Fillable Ex Parte Emergency Family Law Temporary Orders May (California)

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Ex Parte Emergency Family Law Temporary Orders May (California)

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Superior Court of California, County of Sacramento
Family Law & Probate
Ex Parte Emergency Family Law Temporary Orders Page 1 of 2
Cover Sheet:
Ex Parte Emergency Family Law Temporary Orders
Effective Date:
May 1, 2019
Last Revision Date:
Not applicable.
Purpose:
These forms are used to request an emergency order with short
notice to the other party in order to avoid irreparable harm for
matters that cannot wait until a regularly scheduled hearing.
Assistance:
If you are unable to complete the forms on your own, you may wish
to hire a private attorney. If you need help finding an attorney,
please contact the State Bar of California at www.calbar.ca.gov or
the Sacramento County Bar Association at www.sacbar.org .
Required Forms:
All forms are Judicial Council forms, unless otherwise indicated:
•
Request for Order, FL-300
•
Declaration Regarding Notice and Service or Request for
Temporary Emergency (Ex Parte) Orders, FL-303
•
Temporary Emergency (Ex Parte) Orders, FL-305
Optional Forms:
This form is needed only if you are requesting orders regarding
payment of monies, including child support, spousal support or
attorney’s fees and costs:
•
Income and Expense Declaration, FL-150
This form is needed only if you are requesting orders regarding child
custody or visitation:
•
Family Law Case Demographics Information Sheet, local form
FL/E-ME-811
This form is needed only if you have not already filed one or wish to
change the information on the form that you previously filed:
•
Family Law Case Participant Enrollment Form (Party), local
form FL/E-LP-665
Filing Fee:
There is a $120 fee ($145 if you are requesting orders regarding
child custody or visitation) to file these documents. The current fee
schedule may be found on the Court’s website at:
https://www.saccourt.ca.gov/fees/docs/fee-schedule.pdf .
Copies:
Make three copies of the completed forms.
Before You File:
Notify all parties to the case no later than 10:00 am the court day
before the ex-parte appearance, unless you can demonstrate that
irreparable harm will result if notice is given. (California Rules of
Court 5.165 )
Superior Court of California, County of Sacramento
Family Law & Probate
Ex Parte Emergency Family Law Temporary Orders Page 2 of 2
•
Notice must be given in person, by telephone or by fax. If the
other party is represented by an attorney, the notice must go
to the attorney.
•
Notice must include the date, time and place where you will
appear to request the temporary orders. Check the Court’s
website for the time and location of the ex parte hearing:
https://www.saccourt.ca.gov/family/court-
appearances.aspx#emergency .
Filing:
All forms must be typewritten or printed in blue or black ink. (See
California Rules of Court, Rules 2.100-2.119)
Bring completed forms and copies to the Department (courtroom)
assigned to your case at or before 8:30 am.
Next Steps:
The Request for Order and all attachments must be served on the
other party at least sixteen court days before the next scheduled
hearing, unless a shorter time for service is included in the order.
WARNING to the person served with the Request for Order: The court may make the requested orders without you if you do
not file a Responsive Declaration to Request for Order (form FL-320), serve a copy on the other parties at least nine court days
before the hearing (unless the court has ordered a shorter period of time), and appear at the hearing. (See form FL-320-INFO for
more information.)
Form Adopted for Mandatory Use
Judicial Council of California
FL-300 [Rev. July 1, 2016]
7.
JUDICIAL OFFICER
COURT ORDER
(FOR COURT USE ONLY)
6.
A COURT HEARING WILL BE HELD AS FOLLOWS:
Time:Date:
Address of court
(specify):
Page 1 of 4
REQUEST FOR ORDER
Family Code, §§ 2045, 2107, 6224,
6226, 6320–6326, 6380–6383;
Government Code, § 26826
Cal. Rules of Court, rule 5.92
www.courts.ca.gov
8.
2.
(date):
(date):
TEMPORARY EMERGENCY ORDERS
REQUEST FOR ORDER
CHANGE
Domestic Violence OrderChild Support
Child Custody
Attorney's Fees and Costs
Visitation (Parenting Time) Spousal or Partner Support
Property Control
Other (specify):
FOR COURT USE ONLYFOR COURT USE ONLY
TELEPHONE NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
FAX NO.:
STATE: ZIP CODE:CITY:
STREET ADDRESS:
FIRM NAME:
NAME:
STATE BAR NUMBER:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
CASE NUMBER:
FL-300
1.
a.
b. same as noted above
Dept.: Room.:
other
4.
