Form Pkt-008 - Domestic Violence - Restraining Order With Children Packet Page 14
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23CONFIDENTIAL
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO
FAMILY COURT SERVICES (FCS) DATA SHEET
(CONFIDENTIAL)
Case Name __________________________
COMPLETE ALL THREE PAGES
Case No. ___________________________
FCS Date ___________________________
Have you previously been to Family Court Services?
Yes
No
Next Court Date _____________________
IF YOU ARE BEING PROTECTED BY A RESTRAINING ORDER OR IF YOU ALLEGE DOMESTIC VIOLENCE, YOU MAY BE
SEEN SEPARATELY. Are you requesting a separate session?
Yes
No
If you want to be seen separately, advise the Family Court Services Clerk when you check in.
SUPPORT PERSON: If you are being protected by a restraining order, a support person may accompany you during your
FCS session. The support person must first sign a Family Court Services Domestic Violence Support Person Agreement
(SDSC Form #FCS-038). Advise the Family Court Services Clerk of your support person when you check in.
Are you requesting that your address and telephone number remain confidential?
Yes
No
CHECK ONE
Father
Mother
Grandparent
Other (specify relationship): ______________________________________
FULL LEGAL NAME
AKA OR MAIDEN NAME
ADDRESS
Number and Street
Apt. #
City
State
Zip Code
HOME TEL. NO. ______________________________ WORK TEL. NO. ______________________________________
WORK SCHEDULE ________________________________________________________________________________
BIRTH DATE
/
/
PLACE OF BIRTH _____________________________________
LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER
XXX – XX – ___ ___ ___ ___
DRIVER LICENSE NUMBER ___________________ STATE_________________ CURRENTLY VALID
Yes
No
ATTORNEY ____________________________________________________ TEL. NO. _________________________
ADDRESS
Number and Street
Apt. #
City
State
Zip Code
CHILD(REN)'S ATTORNEY (if any) ____________________________________ TEL. NO. _________________________
ADDRESS
Number and Street
Apt. #
City
State
Zip Code
PARENTS
Date of Marriage __________________________ or Date Began Living Together
Date of Separation ________________________ If dissolution fıled, when?
NAME OF MINOR CHILD(REN)
Parent with
First
Middle
Last
Date of Birth
Place of Birth
whom residing
1.
2.
3.
4.
FAMILY COURT SERVICES (FCS) DATA SHEET
SDSC FCS-002 (Rev. 5/16)
Page 1 of 3
(CONFIDENTIAL)
Mandatory Form
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