Superior Court Form : Sdsc Adm-243 - Personal Information Sheet

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SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO
FOR COURT USE ONLY
CENTRAL DIVISION, COUNTY COURTHOUSE, 220 W. BROADWAY, SAN DIEGO, CA 92101
To keep other people from seeing
CENTRAL DIVISION, FAMILY COURT, 1555 6TH AVE., SAN DIEGO, CA 92101
CENTRAL DIVISION, MADGE BRADLEY, 1409 4TH AVE., SAN DIEGO, CA 92101
what you entered on your form,
EAST COUNTY DIVISION, 250 E. MAIN ST., EL CAJON, CA 92020
please press the Clear This Form
NORTH COUNTY DIVISION, 325 S. MELROSE DR., VISTA, CA 92081
SOUTH COUNTY DIVISION, 500 3RD AVE., CHULA VISTA, CA 91910
button at the end of the form
PETITIONER(S)
when finished.
RESPONDENT(S)
THIRD PARTY
CASE NUMBER
PERSONAL INFORMATION SHEET
RE: ORDER TO REIMBURSE THE COURT MINOR’S COUNSEL FEES
(CONFIDENTIAL)
You were ordered to reimburse the San Diego Superior Court for the fees and costs paid by the court to the attorney for
your minor child[ren]. You were notified that payment dates would be set and separate statements indicating both the
amount and date due would be mailed to you. The following information is required for purposes of billing and will be kept
confidential. Please print and provide current information. It is your responsibility to inform the court of any changes to
your mailing address.
Petitioner
Respondent
Third Party
Last Name: ________________________________ First Name: __________________________ M.I.:
Mailing Address: __________________________________________________________________________________
City:_____________________________ State:_________________ Zip Code:____________
Telephone Number:
( ______ ) __________________ (home)
(
) __________________ (work)
( ______ ) __________________ (cell)
Driver’s License Number:
State:
Date of Birth:
Social Security Number:
-
-
Date:
____________________________________________
Signature
NOTICE
Any party required to pay court-ordered attorney’s fees and costs or to reimburse the court for attorney’s fees and
costs paid on a party’s behalf must pay interest on amounts more than 30 days past due at the legal rate, which is
currently 10% per year. Failure to pay court-ordered attorney’s fees and costs or reimburse the court for fees and
costs paid on a party’s behalf may result in a legal action being initiated to collect overdue payments and interest
on overdue amounts. The information provided, including your Social Security number, may be used as an aid in
identification should it become necessary to pursue collection of any unpaid amounts.
PERSONAL INFORMATION SHEET
SDSC ADM-243 (New 5/09)
RE: ORDER TO REIMBURSE THE COURT MINOR’S COUNSEL FEES
(CONFIDENTIAL)
For your protection and privacy, please press the Clear This
Print This Form
Clear This Form
Form button after you have printed the form

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