A Responsive Declaration to Request for Order (form FL-320) must be served on or before
Time for service until the hearing is shortened. Service must be on or before
The parties must attend an appointment for child custody mediation or child custody recommending counseling as follows
(specify date, time, and location):
Other (specify):
Date:
It is ordered that:
The orders in Temporary Emergency (Ex Parte) Orders (form FL-305) apply to this proceeding and must be personally
served with all documents filed with this Request for Order.
(Forms FL-300-INFO and DV-400-INFO provide information about completing this form.)
NOTICE OF HEARING
3.
5.
Other Parent/PartyRespondentPetitioner
TO (name(s)):
PARTY WITHOUT ATTORNEY OR ATTORNEY
Other (specify):
Sacramento
William R. Ridgeway Family Relations Courthouse
Sacramento, CA 95826
3341 Power Inn Road
3341 Power Inn Road
The visitation (parenting time) order was filed on
The order for legal or physical custody was filed on
(date):
(2)
.
The court ordered (specify):
. The court ordered (specify):
(1)
(date):
Attachment 2d.
visitation (parenting time).child custodyThis is a change from the current order for
The orders that I request are in the best interest of the children because (specify):
Attachment 2a.
a.
Form FL-311
Form FL-312
Form FL-341(D)
Form FL-341(C)
Form FL-341(E)
Form FL-305
(specify):
Other
(2)
As follows (specify):
Specified in the attached forms:
(1)
Attachment 2b.
visitation (parenting time) are:child custodyThe orders I request forb.
Child's Name
Date of Birth
Legal Custody to (person who
decides: health, education, etc):
Physical Custody to (person
with whom child lives):
I request that the court make orders about the following children (specify):
c. Attachment 2c.
d.
REQUEST FOR ORDER
FL-300
Page 2 of 4
FL-300 [Rev. July 1, 2016]
REQUEST FOR ORDER
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
2.
CHILD CUSTODY
VISITATION (PARENTING TIME)
I request temporary emergency orders
The orders are from the following court or courts (specify county and state):
(specify):
(specify):
(specify):
(specify):
Case No. (if known):
Case No. (if known):
Case No. (if known):
Case No. (if known):
Petitioner
Respondent
Other Parent/Party (Attach a copy of the orders if you have one.)
a.
b.
c.
d.
Criminal: County/state
Family: County/state
Juvenile: County/state
Other: County/state
One or more domestic violence restraining/protective orders are now in effect between (specify):
1.
Note:
Place a mark in front of the box that applies to your case or to your request. If you need more space, mark the box for
“Attachment.” For example, mark “Attachment 2a” to indicate that the list of children's names and birth dates continues on a paper
attached to this form. Then, on a sheet of paper, list each attachment number followed by your request. At the top of the paper, write
your name, case number, and “FL-300” as a title. (You may use Attached Declaration (form MC-031) for this purpose.)
X
RESTRAINING ORDER INFORMATION
FL-300 [Rev. July 1, 2016]
Page 3 of 4
REQUEST FOR ORDER
4.
a. $
Amount requested (monthly):
The court should should make, change, or end the support orders because (specify):
I have completed and filed a current Income and Expense Declaration (form FL-150) in support of my request.
d.
e.
(date):
end the current support order filed onchange b.
I want the court to
Attachment 4e.
The court ordered $
c.
This request is to modify (change) spousal or partner support after entry of a judgment.
I have completed and attached Spousal or Partner Support Declaration Attachment (form FL-157) or a declaration
that addresses the same factors covered in form FL-157.
(Note: An Earnings Assignment Order For Spousal or Partner Support (form FL-435) may be issued.)
per month for support.
I have completed and filed with this Request for Order a current Income and Expense Declaration (form FL-150) or I filed
a current Financial Statement (Simplified) (form FL-155) because I meet the requirements to file form FL-155.
c.
(date):
I want to change a current court order for child support filed on
b.
d.
The court should make or change the support orders because (specify):
Attachment 3d.
The court ordered child support as follows (specify):
Monthly amount ($) requested
(if not by guideline)
Child's name and age
a.
I request support for each child
based on the child support guideline.
Attachment 3a.
I request that the court order child support as follows:
(Note: An earnings assignment may be issued. See Income Withholding for Support (form FL-195)
FL-300
SPOUSAL OR DOMESTIC PARTNER SUPPORT
3.
CHILD SUPPORT
a.
control of the following property that we
The petitioner respondent other parent/party be given exclusive temporary use, possession, and
b.
and liens coming due while the order is in effect:
The petitioner respondent other parent/party be ordered to make the following payments on debts
own or are buying
lease or rent (specify):
c. This is a change from the current order for property control filed on
(date):
Specify in Attachment 5d the reasons why the court should make or change the property control orders.
d.
