1. No category

ATToRNEY oR pARTy WTHoUT
erronNti f|aie
sra ta
Ba,
nunbe;;t1d;A;A
_Larry A..Ginsberg, Esq. (SBN 1255G)
Harris
Ginsberq f,in
6420 Wilshire Blvd., SixCeenth Floor
Los Angeles, CA gOOaB
310 444 -6333 "case is rtsigred
AnoRNEy FoR (rv,"|g). TaluLah RiIey ptUsk
.'il^TiiliJJ;
STREETADDRESs:
111 North Uiff
FOR COURI USE
ONLI
'"r*fl,J,htPllt**"
to
HAR
Shcm
Bireef
21
2016
R Canct'
Same as above
Los Angel-es, CA 9004g
BRANcHMME. Stanley Mosk
P ETITI ON E R : tAr,Uffi -r-i
r,EY...-- MG
M^tLtNcAoDRESS:
crry^NozrpcoDE.
K
E]
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-J
1.
LEGAL RELAT|ONSH|P (check
a.
We are married.
E
b r]
c fl
2.
a/
''
" rr
CASE NUMEER
E
f]
Marriage
Maffiage
Maniage
L-
b
rr
BD 6
38089
we are domestic partners and our domestic partnership
was estabrished in carifomia.
we are domestic partners and ou, oor""ti"
p"in",.nil *a. nor
in california.
a
"stablished
that apply):
Petitioner f X I Resoondent has
been a resident of this stare for
at least six months and ol this county
for at least
gnT;J:|',,ffi",rj1,v p,"""o,Jt-r,l i,Iis'
;iiiii;l;i,,,.
ror
[il#i#;;1'#.::;;trx#rtrii
petirione/s
-
:t*tf:ffi
Bff."Jll"",uflmsy,,-^";es,ab,ished
in ca,iromia
risidence lstate or nai,iinli
STATISTICAL FACTS
" [E]
Domeslic Partnershio
Domestic parlnership
J Domestic partnership
that appty):
RESTDENCE REQUTREMENTS (check
a E]
_
3,
E
E
E
Dissotution (Divorce) of:
Legat Separation of:
(1) Date of marriage
(3) Time from date of
(1)
rsp
ecify):1
/29/73
a auorce,
i
ii-iii,i,i.i""."on ,n ,nu ,esat retationship
il#;;;],",il,
.,,",,,",,n
^",,H:il5:'i,:T:':i::::::ff:%mici,e
(2)
chird,sname
(t)
in ca,iromia
**on ,,,r","J;ff:tr-T"#r"#lilJ"jji,yi1,:"",j,";"Ji:",;lI,:Il;"0,,,,,",,
MINOR CHILDREN (chitdren
bo
(or bom or adopted duing)
lhe maniage
a.
rhere are no ,,no, *,ilrjn'."re
b.
rhe minor children are:
(2)
.,
DBte ofseparat ion(specify):TBD
(specirybetow):
Date of separation (specify):
(3) Time from date of (,gistration
ofdomestic partnership to date ofseparation
(speclfi|
E
E
",,,u
I
(2)
4.
u
or
years
Months
domestic paftnership):
Birrhdate Ase *fi#',6
FHPFFs$;
!l:'' "
fiE g
fI continuedonAttachment4b
flactrirowhoisioryerborn
'-
W[1f;;:Xff:]l?f3Siff|l[ffi,fl&j"fl::ffi:,,aacompreted
d. f]
d.
Petitioner and Respondent
f] petitioner
Resoondenr signed
eidh.a aa voluntary
,,^1.^.^-. r.
hiE
$i
$H
H
H
DoctarationundertJniromchit(1",",,;n$"- E
dectaration of paternity. A
Acopy
copy
f] _l f_l
L
Ll n6
permot-uan@
tErrrloN-MARR,ogYoo,
.iYfii',^:?"1ff"1ts:,
rr".iiir-"*i'' -' ^" "'=^on'r .+*E-EHiH " T= #:J##;
is
is
atrar[5e0.
