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Family Law Case Demographics Information Sheet FL-E-ME-811 - California
| Family Law Case Demographics Information Sheet Form. This is a California form and can be used in Family Law Sacramento Local County . |
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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 First Name Petitioner's Attorney Information Middle Initial Last Name Street Number/Apt. or Suite # Street Number/Apt. or Suite # City State Zip Code City State Zip Code Date of Birth: Month Home Phone: Work Phone: Other Phone: ( ( ( ) ) ) Day Year Work Phone: Other Phone: ( ( ) ) Respondent's Information First Name Middle Initial Last Name First Name Respondent's Attorney Information Middle Initial Last Name Street Number/Apt. or Suite # Street Number/Apt. or Suite # City Date of Birth: Month Home Phone: Work Phone: Other Phone: ( ( ( ) ) ) State Zip Code City State Zip Code Day Year Work Phone: Other Phone: ( ( ) ) FL/E-ME-811 (Revised 1/1/2010) Mandatory Family Law Case Demographics Information Sheet American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 3 Local Rule 14.16(C) (1), (2) www.saccourt.ca.gov FL/E-ME-811 Court Case Number: ____________________ Family Court Services Number: _____________________ Claimant's Attorney Information (Third Party) Claimant's Information First Name Middle Initial Last Name First Name Middle Initial Last Name Street Number/Apt. or Suite # Street Number/Apt. or Suite # City Date of Birth: Home Phone: Work Phone: Other Phone: Month ( ( ( ) ) ) State Day Zip Code Year City State Zip Code Work Phone: Other Phone: ( ( ) ) Claimant's Information First Name Middle Initial Last Name Claimant's Attorney Information (Third Party) First Name Middle Initial Last Name Street Number/Apt. or Suite # Street Number/Apt. or Suite # City Date of Birth: Home Phone: Work Phone: Other Phone: Month ( ( ( ) ) ) State Day Zip Code Year City State Zip Code Work Phone: Other Phone: ( ( ) ) Minor's Counsel Attorney Information First Name Middle Initial Last Name Street Number/Apt. or Suite # City State Zip Code Work Phone: Other Phone: ( ( ) ) Family Law Case Demographics Information Sheet American LegalNet, Inc. www.FormsWorkFlow.com FL/E-ME-811 (Revised 1/1/2010) Mandatory Page 2 of 3 Local Rule 14.16(C) (1), (2) www.saccourt.ca.gov FL/E-ME-811 Court Case Number: ____________________ Family Court Services Number: _____________________ 1. List all children of the parties: Name Date of Birth Age School Resides with 2. Please check all boxes that apply. a. Are you currently restrained by a Restraining Order or ever been restrained by a Restraining Order (domestic violence restraining order, emergency protective order, or criminal protective order)? b. Do you have a restraining order against the other party now(domestic violence restraining order, emergency protective order, or criminal protective order)? a. Number of previous mediation appointments: Yes Yes No No 3. None One Two Three Four or more No No No No b. Do Petitioner/Respondent live 2-4 hours apart from each other? c. Do Petitioner/Respondent live more than 4 hours apart from each other? d. Is one or more of your children a Special Needs Child? e. Has there been past non-compliance with a Court Order? 4. a. b. c. d. e. f. g. 5. a. Are you or the other parent planning on moving out of the area? b. Does either parent pose a flight risk? Please note whether each or any of these issues are involved in your case: Custody Change Domestic Violence Substance Abuse Mental Health Current or Previous CPS Involvement Child Physical/Sexual Abuse Child Neglect Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No Yes Yes No No FL/E-ME-811 (Revised 1/1/2010) Mandatory Family Law Case Demographics Information Sheet American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 3 Local Rule 14.16(C) (1), (2) www.saccourt.ca.gov
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