For: Pay to: Amount: $ Due date:
Pay to: For: Amount: $ Due date:
Pay to: For: Amount: $ Due date:
Pay to: For: Amount: $ Due date:
5.
PROPERTY CONTROL
I request temporary emergency orders
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
I want the court to change or end the orders because (specify):
The Restraining Order After Hearing (form DV-130) was filed on (date):
a.
endchange
I request that the court the personal conduct, stay-away, move-out orders, or other
protective orders made in Restraining Order After Hearing (form DV-130). (If you want to change the orders, complete 7c.)
b.
Attachment 7c.
I request that the court make the following changes to the restraining orders (specify):
c.
Attachment 7d.
d.
10.
I declare under penalty of perjury under the laws of the State of California that the information provided in this form and all attachments
is true and correct.
Page 4 of 4
FL-300 [Rev. July 1, 2016]
REQUEST FOR ORDER
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). (Civ. Code, § 54.8.)
FACTS TO SUPPORT the orders I request are listed below. The facts that I write in support and attach to this request
cannot be longer than 10 pages, unless the court gives me permission.
The hearing date and service of the the Request for Order to be sooner.
I need the order because (specify):
b.
(number):
court days before the hearing.
To serve the Request for Order no less than
a.
c.
Attachment 9c.
Date:
(TYPE OR PRINT NAME)
(SIGNATURE OF APPLICANT)
OTHER ORDERS REQUESTED (specify):
8.
FL-300
7.
DOMESTIC VIOLENCE ORDER
Attachment 8.
6.
A current Income and Expense Declaration (form FL-150).
b.
A Supporting Declaration for Attorney's Fees and Costs Attachment (form FL-158) or a declaration that addresses the
factors covered in that form.
c.
A Request for Attorney's Fees and Costs Attachment (form FL-319) or a declaration that addresses the factors covered
in that form.
a.
I request attorney's fees and costs, which total (specify amount):
$ . I filed the following to support my request:
ATTORNEY'S FEES AND COSTS
Do not use this form to ask for domestic violence restraining orders! Read form DV-505-INFO, How Do I Ask for a
Temporary Restraining Order, for forms and information you need to ask for domestic violence restraining orders.
Read form DV-400-INFO, How to Change or End a Domestic Violence Restraining Order for more information.
TIME FOR SERVICE / TIME UNTIL HEARING
9.
I urgently need:
•
•
Attachment 10.
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
Form Approved for Optional Use
Judicial Council of California
MC-031 [Rev. July 1, 2005]
ATTACHED DECLARATION
PLAINTIFF/PETITIONER:
CASE NUMBER:
DEFENDANT/RESPONDENT:
MC-031
(This form must be attached to another form or court paper before it can be filed in court.)
DECLARATION
Date:
(SIGNATURE OF DECLARANT)
(TYPE OR PRINT NAME)
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Plaintiff
Other
(Specify):
Defendant
Attorney for
Petitioner
Respondent
Page 1 of 1
I gave notice to (select all that apply)
(1)
(3)
(specify):
I gave notice (select one)
petitioner.
respondent.
child's attorney.
petitioner's attorney.
other parent/party.
respondent's attorney.
other parent's/party's attorney.
Form Approved for Optional Use
Judicial Council of California
FL-303 [Rev. July 1, 2020]
Page 1 of 2
3.
NOTICE (If you gave notice, complete item 3a. If you did not give notice, complete item 3b or 3c.)
a.
I gave notice as described in items (1) through (5) below:
DECLARATION REGARDING NOTICE AND SERVICE OF REQUEST
FOR TEMPORARY EMERGENCY (EX PARTE) ORDERS
FOR COURT USE ONLY
PARTY WITHOUT ATTORNEY OR ATTORNEY
STATE: ZIP CODE:CITY:
STREET ADDRESS:
FIRM NAME:
NAME:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
STATE BAR NUMBER:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
CASE NUMBER:
FL-303
Family Law, §§ 2045, 3062–3064,
4620, 7710
Cal. Rules of Court, rules 5.151–5.169
www.courts.ca.gov
Time:Date:
Address of court:
(specify):
2.
same as noted above other
Dept.:
Room:
NOTICE: Do not use this form to ask for domestic violence restraining orders. Before completing this form, read your court's local
procedures for requesting temporary emergency orders and obtaining the information needed to complete item 2 of this form.
Courts may grant temporary emergency orders with or without an emergency hearing. Find local rules at .
I am (specify)
attorney for
petitioner respondent
not a party in the case
other parent/party
(name and title/relationship to party):
1.