PETITIONER;TAIULAH Rf
RESPONDENT:ELON MUsK
I,Ey
MUSK
Petitioner requests that the court mak" tn"
5.
fotto*inllt
LEGAL GROUNDS (Family Code se ctions 220c._2210,231U23,t2)
a. I
or E Legal separalion ortheman
rFr irreconirabredifferences,t ET""l#ffi'[J.1iffi:ff?:"i#,;ff:i"::r,
b. [ ] tuttity of void marriage or domestic partnership based on:
(1) f-l incest. (2) [l bigamy.
c. f_l ttuttity ofvoidable marriage or domestic partnership based
on:
(1) rl petitione/s age at time of registration of
domestic
(a) f_l fraud.
partnership or marriage.
_
(2) fI prior existing marriag! or domestic partnership. (51 [__l force.
(3) E unsouno mind.
(6) [-..l physicat incapacity.
6' cHlLo cusroDY ANo vtstrATroN (PARENTTNG T|ME)
p"titioner Respondent
Joint other
a.Legatcustodyofchitdrento.........EEEE
b. physicat custody of chitdren to_....
E
EE
c. Chitd visitation (parenting time) be granted lo.......................... E
E
E
As requested in: f-l tum
EL.glt E form FL_312 f l form FL_341(C) E
rormFL-341(p) f-_lro,, }rel
T_l on""ii*iii,,,
d E Determin" lh" [-_l
p"'unt"s" orJ Ei 0".;;;;;;;"0
R""pona"nt u"rol-ilIiffie
Divorce
1r1
t
7.
or domesric partnership.
CHILD SUPPORT
lf there are minor children bom
lo or adopted by Petitioner and.Respondent
before or during this maniage
wirl make orde'"
or domestic
a
u.
"
,pon
,"qr".t
lrn earntngs assignmenl may be issued
wilhoul furlher notice.
i. fl'il#i""lj|
8.
d6; .i,;il;i,iJ'.i',.,"n
["#"J,'ilX,licourr
o"'
'uo'on
,n*t
p"v
i"i"'*i'ii
"riiii,e
nnanciar rorms by rhe
amounts ar the "resar,, rate, which
is currenry 10 percent
SPOUSAL OR DOMESTIC PARTNER
SUPPORT
a. [xl
Spousal or domeslic partner support
payable
petilioner t]
Io E
I E lilffi::Tfl,ffrou('sabiriryroawarasupportto-fr to m
o. t
othet (specity):
srmination the issue of suppon payabte
Respondent
-E;";*.
p"lition"I[--l'-l'""poro"nr
petit,oner
9.
"nJ.roliss]oi'or
SEPARATE PROPERTY
a. [_l
u tFl
There are no such assets or debts
that I know of to be confirmed by
the court.
confirm as separare property the
assets
E
the fo owing
tist.
o"oi.
""0
Ic!0
i"
-'r
)
propeny Declararbn
(form FL_160)
The true naEure and extG
seParaEe ProPe!Ey asseEs
& alebts are unl.nown aE ill^"l."tttlo""t'E
lime, peEitioner ask6
to
amend
t.his petition I
'hen
E
Attachment gb
Confirm to
leave of CourE to
salne have been ascer!ained.
PETITION-MARRIAGE/DOMEST'IC
{Family Law)
P-
P.g!
2 o,
t
(1
PETIfIONERT TALULAH RITJEY l.tUSK
10. COMMUNTTY AID AUASI4OMMUNIIY PROPERW
ThEro are no ssch asrets or dsbts that I know
o, to b€ dvld€d by lh€ coun.
ogrmqr aehtr b community and quasl-communlv s6ssB and
dsbts. A[ BUch sssets srd d€bts Erc tisEd
pnprty
a, El
u El
-1
fFl
h
t)cdarraon
E
it*, L$Ol
n eUcrrlrprr, 1Ot.
