Short Title
Case Number
A5510 Legal Separation
1. 2
A5511 Legal Separation of Domestic Partnership
1. 2
A6126 Petition for Custody and Support of Minor
1. 2. 3
1.
A6131 Child Support Services Department (CSSD)
Parentage/Support
A6139 Foreign Support Order
1. 2. 3
A6136 Foreign Custody Order
1. 2. 3
1. 2. 3
A6138 Uniform Interstate Family Support Act (UIFSA)
Responding Petition
(Any Court Jurisdiction – DV’s only)
A6122 Domestic Violence Restraining Order (Civil
Harassment – use Civil Cover Sheet)
1. 3
A6600 Habeas Corpus Petition – Child Custody
A6080 Petition to Establish Parentage / Paternity (Non-
1. 2. 3
governmental)
1
A6111 Approval of Minor’s Contract (6751 Family Code)
1. 2. 3
A6130 Other Family Complaint or Petition (Specify):
1. 4
A6101 Agency Adoption
1. 4
A6102 Independent Adoption
1. 4
A6104 Stepparent Adoption
1. 4
A6103 Adult Adoption
1. 4
A6106 Sole Custody Petition
Enter address of minor child if known. (DO NOT COMPLETE UNLESS YOU HAVE CIRCLED ITEM 3 AS AN APPLICABLE REASON
III.
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: ___________________________________.
____________________________________________
(SIGNATURE OF ATTORNEY/PARTY WITHOUT ATTORNEY)
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
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