I did did not
give notice (select all that apply)
that papers will be submitted to the court on the request
that there will be an emergency court hearing
other
at (location):
, California.
using telephone no.:
I gave notice(2)
personally
by telephone
by voicemail
at:
using voicemail no.:
p.m.
a.m.
by electronic means (if permitted)
on (date):
(specify electronic service address of person):
to reschedule a hearing
for temporary emergency (ex parte) orders
on the date, time, and location indicated below:
to reschedule a hearing involving temporary emergency (ex parte) orders
using fax no.:
by fax
by overnight mail or other overnight carrier
DECLARATION REGARDING NOTICE AND SERVICE OF REQUEST
FOR TEMPORARY EMERGENCY (EX PARTE) ORDERS
(specify address of delivery):
by 10 a.m. the court day before this emergency hearing.
after 10 a.m. the court day before this emergency hearing because of the following exceptional circumstances
(specify):
William R. Ridgeway Family Relations Courthouse
Sacramento, CA 95826
3341 Power Inn Road
3341 Power Inn Road
courts.ca.gov/3027.htm
by electronic means (if permitted)
A copy of a request to reschedule hearing and Order on Request to Reschedule Hearing (form FL-309). Form FL-306
may be used for the request.
The person in 3a(1) responded as follows:
Facts showing exceptional circumstances in support of the request to waive notice include (specify):
Page 2 of 2
FL-303 [Rev. July 1, 2020]
c.
FL-303
CASE NUMBER:
RESPONDENT:
OTHER PARENT/PARTY:
PETITIONER:
Unable to provide notice. I did not give notice about the request for temporary emergency orders. I used my best efforts
to tell the opposing party when and where this hearing would take place but was unable to do so. The efforts I made to
inform the other person were (specify below):
(1)
(2)
(3)
(4)
immediate danger or irreparable harm to myself (or my client) or to the children in the case.
an immediate risk that the children in the case will be removed from the state of California.
immediate loss or damage to property subject to disposition in the case.
b.
Request for waiver of notice. Due to exceptional circumstances, I did not give notice about the request for temporary
emergency orders. I ask that the court waive notice to the other party to help prevent (specify)
(5)
(6)
I
do do not
I notified the person in 3a(1) that the following temporary emergency orders are being requested (specify):
(4)
c.
3c, above.
3b, above.
4.
a.
(specify):
petitioner
other parent/party
respondent
petitioner's attorney
respondent's attorney
other parent's/party's attorney
child's attorney
SERVICE OF DOCUMENTS
(1)
A copy of Request for Order (form FL-300) for temporary emergency orders, and Temporary Emergency (Ex Parte)
Orders (form FL-305).
at (location):
, California.
Documents were served onb.
personally
by fax on
at:
using fax no.:
p.m.
a.m.
(date):
(specify electronic service address of person served):
by overnight mail or other overnight carrier
(2)
(3)
A copy of a request to reschedule hearing involving temporary emergency (ex parte) orders and Order on Request
to Reschedule Hearing (form FL-309). Form FL-307 may be used for the request.
(4)
The following documents were served on
Date:
(TYPE OR PRINT NAME)
(SIGNATURE)
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
DECLARATION REGARDING NOTICE AND SERVICE OF REQUEST
FOR TEMPORARY EMERGENCY (EX PARTE) ORDERS
Other documents
before the request was filed with the court:
believe that the person in 3a(1) will oppose the request for temporary emergency orders.
other
Documents were not served on the opposing party due to the exceptional circumstances specified in
(specify address of delivery):
(specify):
other exceptional circumstances (specify):
Attachment 3a(5)
Attachment 3b
Attachment 3c
Attachment 4c.
TEMPORARY EMERGENCY (EX PARTE) ORDERS
Child Custody
Other (specify):
Property Control
Visitation (Parenting Time)
FOR COURT USE ONLY
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
CASE NUMBER:
FL-305
ATTORNEY OR PARTY WITHOUT ATTORNEY
STATE: ZIP CODE:CITY:
STREET ADDRESS:
FIRM NAME:
NAME:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
STATE BAR NUMBER:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
3.
CHILD CUSTODY
Page 1 of 2
Form Adopted for Mandatory Use
Judicial Council of California
FL-305 [Rev. July 1, 2016]
Family Code, §§ 2045, 3062–3064,
Cal. Rules of Court, rules 5.151–5.169
www.courts.ca.gov
TEMPORARY EMERGENCY (EX PARTE) ORDERS
THIS IS A COURT ORDER.