The true naEure anC exten! o! communlty prop€rEy
as8ets and obrigations arc ,nknown at this
tlmei pecltioner aakE reave
of courE Lo amehd thia peliti9n when aane have
bBsn ascerlalned.
as fotlows (.rpo6iyJ;
11, OTHER REQUESTS
e. E
b. El
c. El
I
I
,,
petitioner,e
iBiIsffi?i
by L-f
petitionor
brmer namo beredoredte (specify):
Other (specfr?)..
El
I
I
AnomEfs fees and cosls payabl€
See AltachrnenE tLc
[Ei
Respondent
Talulah Riley
Continu6d on Attachmant I I c.
lx[x?rr,I|t,xrr,ro
oRoERs oN rHE BACK oF rHE suM,oirs, Ar{o
I uNDERsTAr,rD rHAr rHEy
apply
I
I
I
I
I
I declare undEr penary ot p€rjury under the rsw! of tho
stare ofcarifornr. thai lho lorBgohg ls truB
Oate:
March 2], 20L6
I
I
I
rsrotrerunr or
I
I
I
I
I
I
I
I
a
[ilf*f#t51:
I
I
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*0'od'r
y#:*::,:ffi r::i.#f;Hffi
y#tfl
$:#xffi "itrtrx,#n:
i,trjl:ffi:ililiffi
::*trH#'."::fl lr"ru;H#:l",fl fil#'fl"'#l:} ffijT,,# f,ffi iltr","]trHffi1]i#',",ffi*
nno*?*,i l;lx:lr*i:t#ffi ,j;H#f,
:ffi T rfrT*:ru,*,,_
#illl{ffiffifl ;}
6urylyor3hi, rights to any propeny otmed
a! rvgll
I
t
(b'""t
aniffi ?6iiffi 6iEi'
ES
fl
rny crEdlt @rd8, other credll Ec
PET]TION-[IARRI AGE/DOUES
(Famity
trw)
PARTNERSHIP
1
2
ATTACHMENT lt.c.
J
4
I
5
6
7
8
9
l0
ll
1.c.
Other (specifi)
Pursuant to ca.rifomia code
of civil procedure, Section 632, mdRule
3.1590,
califomia Rules of court, petitioner hereby requests
a statement of Decision with respect to any
contested issue submitted to the court for
determination in the within proceeding. petitioner
specifically requests that the Court include
in the Statement of Decision any and all calculations
upon which the determination ofany
issue was made incruding, but not rimited
to, issues ofspousal
suppofl, property valuation, property
division, tax consequences and attomey,s fees
and costs.
t2
t3
t4
l5
l6
17
l8
t9
20
2t
22
23
24
25
26
27
28
ATTACHMENT I Lc.
FL_l10
SUMMONS (Family Law)
CITACION (Derecho familiar)
NOTICE TO RESPONDENT (tJame)j ErJeN MUSK
AVISO AL DEMANDADO (Nombre):
FOR COURT USE ONLY
PAM USO OE ta CORT9
ISOLO
---l
You have been sued. Read the information betow and on th" n"J!-"!I.
lLo han clemandaclo. Lea ta in{ormaci6n a continuaciln y en ta plgina siguiente.
I
l-'
Petitioner's name 16: TALULAH
Nombre del demandante:
RILEy
I
MUSK
cAsE NUMBER
rx'BErc
'YW*
"-#rftt*,r$r,ur,,,
6.T8 0 g g
You have 30 calendar days aner this Summons and
Petit on are served on you to lile a Response (form
FL-120) at the court and have a copy seryed on lhe
petitioner. A letter, phone call, or courl appearance
will nol protecl you.
