proc., 412.30, 415.10, 474): a. X As an individual or b. On behalf of respondent who is a (1) (2) (3) minor. (Code Civ. Proc., 416.60.) ward or conservatee. (Code Civ. Proc., 416.70.) other (specify): 5. Person who served papers Name: Address: To be completed by the person who served the Respondent. Telephone number: This person is a. b. X exempt from registration under Business and Professions Code section 22350(b). not a registered California process server. c. a registered California process server: an employee or an independent contractor (1) Registration no.: (2) County: d. The fee for service was (specify): $ 0.00 6. X I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. or 7. I am a California sheriff, marshal, or constable, and I certify that the foregoing is true and correct. To be completed and signed by the person who served the Respondent. Date: (NAME OF PERSON WHO SERVED PAPERS) (SIGNATURE OF PERSON WHO SERVED PAPERS) FL-115 [Rev. July 1, 2012] PROOF OF SERVICE OF SUMMONS (Family Law Uniform Parentage Custody and Support) Page 2 of 2 288 25th Edition

Sample Form 9F: Petition (Family Law) DISSOLUTION I FORMS 9 ATTORNEY OR PARTY W ITHOUT ATTORNEY (Name, State Bar number, and address): Mary Smith 433 1st Street Los Angeles, CA 90008 TELEPHONE NO.: (213)222-5555 FAX NO. (Optional): Petitioner in Pro Per Los Angeles STREET ADDRESS: 111 N. Hill Street MAILING ADDRESS: 111 N. Hill Street CITY AND ZIP CODE: Los Angeles, CA 90012 BRANCH NAME: Central District E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF MARRIAGE OF PETITIONER: Mary Smith RESPONDENT: Jose Smith PETITION FOR X Dissolution of Marriage Legal Separation Nullity of Marriage HBCFL AMENDED CASE NUMBER: FOR COURT USE ONLY FL-100 1. RESIDENCE (Dissolution only) X Petitioner Respondent has been a resident of this state for at least six months and of this county for at least three months immediately preceding the filing of this Petition for Dissolution of Marriage. 2. STATISTICAL FACTS a. Date of marriage: b. Date of separation: 06/24/2001 c. Time from date of marriage to date of separation (specify): 12/15/2007 Years: 6 Months: 6 3. DECLARATION REGARDING MINOR CHILDREN (include children of this relationship born prior to or during the marriage or adopted during the marriage): a. There are no minor children. b. X The minor children are: Child's name Birthdate Age Sex Ana Smith 01/19/96 11 F Paul Smith 12/30/00 7 M 4. Continued on Attachment 3b. c. If there are minor children of the Petitioner and Respondent, a completed Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) (form FL-105) must be attached. d. A completed voluntary declaration of paternity regarding minor children born to the Petitioner and Respondent prior to the marriage is attached. SEPARATE PROPERTY Petitioner requests that the assets and debts listed in Property Declaration (form FL-160) in Attachment 4 X below be confirmed as separate property. Item Confirm to 1978 Ford Mustang 1978 Ford Pick-Up Truck Petitioner Petitioner NOTICE: You may redact (black out) social security numbers from any written material filed with the court in this case other than a form used to collect child or spousal support. Form Adopted for Mandatory Use Judicial Council of California FL-100 [Rev. January 1, 2005] PETITION MARRIAGE (Family Law) Page 1 of 2 Family Code, 2330, 3409 25th Edition 289