A court hearing will be held on the Request for Order (form FL-300) served with this order, as follows:
Time:Date:
Address of court
(specify):
a.
b.
same as noted above
Dept.: Room:
other
Findings: Temporary emergency (ex parte) orders are needed to: (a) help prevent an immediate loss or irreparable harm to a
party or to children in the case, (b) help prevent immediate loss or damage to property subject to disposition in the
case, or (c) set or change procedures for a hearing or trial.
Child's name
a.
The temporary orders for physical custody, care, and control of the minor children in
(3) are subject to the other party's or parties' rights of visitation (parenting time) as follows (specify):
Visitation
(Parenting Time)
b.
Temporary physical custody, care, and control to:
Petitioner Respondent Other Party/Parent
Continued on Attachment 3(a)
Date of Birth
See Attachment 3(b)
2.
COURT ORDERS: The following temporary emergency orders expire on the date and time of the hearing scheduled in (1), unless
extended by court order:
1.
Respondent
Petitioner
TO (name(s)):
Other (specify):
Other Parent/Party
Sacramento
William R. Ridgeway Family Relations Courthouse
Sacramento, CA 95826
3341 Power Inn Road
3341 Power Inn Road
FL-305
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
(3)
Country of habitual residence: The country of habitual residence of the child or children is (specify):
(4) If you violate this order, you may be subject to civil or criminal penalties, or both.
The United States of America
Other (specify):
e. (1) Jurisdiction: This court has jurisdiction to make child custody orders in this case under the Uniform Child Custody
Jurisdiction and Enforcement Act (part 3 of the California Family Code, commencing with section 3400).
Notice and opportunity to be heard: The responding party was given notice and an opportunity to be heard as
provided by the laws of the State of California.
(2)
Child abduction prevention orders are attached (see form FL-341(B)).
d.
4. PROPERTY CONTROL
a.
Petitioner
Respondent
Other Parent/Party is given exclusive temporary use, possession, and
control of the following property that the parties own or are buying
lease or rent
b. Petitioner Respondent
Other Parent/Party is ordered to make the following payments on the liens
and encumbrances coming due while the order is in effect:
Pay to: For: Amount: $ Due date:
Pay to: For: Amount: $ Due date:
Pay to: For: Amount: $ Due date:
Pay to: For: Amount: $ Due date:
6.
OTHER ORDERS (specify):
Additional orders are listed in Attachment 6.
Date:
JUDGE OF THE SUPERIOR COURT
Page 2 of 2 FL-305 [Rev. July 1, 2016]
TEMPORARY EMERGENCY (EX PARTE) ORDERS
All other existing orders, not in conflict with these temporary emergency orders, remain in full force and effect.
5.
THIS IS A COURT ORDER.
c.
(a) from the state of California.
(b)
from the following counties (specify):
(c)
other (specify):
The party or parties with temporary physical custody, care, and control of minor children must not remove the minor
children from the state of California unless the court allows it after a noticed hearing.
(1)
Travel restrictions
Petitioner
Respondent Other Parent/Party must not remove their minor children (specify):
(2)
CHILD CUSTODY (continued)
3.
(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.)
1.
Employment
(Give information on your current job or, if you're unemployed, your most recent job.)
Form Adopted for Mandatory Use
Judicial Council of California
FL-150 [Rev. January 1, 2019]
INCOME AND EXPENSE DECLARATION
Family Code, §§ 2030–2032, 2100–2113,
3552, 3620–3634, 4050–4076, 4300–4339
www.courts.ca.gov
Page 1 of 4
Employer:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
FOR COURT USE ONLY
CASE NUMBER:
INCOME AND EXPENSE DECLARATION
PARTY WITHOUT ATTORNEY OR ATTORNEY
STATE: ZIP CODE:CITY:
STREET ADDRESS:
FIRM NAME:
NAME:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (
name
):
STATE BAR NUMBER:
FL-150
Attach copies
of your pay
stubs for last
two months
(black out
Social
Security
numbers).
a.
Employer's address:
b.
Employer's phone number:
c.
Occupation:
d.
Date job started:
e.
If unemployed, date job ended:
f.
g. I work about hours per week.
h. I get paid $ gross (before taxes)
(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
My age is
(specify):
a.
b.
I have completed high school or the equivalent:
Yes
No
If no, highest grade completed
(specify):
Number of years of college completed
(specify):
c.
Degree(s) obtained
(specify):
Number of years of graduate school completed
(specify):
d.
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):
I claim the following number of exemptions (including myself) on my taxes
(specify):
d.
Other party's income.
I estimate the gross monthly income (before taxes) of the other party in this case at
(specify):
$
4.
This estimate is based on
(explain):
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.
(SIGNATURE OF DECLARANT)
Date:
(TYPE OR PRINT NAME)
per month per week
per hour.