Tiene gO dias de catendario-d'ispi€s Qe haber rccibido ta
entrega legal de esra Citacion y petici6n para prcsentat una
Respuesta (fomulaio FL-IZO anle la cdde y electuar la
entrega legal de una copia al demandante. tJna cada o llamada
telef6nica o una audiencia de ta cofie no basta para prategedo.
lf you do not file your Response on time, the court
may make orders affecting your marriage or domestic
partnership. your property, and custodtof your
children. You may be ordered to pay support and
attorney fees and cosls.
S, no presenla su Respuesta a tiempo, la cofte puede dar
ddenes que afeclen su matrimonio o pareja de hecho, sus
bienes y la custodia de sus l,rbs. La iode'tambien b puede
oft,enar que pague manutenci6n, y hononios y costos legales.
For le-gal advice. contact a lawyer immediately. Get
help finding a lawyer at the California Courts 6nline
Self-Help Center (lvww. coutts.ca.gov/selfhelp), al lhe
California Legal Services website (g444!ggS;.lp9qp1g,l,
or by contacting your local county bar associaton
Pam asesoramiento legal, p1ngase en contacto de inmediato
can un abogado. Puede obtener infomaciOn para encontrar un
abogado en el Centro de Ayuda de las Cone; de Catifomia
(www.sucoie.ca.gov), on el silio web de los Seryicios Lega/es
de Qalifomia (WMbqlpq3gry) o poni,ndose en cont;cto
con el colegio de abogados de su condado.
NOTICE_RESTRAINING ORDERS ARE ON PAGE 2:
These restraining orders are efiective against both
spouses or domeslic partners until the pitition is
dismissed, a judgment is entered, or thb court makes
flrther orders. They are enforceable anMere in
California by any law enforcement officir who has
received or seen a copy of them.
Ayrso-LAsOnoervffi
ENCUENTRAN
FEE WAIVER: lf you cannot pay the filing fee, ask the
clerk for a fee waiver form. The court may order you to
pay back all or parl of the fees and cosls that th; court
waived for you or the other party.
EN LA PAGINA 2: LAS 6dENES dE rEStiCCi,N
estdn en vigencia en cuanto a ambos c nyugos o miembros de
la pareja de hecho hasta que se despida ia
fietici,n, se emita un
fallo o la corte d6 orras 6rdenes. Cuilquier igencia del orden
p,blico que haya recibido a visto una copia cle estas ,rdenes
puede hacodas acatar en cualquier lugar de Califomia.
EXENCTON DE CUOIAS: Si no puede pagat la cuota de
presentaci,n, pida al secretaio un fomulaio de exenci1n de
cuotas. La cofie puede ordenar que usted pague, ya sea en
pafie por completo, las cuotas y costos de h corte previamente
.o
exenlos a petici'n de usted o de la otra pade.
The name and address of the court are (El nombre y direcci1n de la
Los Angeles Superior CourL
111 North Hi 1I Street
same as above
Los Ange1es, CA 90048
coie
son):
The name, address, and rerephone number of the petitioner's aflomey, or the petitioner
without an
a.ttomey, are: (El nombre, direcci'n y n1mero de tel,lono del abogaAo clel demandante,
o del
demandante si no tiene abogado, son):
A. .Ginsberg, Esq. (SBN 1255G)
larry
Harrrs c]-ns-berq
LLp
6420 Wilshire Etvd., sixreenrh F100r
Los
Ange-tes, CA 90048
310 444-6333
Date (Fecha)
ltAli 2,1 ZOfi
lq Mand.tory ule
Judicial Counot o, C6t ornr!
FL-l10lR€v. Janu€ry I 20151
Form Adopl€d
R.
ctHts
(sut'"tario' Poo
(Db.fi.r
,
Deputy (Asisrent4
P.9. i ot 2
SUMMONS
(Family Law)
Famiry cod6. gli 232.233,20247.2040 77m_
cdr.
or
cd
Procodurs s541220 41660-.11590
*ww @uns ca 9o!
