Cross Reference Intake Form

Superior Court of the District of Columbia Family Court Cross Reference Intake Form Party Plaintiff/Petitioner 1 Name Address Date of Birth Social Security Number Driver License Number Co-Plaintiff/Co-Petitioner Defendant/Respondent 2 Co-Defendant/Co-Respondent Child Child Child Child Child Household Members Household Members 1. What type of case are you filing today? 2. Do you have any other court cases in this court? ______ If yes, please list the name, type, and case number: 3. Do you have any other court cases in another court? ______ If yes, please list the name of the court, case, type, and number: 4. Are you pro se (representing yourself)? ______ If yes, please visit the Family Court Self-Help Center in Room JM-570. 1 2 The person who is filing the case is the plaintiff/petitioner The person against whom the case is filed is the defendant/respondent Disclaimer: This form will not be kept in the official court jacket. After your information has been entered into the system, this form will be destroyed. Revised December 15, 2014 by the D.C. Bar Pro Bono Program American LegalNet, Inc. www.FormsWorkFlow.com