9 DISSOLUTION I FORMS Sample Form 9F: Petition (Family Law) MARRIAGE OF (last name, first name of parties): Smith and Smith CASE NUMBER: 5. DECLARATION REGARDING COMMUNITY AND QUASI-COMMUNITY ASSETS AND DEBTS AS CURRENTLY KNOWN a. There are no such assets or debts subject to disposition by the court in this proceeding. b. X All such assets and debts are listed in Property Declaration (form FL-160) in Attachment 5b. X below (specify): Target credit card debt, 1999 Nissan Truck, First interstate VISA credit card debt, any and all pension, retirement plans, 401ks or other employee benefits earned during marriage by Respondent, and other assets and debts acquired during the marriage. 6. Petitioner requests a. X dissolution of the marriage based on d. nullity of voidable marriage based on (1) X irreconcilable differences. (Fam. Code, 2310(a).) (1) petitioner's age at time of marriage. (2) incurable insanity. (Fam. Code, 2310(b).) (Fam. Code, 2210(a).) b. legal separation of the parties based on (2) prior existing marriage. (1) irreconcilable differences. (Fam. Code, 2310(a).) (Fam. Code, 2210(b).) (2) incurable insanity. (Fam. Code, 2310(b).) (3) unsound mind. (Fam. Code, 2210(c).) c. nullity of void marriage based on (4) fraud. (Fam. Code, 2210(d).) (1) incestuous marriage. (Fam. Code, 2200.) (5) force. (Fam. Code, 2210(e).) (2) bigamous marriage. (Fam. Code, 2201.) (6) physical incapacity. (Fam. Code, 2210(f).) 7. Petitioner requests that the court grant the above relief and make injunctive (including restraining) and other orders as follows: Petitioner Respondent Joint Other a. Legal custody of children to......................................... X b. Physical custody of children to....................................... X c. Child visitation be granted to........................................ X As requested in form: X FL-311 FL-312 X FL-341(C) X FL-341(D) FL-341(E) Attachment 7c. d. Determination of parentage of any children born to the Petitioner and Respondent prior to the marriage. e. Attorney fees and costs payable by.................................... X f. Spousal support payable to (earnings assignment will be issued)............... X g. X Terminate the court's jurisdiction (ability) to award spousal support to Respondent. h. X Property rights be determined. i. X Petitioner's former name be restored to (specify): j. Other (specify): 1. Consolidation of DVPA case; 2. Health Care for Minor Children; 3. Health Care for Spouse, an 4. Child support be made retroactive to the date of filing of this petition pursuant to Family Code Section X Continued on Attachment 7j.(1), 7j(2) and 7j(3) 8. Child support If there are minor children born to or adopted by the Petitioner and Respondent before or during this marriage, the court will make orders for the support of the children upon request and submission of financial forms by the requesting party. An earnings assignment may be issued without further notice. Any party required to pay support must pay interest on overdue amounts at the "legal" rate, which is currently 10 percent. 9. I HAVE READ THE RESTRAINING ORDERS ON THE BACK OF THE SUMMONS, AND I UNDERSTAND THAT THEY APPLY 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: 01/01/11 Mary Smith Date: (TYPE OR PRINT NAME) Mary Smith (SIGNATURE OF PETITIONER) (TYPE OR PRINT NAME) (SIGNATURE OF ATTORNEY FOR PETITIONER) NOTICE: Dissolution or legal separation may automatically cancel the rights of a spouse under the other spouse's will, trust, retirement plan, power of attorney, pay on death bank account, survivorship rights to any property owned in joint tenancy, and any other similar thing. It does not automatically cancel the right of a spouse as beneficiary of the other spouse's life insurance policy. You should review these matters, as well as any credit cards, other credit accounts, insurance polices, retirement plans, and credit reports to determine whether they should be changed or whether you should take any other actions. However, some changes may require the agreement of your spouse or a court order (see Family Code sections 231 235). FL-100 [Rev. January 1, 2005] PETITION MARRIAGE (Family Law) 290 Page 2 of 2 25th Edition

Sample Form 9G-1: Child Custody and Visitation Application Attachment (FL-311) DISSOLUTION I FORMS 9 PETITIONER/PLAINTIFF: CASE NUMBER: FL-311 RESPONDENT/DEFENDANT: Jose Smith CHILD CUSTODY AND VISITATION APPLICATION ATTACHMENT TO X Petition, Response, Application for Order or Responsive Declaration Other (specify): To be ordered now and effective until the hearing 1. X 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.) Ana Smith 1/19/96 & Jose Smith Paul Smith 12/30/00 & Jose Smith 2. X 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. X Visitation for the petitioner X respondent will be as follows: (1) X Weekends starting (date): August 1, 2012 (The first weekend of the month is the first weekend with a Saturday.) X 1st 2nd X 3rd 4th 5th weekend of the month from Saturday at 10:00 X a.m. p.m. (day of week) (time) to Sunday at 5:00 a.m. X p.m. (day of week) (time) (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 from (day of week) will have the children with him or her during the period at a.m. p.m. (time) to at a.m. p.m. (day of week) (time) (3) (4) X Weekdays starting (date): August 1, 2012 The petitioner X respondent will have the children with him or her during the period from Wednesday at 4:00 a.m. x p.m. (day of week) (time) to Wednesday at 8:00 a.m. X p.m. (day of week) (time) Other (specify days and times as well as any additional restrictions): Form Approved for Optional Use Judicial Council of California FL-311 [Rev. July 1, 2005] CHILD CUSTODY AND VISITATION APPLICATION ATTACHMENT See Attachment 2e(4). Page 1 of 2 Family Code, 6200 et seq. 25th Edition 291

9 DISSOLUTION I FORMS Sample Form 9G-1: Child Custody and Visitation Application Attachment (FL-311) PETITIONER: CASE NUMBER: RESPONDENT: Jose Smith 3. X Supervised visitation. I request that (name): Jose Smith have supervised visitation with the minor children according to the schedule set out on page 1 and that the visits be supervised by (name): Beth Smith or person of Petitioner's choice who is a professional X nonprofessional supervisor. The supervisor's phone number is (specify):(562)722-3700 I request that the costs for 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. X Transportation for visitation and place of exchange a. b. c. X Transportation to the visits will be provided by (name): Transportation from the visits will be provided by (name): Drop-off of the children will be at (address): 65 Oak St., L.A., CA 90012 or future home of Petitioner d. X Pick-up of the children will be at (address): 65 Oak St., L.A., CA 90012 or future home of Petitioner 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. X Travel with children. The petitioner X 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. c. X the following counties (specify): other places (specify): Los Angeles 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. X Children's holiday schedule. I request the holiday and visitation schedule set out on the attached X form FL-341(C) other (specify): 8. X Additional custody provisions. I request the additional orders regarding custody set out on the attached X form FL-341(D) other (specify): 9. X Joint legal custody provisions. I request joint legal custody and want the additional orders set out on the attached X form FL-341(E) other (specify): 10. Other. I request the following additional orders (specify): FL-311 [Rev. July 1, 2005] Page 2 of 2 CHILD CUSTODY AND VISITATION APPLICATION ATTACHMENT 292 25th Edition