STANDARD F
FL-i10
Y LAW RESTMINING ORDERS
DE
FAMILIAR
ES';
DE DERECHO
Starting immediately, you and your spouse or domestic
partner are restrained from:
'1. removing the minor children of the parlies
En forma inmediata, usted y su c'nyuge o pareia de hecho
from the state
or applying for a new or replacement passport for those
minor children without the prior written consent of the
other party or an order of the courti
1.
2.
cashing, borrowing against, canceling, transferring,
disposing of, or changing the benefici-aries of anv-'
insurance or olher coverage, including life, health,
automobile, and disability. held for the benefit of the
parties and their minor children;
2.
transfening, encumbering, hypothecating, concealing, or in
-
3.
3.
lienen prohibido:
cobrar, pedir prestado, cancelar, transfedt, deshacerse o
cambiar el nombre de los benefrciaios de cualqaier seguro
- -u
otto tpo de cobedun, como de vida, salud. veiiculo
ois9y.agtg1a, que tenga como benefician;@ a h;-p;les y
su ( s) hijo( s) meno4e s) ;
i--
any way disposing of any property, real or personal,
whelher community, quasi-community, or aeparale, wilhout
the written consent oflhe other party or an oider oithe
court, except in the usual course of business or ,or the
necessities of lite; and
4.
llevatse del estado de Calilomia a los hrbs menores de ,as
paies, o solicitar un pasapode nuevo o de repueslo Dara los
huos menores, sin el consentimiento previo por escito de la
otra pafte o sin una orden de la cofte;
creating a nonprobate transfer or modifying a nonprobate
transfer in a manner that affects the dis-pos-ition of orooertv
subject to the transter, withoul the writtin mnsent bf tire
other parly or an order of the court. Before revocation of a
nonprobale transfer can take effect or a right of
survivorship to property can be eliminatedl notice of the
change must be tiled and served on ihe other party.
'
transfeir, gnvat, hipotecar, ocultat o deshacerse de
cualquier manera de cualquier propiedad, inmuebte o
personat, ya sea comunitaia, cuasicomunitada
o se}arada.
sin et consentimiento esuito de la olra pane o una
-la cofte, excepto en et curso habitual de actividadei
perconales y comerciales o para satisfacer ras
necesdades
de la vida; y
crear o modifrcet una transferencia no testamentatia de
manera que- atecte la asignaci,n de una propiedad sujeta
a
transtercncia, sin el consentimiento por escito de la otra
pafte o una orden de la code. Antes de que se pueda
eliminar la revocaci'n de una tnnsferencia no'
testamentaia, se debe presentar ante la code un aviso del
cambio y hacer una entrega legal de dicho aviso a la
pafte.
6iiil
-
4.
oti
You must notiry each other of any propgsed extraordinary
Cada palle tiene que notificar a la otra sobre cualquier gasto
expenditures al least five business days prior to incufl.ing lhese
extmodinaio propuesto por lo menos cinco aias itaOids iites
extraordinary expendilures and account to the court for ;ll
oe reatEano, y rendir cuenta a la cofte de lodos los gasros
extraordinary expenditures made afler these restraining orders
extra.ordinarios realizados despuis de gue estas drd-enes
de
However, you may use community prope-rty,
9tc]lru
resnccton hayan entndo en vigencia. No obslante, puede
?l:quasr-communily property, or your own separate properti
usar
to
prcptedad comunitaia, cuasicomunitada o suya separ642 psrg
pay an attorney to help you or to pay court cosls.
pag.ar a un abogado que lo ayude o para pagbr
los costos'di ta
corle.
NOTICE-ACCESS TO AFFORDABLE HEALTH
INSURANCE: Oo you or someone in your household need
affordable_ h6allh insurance? lf so, you should apply for
Covered California. Covered Califo;nia can help ieiuce the
cost you pay towards high quality affordable heallh c€re. For
more rntormation, visit www.coveredca,com. Or call Covered
California at I -800-300-1 506.