Sacramento
William R. Ridgeway Family Relations Courthouse
Sacramento, CA 95814
3341 Power Inn Road
3341 Power Inn Road
Spousal support
Spousal support that I pay by court order from a different marriage ..........................
Attach copies of your pay stubs for the last two months and proof of any other income. Take a copy of your latest federal tax
return to the court hearing.
(Black out your Social Security number on the pay stub and tax return.)
Income
(For average monthly, add up all the income you received in each category in the last 12 months
and divide the total by 12.)
FL-150 [Rev. January 1, 2019]
Page 2 of 4
INCOME AND EXPENSE DECLARATION
All other property,
(estimate fair market value minus the debts you owe)
.....c. real and personal
*
Check the box if the spousal support order or judgment was executed by the parties and the court before January 1, 2019, or if a court-ordered change
maintains the spousal support payments as taxable income to the recipient and tax deductible to the payor.
$
FL-150
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
5.
Salary or wages (gross, before taxes).....................................................................................................a.
Overtime (gross, before taxes)................................................................................................................b.
Commissions or bonuses.........................................................................................................................c.
Public assistance (for example: TANF, SSI, GA/GR) ..................................d.
e.
Partner supportf.
currently receiving
f
rom this marriage
from a different marriage
from this domestic partnership from a different domestic partnership
Pension/retirement fund payments..........................................................................................................g.
Social Security retirement (not SSI).........................................................................................................h.
Disability:i. Social Security (not SSI)
State disability (SDI) Private insurance
Unemployment compensation.................................................................................................................j.
Workers' compensation............................................................................................................................k.
l
. Other (military allowances, royalty payments)
(specify):
Investment income
(Attach a schedule showing gross receipts less cash expenses for each piece of property.)
6.
Dividends/interest....................................................................................................................................a.
Rental property income...........................................................................................................................b.
Trust income............................................................................................................................................c.
d. Other
(specify):
Income from self-employment, after business expenses for all businesses
.........................................7.
I am the owner/sole proprietor business partner other
(specify):
Number of years in this business
(specify):
Name of business
(specify):
Type of business
(specify):
Attach a profit and loss statement for the last two years or a Schedule C from your last federal tax return. Black out your
Social Security number. If you have more than one business, provide the information above for each of your businesses.
Additional income.
I received one-time money (lottery winnings, inheritance, etc.) in the last 12 months
(specify source and
amount):
8.
Change in income.
My financial situation has changed significantly over the last 12 months because
(specify):
9.
10.
Deductions
Required union dues....................................................................................................................................................a.
Required retirement payments (not Social Security, FICA, 401(k), or IRA)..................................................................b.
Medical, hospital, dental, and other health insurance premiums
(total monthly amount)
.............................................
c.
Child support that I pay for children from other relationships.......................................................................................d.
e.
Partner support that I pay by court order from a different domestic partnership..........................................................f.
Necessary job-related expenses not reimbursed by my employer
(attach explanation labeled "Question 10g")
.........
g.
11.
Assets
Cash and checking accounts, savings, credit union, money market, and other deposit accounts...............................a.
Stocks, bonds, and other assets I could easily sell.......................................................................................................b.
$
$
$
$
$
$
$
$
$
$
$
$
Last month
Average
monthly
$
$
$
$
$
Last month
Total
federally taxable*
federally tax deductible*
$
$
$
$
$
$
$
$
$
The following people live with me:
FL-150 [Rev. January 1, 2019]
Page 3 of 4
INCOME AND EXPENSE DECLARATION
FL-150
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
12.
Attorney fees
(This information is required if either party is requesting attorney fees):
15.
a.
b.
c.
d.
My attorney's hourly rate is
(specify):
I confirm this fee arrangement.
Average monthly expenses
13. Estimated expenses Actual expenses Proposed needs
Installment payments and debts not listed above
14.
To date, I have paid my attorney this amount for fees and costs
(specify):
$
The source of this money was
(specify):
I still owe the following fees and costs to my attorney
(specify total owed):
$
(SIGNATURE OF DECLARANT)
Date:
(TYPE OR PRINT NAME)
Name
Age
How the person is
related to me
(ex: son)
That person's gross
monthly income
Pays some of the
household expenses?
a.
b.
c.
d.
e.
Yes
No
Yes No
Yes No
Yes No
Yes No
a. Home:
(1) Rent or mortgage..........
$
$
$
$
$
$
If mortgage:
(a) average principal:
$
(b) average interest:
$
(2) Real property taxes..................................
(3) Homeowner's or renter's insurance
(if not included above)..............................
