FL-172
Page 1 of 2
Form Approved for Optional Use
Judicial Council of California
FL-172 [New January 1, 2012]
www.courts.ca.gov
PETITION2.
The petition for
dissolution legal separation nullity parentage other (specify):
was filed on (date):
BACKGROUND DATA
3.
There is a dispute about the length of the marriage or partnership.
Date of marriage/registered domestic partnership:a.
b.
c.
Date of separation on the petition:
on the response (if different):
Length of marriage or partnership:
Name of child or children
Birthdate Age
CHILDREN
4.
Gender
Additional children listed on Attachment 4.
RELATED CASES
5.
One or both of the parties, or a child or children of the parties, has been involved in other related court cases. (List county or district
and case number, if known):
Custody or visitation (parenting time) for the children of this case:
Juvenile delinquency:
Juvenile dependency:
Domestic violence/protective order:
Bankruptcy:
Criminal (only if reasonably related to the issues of this case):
Other:
CASE INFORMATION—FAMILY LAW
a.
b.
c.
d.
e.
f.
g.
6.
JUDGMENT TERMINATING STATUS OF MARRIAGE OR DOMESTIC PARTNERSHIP HAS BEEN ENTERED
a.
Date of termination:
Date status judgment entered:
b.
(THIS FORM IS FOR COURT USE ONLY)
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
CASE NUMBER:
CASE INFORMATION—FAMILY LAW
ASSIGNMENT Case assigned to
1.
OTHER PARTY:
Judicial Officer (name): Dept. No.
Interpreter needed
Petitioner's Language:
Respondent's Language:
Other Party's Language:
(1)
(2)
(3)
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