WARNING_IMPORTANT INFORMATION
California law provides that" for purposes of division of
property upon dissolut on of a marriago or domestic
partnership or upon legal sepaEtion, property acquired
by the parties during mariage or domLstic pirtneisnip in
joint form is presumed to be communlty property.
lf eiiher
party to this action should die befors tha
ioinuy ietd
community property is divided, the languige in the deed
that characterizea how tifle is held (i.a.ljoiit tenancy,
tenants in common, or community property) will be contuolling, and not the communiir'pr6periy
presumption. You should consult your attorney if you
want the community property presumption to UL wiitten
into the recorded title to the property.
Ftr10lR
J.nuary 1 2O1SI
AY'SO_ACCESO A SEGURO DE SALUD MAS ECON'I ICO:
aNecesita seguro de satud a un costo asequiure, ya iea piia ustlo
o alguien-en.su hoga, Sies asi, puede prd"entai rn"i&i"itro
uovereo uatrtornia. Covered Califomia lo puede ayudar a reducir"oi
el
-'
costo que paga por seguro de salud aseqiriUle y Oi afia
Para obtener m6s informacion, visite www.covdredca.com.
O llame
a Covered California al 1-BO0-3OO-0213
cafial
A DVE RT EN CI A_IM FO RM ACI O N I M PO RTAN TE
De acuerdo,a la-tey de Catifomia,las propieclacles adquiddas
por las partes durtnte su matimonio o
iareja de heclho en
consideran propieaao cimuniiii
1"1!
fines de la divisl6n ds blenes que ocurre cuando se plroduce
una.disolucidn o separaci,n tsgal det matrimonio o parcja de
he.cho. Si cualqulera de ,as partes de aste caso t/egi
fallecer antes de que se divida la propiedad comuiitaria de
tenencia conjunh, el clestino de la m;isme quedard
determinado por las cbusulas de la escrttun
correspondiente que descnbe,, su te nencla (por ej,, Enencia
tenencta en comtn o propiedact comunnarAl y io
l?liynh,
por
la presuncidn de propiedad comunlaria. Si quiere
iue la
presunci6n comunitada quade registaAa en ta iscritu;
Ae
propiedad,
la
deborla consultar con un abogado.
SUMMONS
(Family Law)
?o!i"!g::
jai
a
P.g.
Z
of 2
Ml,lE
ADoRESS. O"O
raLarnona
",
Larry A. Ginsberg,
Esq.
Harris cinsberg LLp
6420
(SBN
12556)
wilshire Blvd., sixEeent.h Floor
aes€&Ed lor Cbrts Fil€ Srarri
I
L
Los Angeles, CA 90049
310 444-5333
ArroRNEy FoR (NanE):
FILEI,l
TaIULah Riley Musk
iuoerior Coun of Califomia
tountY oflns Annetes
SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES
uuux, neusE Auur(Ess:
PEr|r|oNER/PLATMT|FF
111 North Hill sEreet
Lgs Angeles, CA 90048
taf,Uj1g11Rf f.f y MUSK
RESPONoENT/DEFENDAU,
g1g5
HAR
21 20lb
qhe ri R. Lancr, pxc.;u'rv( '-,,ltlcel/Clerl
ffie
By
y1jfgX1
'"'o"
r\i\/lAailrf),.|
FAMILY LAW CASE COVER SHEET
"^trugrrOUUU
CERTIFICATE OF GROUNOS FOR ASSIGNMENT TO OISTRICT
Case Filing lnstructions
This cover sheet is required so that the court can assign your case to the correct court district for filing and hearing. lt
satisfies the requirement for a certificate authorizing filing in the district, as set forth in Los Angeles Superior Cou(
Rules 2(d) and 14 2. lt must be completed and submitted to the court along with the original Coirptaint or petition in
ALL Family cases filed in any district of the Los Angeles County Superior Court. This form is not required
Abandonment & Emancipation cases, which are to be filed at Children,s Court.
in
r. Fill in the requested information.
