Fill and Sign the What Do I Put in the Ampquotattorney or Party Without Attorneyampquot Section Form

                  F L-1 0 3ATTO RNEY O R P AR TY W IT H O UT A TTO RNEY ( N am e, S ta te B ar n um ber, a nd a ddre ss):FOR COURT USE ONLYTELEPHONE NO.:FA X N O . ( O ptio nal) :E -M AIL A D DR ESS ( O ptio nal) :A TTO RNEY F O R ( N am e):S U PER IO R C O URT O F C ALIF O RNIA , C O UNTY O FSTR EET A D DR ESS:M AIL IN G A D D RESS:C IT Y A N D Z IP C O DE:BR AN CH N AM E:D O M ESTIC P A RTN ER SH IP O F PETIT IO NER :RESPO NDEN T:P ETIT IO N F O RCASE N UM BER :D is so lu tio n o f D om estic P artn ers h ip Le g al S ep ara tio n o f D om estic P artn ers h ip Nu llit y o f D om es tic P artn ers h ipA M EN DED1. STATISTICAL FACTSa. D ate o f r e gis tr a tio n o f d om estic p artn ers h ip o r e quiv a le nt:b. Date of separation:c. T im e f r o m d ate o f r e gis tr a tio n o f d om estic p artn ers h ip t o d ate o f s e p ara tio n ( s p ecif y ):Y earsM onth s2. R ESID EN CE ( P artn ers h ip s e sta blis h ed o ut o f s ta te o nly )a.O ur d om estic p artn ers h ip w as e sta blis h ed in a noth er s ta te ( s p ecif y s ta te ):b .P etit io nerR esp ondent h as b een a r e sid ent o f t h is s ta te o f C alif o rn ia f o r a t le ast s ix m onth s a nd o f t h is c o unty f o rat le ast t h re e m onth s im media te ly p re ce din g t h e f ilin g o f t h is P etit io n f o r D is so lu tio n o f D om estic P artn ers h ip .3. D EC LA R ATIO N R EG AR DIN G M IN O R C HIL D REN ( in clu de c h ild re n o f t h is r e la tio nsh ip b orn p rio r t o o r d urin g t h is d om estic pa rtn ers h ip o r a d opte d d urin g t h is d om estic p artn ers h ip ):a .T here a re n o m in or c h ild re n.b.T he m in or c h ild re n a re :C hild 's n am eBir th dateA ,q eS exC ontin ued o n A tta ch m ent 3 b.c. I f t h ere a re m in o r c h ild re n o f t h e p etit io ner a nd r e sp ondent, a c o m ple te d D ecla ra tio n U nder U nif o rm C hild C usto dy J u ris d ic tio n and E nfo rc e m ent A ct ( U CCJE A) ( fo rm F L-1 05) m ust b e a tta ch ed.4. SEPARATE PROPERTY Petit io ner r e q uests t h at t h e a sse ts a nd d ebts lis te din P ro perty D ecla ra tio n ( fo rm F L-1 60)in A tta ch m ent 4b elo w b e c o nfir m ed a s s e para te p ro perty .Ite mC onfir m t oN O TIC E: Y ou m ay r e d act ( b la ck o ut) s o cia l s ecu rit y n um bers f r o m a n y w rit te n m ate ria l f ile d w it h t h e c o urt i n t h is c ase oth er t h an a f o rm u se d t o c o lle ct c h ild o r p artn er s u pport.P ag e 1 o f 2F orm A dopte d fo r M andato ry U se Ju dic ia l C ouncil o f C alif o rn ia FL -1 0 3 [N ew J a nuary 1 , 2 005]PETITION-DOMESTIC PARTNERSHIP (Fam ily L aw )Fam ily C ode, § § 2 99, 2 330;C al. R ule s o f C ourt, r u le 5 .2 8ele ctr o nic f o rm  2 005 WWW.LawCA.com La w P ublis h ers                                                    D O M ESTIC P AR TN ER SH IP O F ( L ast n am e, fir s t n am e o f e ach p arty ):C ASE N UM BER5 . D EC LA R ATIO N R EG AR DIN G C O M MUNIT Y A N D Q UASI- C O M MUNIT Y A SSETS A N D D EBTS A S C URREN TLY K N O W Na.T here a re n o s u ch a sse ts o r d ebts s u bje ct t o d is p osit io n b y t h e c o urt in t h is p ro ce edin g.b.A ll s u ch a sse ts a n d d ebts a re lis te din P ro perty D ecla ra tio n ( fo rm F L-1 6 0)in A tta ch m ent 5 b.belo w ( s p ecif y ):6. Petitioner requestsa.d is so lu tio n o f t h e d om estic p artn ers h ip b ase d o nd.n ullit y o f v o id able d om estic p artn ers h ip b ase d o n(1 )ir re co ncila ble d if fe re nce s. ( F am . C ode, § 2 310(a ).) in cu ra ble in sa nit y . ( F am . C ode, § 2 310(b ).)( 1 )(2 )b.le gal s e para tio n o f t h e d om estic p a rtn ers h ip b ase d o n(2 )(1 )ir re co ncila ble d if fe re nce s. ( F am . C ode, § 2 310(a ).) in cu ra ble in sa nit y . ( F am . C ode, § 2 310(b ).)