(4) Maintenance and repair...........................
b. Health-care costs not paid by insurance........
c. Child care.......................................................
$
d. Groceries and household supplies.................
$
e. Eating out.......................................................
$
f. Utilities (gas, electric, water, trash)................
$
g. Telephone, cell phone, and e-mail.................
$
$
h. Laundry and cleaning.....................................
i. Clothes...........................................................
$
j. Education.......................................................
$
k. Entertainment, gifts, and vacation..................
$
l
.
Auto expenses and transportation
(insurance, gas, repairs, bus, etc.).................
$
m. Insurance (life, accident, etc.; do not include
auto, home, or health insurance)...................
$
$
$
$
$
n. Savings and investments...............................
o. Charitable contributions..................................
p. Monthly payments listed in item 14
(itemize below in 14 and insert total here).....
q. Other
(specify):
r.
TOTAL EXPENSES
(a–q)
(do not add in
the amounts in a(1)(a) and (b))
$
s.
Amount of expenses paid by others
Paid to For Amount Balance Date of last payment
$
$
$
$
$
$
$
$
$
$
$
$
CHILD SUPPORT INFORMATION
(NOTE: Fill out this page only if your case involves child support.)
FL-150 [Rev. January 1, 2019]
Page 4 of 4
INCOME AND EXPENSE DECLARATION
FL-150
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
a.
b.
d.
(Do not include the amount your employer pays.)
Number of children
16.
I do I do not
I have
(specify number):
children under the age of 18 with the other parent in this case.a.
Name of insurance company:
The monthly cost for the
children's
health insurance is or would be
(specify):
$
The children spend percent of their time with me and percent of their time with the other parent.b.
Children's health-care expenses
17.
have health insurance available to me for the children through my job.
c.
Additional expense for the children in this case
18.
Childcare so I can work or get job training....................................................................a.
Children's health care not covered by insurance...........................................................b.
Travel expenses for visitation........................................................................................c.
Special hardships.
I ask the court to consider the following special financial circumstances19.
Extraordinary health expenses not included in 18b...................................a.
Major losses not covered by insurance
(examples: fire, theft, other
insured loss)
...............................................................................................
b.
Expenses for my minor children who are from other relationships and
are living with me..................................................................................
c.
d.
Children's educational or other special needs
(specify below):.....................................
(attach documentation of any item listed here, including court orders):
(1)
Names and ages of those children
(specify):
(2)
Child support I receive for those children...............................................(3)
20.
(If you're not sure about percentage or it has not been agreed on, please describe your parenting schedule here.)
Address of insurance company:
Amount per month
Other information I want the court to know concerning support in my case
(specify):
The expenses listed in a, b, and c create an extreme financial hardship because
(explain):
Amount per month
For how many months?
$
$
$
$
$
$
$
$
Page 1 of 2
FL/E-ME-811 (Revised 11/08/19) Family Law Case Demographics Information Sheet
www.saccourt.ca.gov
Mandatory
FL/E-ME-811
Family Law Case Demographics Information Sheet for Child Custody/Visitation
Court Case Number: ____________________ Family Court Services Number: _____________________
Petitioner’s Information
_________________________________________________
First Name Middle Initial Last Name
_________________________________________________
Mailing Address (Include Apt. or Suite #)
_________________________________________________
City State Zip Code
Date of Birth: ________________________________
Month Day Year
Home Phone: ( )
Work Phone: ( )
Relationship to Child/ren: ___________________________
Petitioner’s Attorney Information
_________________________________________________
First Name Middle Initial Last Name
_________________________________________________
Mailing Address (Include Suite #)
_________________________________________________
City State Zip Code
Work Phone: ( )
Respondent’s Information
_________________________________________________
First Name Middle Initial Last Name
_________________________________________________
Mailing Address (Include Apt. or Suite #)
_________________________________________________
City State Zip Code
Date of Birth: ________________________________
Month Day Year
Home Phone: ( )
Work Phone: ( )
Relationship to Child/ren: ___________________________
Respondent’s Attorney Information
_________________________________________________
First Name Middle Initial Last Name
_________________________________________________
Mailing Address (Include Suite #)
_________________________________________________
City State Zip Code
Work Phone: ( )
Page 2 of 2
FL/E-ME-811 (Revised 11/08/19) Family Law Case Demographics Information Sheet
www.saccourt.ca.gov
Mandatory
FL/E-ME-811
Court Case Number: ____________________ Family Court Services Number: _____________________
List all of the children you had or adopted with the other party in this case:
Full Name Date of Birth Age School Resides with
Does any party need an interpreter? _____ Yes _____ No
If Yes, for which party? _____ Petitioner _____ Respondent _____ Claimant / 3
rd
Party
If Yes, please indicate for what language? _____________________________________
I declare under penalty of perjury that the foregoing information is true and correct.
