For Mandatory Use
FAMILY LAW CASE COVER SHEET
AND CERTIFICATE OF GROUNDS FOR ASSIGNMENT TO DISTRICT
Page 2 of 3
LASC Rule 2.3 & 5.2
V. Interpreter Request
The Los Angeles Superior Court provides free interpreter services to participants in all family law cases. You may also request an interpreter
online via the Interpreter Request Portal available at http://www.lacourt.org
. Click the “Online Services” tab to access the Interpreter Request
Portal.
Do you need an interpreter?
Yes
No
If yes, indicate the language requested: ____________________
VI. District Assignment
Step 1. In the “Type of Action” column below, select one type of action which best describes the nature of this case. For dissolution, nullity,
and legal separation cases select one option each in sections A, B, and C.
Step 2. Across from the “Type of Action” you selected, place an “X” in the column that corresponds to the reason for your choice of district.
Note that you may only select from the boxes that are not shaded.
TYPE OF ACTION
(check one)
May be filed in
Central District
District where one
or more of the
parties resides
Child resides within
the county
District where the
Petitioner resides
Dissolution, Nullity, and Legal Separation (required: select one option each in sections A, B, and C below)
☐ Nullity
☐ Legal Separation
☐ Without Minor Children
☐
☐ Marriage
Dept. of Child Support Services (DCSS)
☐ DSU – Summons and Complaint [4814]
☐
DSU – Statement – Registration of California Support Order [4811]
☐
DSU – Petition – Uniform Support [4810]
☐
DSU – Statement – Registration Out-of-State Support Order [4812]
Establish Parental Relationship
☐
Petition – Establish Parental Relationship [4040]
☐ Petition – Special Immigrant Juvenile Status [4068]
☐ Petition – Request – Set Aside Voluntary Dec. of Paternity [4054]
Joint Petition for Summary Dissolution
☐ Domestic Partnership [4042]
(if selected, also complete Section VIII, “Surrogacy Case Jurisdiction”, on page 3 of this form)
☐ Surrogacy – Stipulation and Order [4324]
Other Family Law
☐
Petition – Custody and Support of Minor Child [4032]
☐ Registration of Out-of-State Custody Order [4052]
☐ Statement – Registration of California Support Order [4190]
☐ Petition – Grandparent/Third Party Visitation [4327]
☐ Request – Release Confidential Marriage License/Certificate [4407]
☐ Petition – Minor’s Contract (FC § 6751) [4047]
☐ Petition – Habeas Corpus – Family Law [4011]
☐ Custody Order – Juvenile Final Judgment – Closing Order [174]
☐ Petition – Elder/Dependent Adult Abuse [226]
☐ Order – Register Out-of-State/Tribal Court Restraining Order [4325]
☐ Petition – Family Law Other [4329]
☐ Petition – Withdraw Funds from Blocked Account [4308]
Consent for Minor to Marry/Establish Domestic Partnership
☐ Domestic Partnership [4030]
Restraining Orders/Domestic Violence (DV) Prevention
Note: Use Civil Case Cover Sheet (LA CIV109) for all Civil Restraining Orders
☐ DV Prevention with Minor Children [4038]
☐ DV Prevention without Minor Children [4039]