10911 Chalon Road, Los Anqeles, CA 9oo77
b) Enter address of Respondeni. DO NOT COMPLETE THtS |TEM tF THtS tS A MTNOR'S CONTRACT CASE
MINOR CHILDREN INVOLVED?
f l YES
[xlNo
How MANy?
ll. Select the correct district:
a.
b.
under column 1 below, check the one type oI action which best describes the nature ot this case.
ln Column 2 below, circle the reason for your choice of district that applies to the iype o, action you have checked.
Applicable Reason for Choosing District (See Column 2 betow)
t. May be liled in Centrsl Diskict.
Distrid where one or more of the
2.
TYPE OF ACTION tcucr
orsv
3. Child resides within lhe district.
4. Districl where Petitioner resides.
reside.
onrt tconrnreol
[i] A5520 Dissolution of Marriage
f l 45525 Summary Dissolution of Marriage
f I A5521 Dissolution of Domestic partnership
f l 45530 Nullity of Void or Voidabte Marriage
w
<.APPLICAqLE REASONS
rsor oov"r
1.2
1.2
1.2
f_,1 A5531 Nullity of Void or Voidabte Domestic
Partnership
FAM 020
O2O
(Rev 1 'l /'l
'1)
FAMILY LAW CASE COVER
CERTIFICATE OF GROUNDS FOR ASSIGNMENT TO DISTRICT
PEge 1 of 2
LASC RULE 5,2
MARRIAGE OF MUSK
F
A5s10
LJnssrr
Legal Separation
1.2
Legal Separation of Domestic partnership
1.2
f_-.l 46126 Petition for Custody and Support of Minor
1,2.3
T l A6131
1.
Child Support Services Department (CSSD)
Parentage/Support
l-_-l A6139 Foreign Support Order
1.2.3
[-_l
A6136 Foreign Custody Order
1.2.3
[__-1
46138 Uniform lnterstate Family Support Act (UIFSA)
1.2.3
Responding Petition
a-t
f
A6122 Domestic Violence Restraining Order (Civil
Harassment - use Civil Cover Sheet)
I 46600
fI
Habeas Corpus Petition
-
(Any Court Jurisdiction
governmental)
Approval of Minor's Contract (6751 Family Code)
[_-l A6130 Other Family
[-l
1.
2.3
1
1.2.3
Complaint or Petition (Specify):
A6101 Agency Adoption
1.4
f_-] 46102 lndependent Adoption
1.4
f-l A6104 Stepparent Adoption
f l notog Adutt Adoprion
E A6106 Sole Custody Petition
1.4
1.4
1,4
III,
ENTET AddTESS Of M|NOT
lV.
Enter lhe information below and sign the c€rtificate.
Certificate
/
D\ls onty)
1.3
Child Custody
nooao Petition to Establish Parentage / Paternity (Non-
L_l A6111
-
Chi|d if KNOWN (DO NOT COMPLETE UNLESS YOU HAVE CIRCLED ITEM 3 AS AN APPLICABLE REASON
Declaration ol Assignment. The undersigned hereby certifies and declares that the above enti ed matter i6 properly filed for
assignment to
lheeentral
Diskict of the Los Angles Superior Court under Code oI Civit Procedure 5392 et seq., 23OO et
seq ol the Family Code, and Rule 2(b), (c), and (d) ot lhis court lor reason checked above. I cortify and dectare under
under the laws of the State ot California lhat the foregoing is
ort",
u.rcnJ\
truqtnd correct.
zore
LARRY
FAM O2O
(Rev 1'!/11)
penatty of perjury
A.
GINSBERG
FAMILY LAW CASE COVER SHEET
CERTIFICATE OF GROUNDS FOR ASSIGNMENT TO DISTRICT
Page 2 of 2
LASC RULE 5,2