____/___/_______
DATE SIGNATURE OF DECLARANT
______________________________________________________
TYPE OR PRINT NAME
Claimant’s (3
rd
Party’s) Information
_________________________________________________
First Name Middle Initial Last Name
_________________________________________________
Mailing Address (Include Apt. or Suite #)
_________________________________________________
City State Zip Code
Date of Birth: ________________________________
Month Day Year
Home Phone: ( )
Work Phone: ( )
Relationship to Child/ren: ___________________________
Claimant’s Attorney Information
_________________________________________________
First Name Middle Initial Last Name
_________________________________________________
Mailing Address (Include Suite #)
_________________________________________________
City State Zip Code
Work Phone: ( )
Important Notice about Access to Your Case
Due to the court closure and significant reduction in services, the court is
unable to provide court orders, minute orders, and child custody mediation
reports in person or by mail; they are only available online using our Public
Case Access System. The court is also unable to provide you with access
to your court file.
Access to court orders and minute orders is the only way to obtain
instructions on how to appear for hearings and trials, and to know what the
court ordered in your case. Access to child custody mediation reports is
necessary so that you know what child custody, visitation, or other
requirements that the mediator recommended to the court.
To get secure access to your case online, you must complete and submit to
the court the attached Family Law Case Participant Enrollment Form -
Party, along with a copy of your driver’s license to get an account to our
Public Case Access System. A separate form must be filed for each case
or when you change your email address.
Once you complete the form, you must submit it in person at the courthouse
(Monday through Friday 8:00 a.m. to 5:00 p.m.) using the Drop Box, or by
US Mail at 3341 Power Inn Road, Sacramento, CA 95826.
Submitting the form immediately is important because it takes:
• Three working days for the court to process it if filed by Drop Box
• Seven working days for the court to process it after mailing using
US Mail
Once your access is set up you will receive an email letting you know that
you are subscribed to your case. If you do not receive an email notifying
you that you are subscribed to your case during the timeframes identified
above, please inform the court using our Contact Us page at:
https://www.saccourt.ca.gov/contact.aspx.
click to sign
signature
click to edit
Local Form Adopted for Mandatory Use
FAMILY LAW CASE PARTICIPANT ENROLLMENT FORM
CONFIDENTIAL
FOR COURT USE ONLY
CASE PARTICIPANT
NAME: STATE BAR NO:
FIRM NAME:
ADDRESS:
CITY: STATE: ZIP CODE:
E-MAIL ADDRESS: (must be legible) TELEPHONE NO.:
ATTORNEY FOR (Name): FAX NO. (Optional):
NAME OF COURT:
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
CLAIMANT:
FAMILY LAW CASE PARTICIPANT ENROLLMENT FORM
CASE NUMBER:
You may access orders for law and motion hearings, and mediation reports prepared by Family Court Services using the court's online
Public Case Access System. Free access is available for 72 hours from the time the order is issued or the report is prepared, or from the
time the court creates your case subscription. After 72 hours, you may pay for copies.
INSTRUCTIONS
To setup your account you must:
I,
I declare that my private email address is
(must be legible):
I understand, if I change my email address I must file a new enrollment form with the court.
, request that the court create an account and/or subscription to my Family Law case.
, request that the court update my account with a new email address.
I acknowledge that confidential mediation reports contain private information that is not part of the public court file. I understand that
without a court order, I must not disclose any contents of the Report to anyone (including any minor children) other than the parties to
my case (Petitioner/Respondent/Claimant) and their attorneys and court professionals. I acknowledge that the court may impose a
penalty for any unauthorized disclosure of any content of the Family Court Services report.
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)
•
File this form with a copy of your driver license or a state or federal issued photo identification card.
•
A separate form must be filed for each of your Family Law cases.
•
Once the court has created your subscription to your case, you will receive a confirming email. You must follow the
instructions in that email to complete the process.
www.saccourt.ca.govFL/E-LP-665 (Rev 1/21/21)
(Please use Ø for zero, 1 for one and clearly differentiate i, L, S, 5, 3 and 8's).
PARTY
PARTY
•
Once your subscription is completed, you will receive an email notification each time an order or report is added to your case.
I,
CA
Superior Court of California, County of Sacramento
3341 Power Inn Road
Sacramento, CA 95826
William R. Ridgeway Family Relations Courthouse
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Ex Parte Emergency Family Law Temporary Orders May (California)

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Completed 7 April 2021

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