( 2 )(3 )c.n ullit y o f v o id d om estic p artn ers h ip b ase d o n(4 )p etit io ner's a ge a t t im e o f r e gis tr a tio n o f dom estic p artn ers h ip . ( F am . C ode, § 2 210(a ).) pr io r e xis tin g m arria ge o r d om estic pa rtn ers h ip . ( F am . C ode, § 2 210(b ).) un so und m in d. ( F am . C ode, § 2 210 (c ).) fr a ud. ( F am . C ode, § 2 210(d ).)( 1 )in ce st. ( F am . C od e, § 2 200.) big am y. ( F am . C ode, § 2 201.)( 5 )fo rc e . ( F am . C ode , § 2 210(e ).)( 2 )(6 )p hysic a l in ca pacit y . ( F am . C ode, § 2 210(f) .)7 . P etit io ner r e q uests t h at t h e c o urt g ra nt t h e a bove r e lie f a nd m ake in ju nctiv e ( in clu din g r e str a in in g) a nd o th er o rd ers a s f o llo w s: Pe tit io ner R esp onden t J o in t O th era. Legal custody of children tob. P hysic a l c u sto dy o f c h ild re n t oc. Child visitation granted toAs r e queste d in f o rm :F L -3 1 1F L-3 12F L-3 41 ( C )FL-3 41 ( D )FL-3 41 ( E )A tta ch m ent 7 c.d.D ete rm in atio n o f p are nta ge o f a ny c h ild re n b orn t o t h e P etit io ner a nd R esp ondent p rio r t o t h e d om estic p artn ers h ip .e. Attorney fees and costs payable byf. Partner support payable tog.T erm in ate c o urt's ju ris d ic tio n ( a bilit y ) t o a w ard p artn er s u pport t o r e sp o ndent.h .P ro perty r ig hts b e d ete rm in ed.i.j.P etit io ner's f o rm er n am e b e r e sto re d t o ( s p ecif y ): Oth er ( s p e cif y ):C ontin ued o n A tta ch m ent 7 j.8 . C hild s u pport-If t h ere a re m in o r c h ild re n w ho w ere b orn t o o r a dopte d b y t h e p etit io ner a nd r e sp ondent b efo re o r d urin g t h isd om estic p artn ers h ip , t h e c o urt w ill m ake o rd ers f o r t h e s u pport o f t h e c h ild re n u pon r e quest a nd s u bm is sio n o f f in ancia l f o rm s b y the r e que stin g p arty . A n e arn in gs a ssig nm ent m ay b e is su ed w it h out f u rth er n otic e . A ny p arty r e quir e d t o p ay s u pport m ust p ay inte re st o n o ve rd ue a m ounts a t t h e ''l e gal'' r a te , w hic h is c u rre ntly 1 0 p erc e nt.9 . I H AVE R EA D T H E R ESTR AIN IN G O RDER S O N T H E B ACK O F T H E S U M MONS, A ND I U NDER STA ND T H AT T H EY A PPLY TO M E W HEN T H IS P ETIT IO N I S F IL E D .I d ecla re u nder p e nalt y o f p erju ry u nder t h e la w s o f t h e S ta te o f C alif o rn ia t h at t h e f o re goin g is t r u e a nd c o rre ct.D ate :(T Y PE O R P R IN T N AM E)(S IG NATU RE O F P ETIT IO NER )D ate :(T Y PE O R P R IN T N AM E)(S IG NATU RE O F A TTO RNEY F O R P ETIT IO NER )N O TIC E: D is so lu tio n o r le gal s e para tio n m ay a uto m atic a lly c a nce l t h e r ig hts o f a d om estic p artn er u nder t h e o th er d om estic pa rtn er's w ill, t r u st, r e tir e m ent p la n, p ow er o f a tto rn ey, p ay-o n-d eath b ank a cco unt, s u rv iv o rs h ip r ig hts t o a ny p ro perty o w ned in jo in t tenancy, a nd a ny o th er s im ila r t h in g. I t d oes n ot a uto m atic a lly c a nce l t h e r ig ht o f a d om estic p artn er a s b enefic ia ry o f t h e o th er partn er's lif e in su ra nce p olic y. Y ou s h ould r e vie w t h ese m atte rs , a s w ell a s a ny c re dit c a rd s, o th er c re dit a cco unts , in su ra nce po lic e s, r e tir e m ent p la ns, a nd c re d it r e ports , t o d ete rm in e w heth er t h ey s h ould b e c h anged o r w heth er y o u s h ould t a ke a ny o th er actio ns. H ow eve r, s o m e c h anges m ay r e quir e t h e a gre em ent o f y o ur p artn er o r a c o urt o rd er ( s e e F am . C ode, § § 2 31-2 35).F L-1 03 [N ew J a nuary 1 , 2 0 05]PETITION-DOMESTIC PARTNERSHIP (Fam ily L aw )Pag e 2 o f 2e le ctr o nic f o rm  2 005 WWW.LawCA.com La w P ublis h ers