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ALA FL-041

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address)		FOR COURT USE ONLY
TELEPHONE NO.:	FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, ALAMEDA COUNTY
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:

PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER:

CASE MANAGEMENT CONFERENCE QUESTIONNAIRE for		CASE NUMBER:
CASE MANAGEMENT CONFERENCE QUESTIONNAIRE for

Continued Family Law Status Conference

Family Centered Case Resolution Conference

1.Statistical Information

a.Date of marriage:

b.Date of separation:

If disputed:

Petitioner’s proposed date:

Respondent’s proposed date:

c. Date petition filed: d. Date of service:

2.Child Custody/Child Visitation Not applicable

a. Are there current custody/visitation orders? YES NO

If yes:	Date of current order:
	Brief description of orders (e.g., alt weeks, 2-2-5, supervised):
	Time share for Petitioner ________ % and for Respondent _________ %
If no:	Is a custody/visitation order requested?	YES	NO

Does either party request a change in the current order?				YES		NO
b. Do the parties require a referral to Family & Children’s Bureau?				YES	NO
c. Is it anticipated that a custody evaluation will be required? YES				NO
3. Child Support	Not applicable
a. Is there a current child support order? YES		NO
If yes, date of current order:			amount ordered: $			per month
b. Is either party seeking a child support award?		YES	NO

c. What is the date of filing of each party’s most current income and expense declaration?

Petitioner: ___________________, 20_____; Respondent: ____________________, 20_____.

d. Is either party seeking to modify the current child support order?			YES	NO
If yes, brief description of the reason for modification:
e. Is either party claiming child support arrearages or over-payment?			YES	NO
If yes, amount claimed to be owed: $ ______________ amount claimed overpaid: $ ______________
4. Spousal Support
a. Is there a current spousal support order?	YES	NO
If yes, date of current order:		amount ordered $		per month

b. Is either party seeking an award of spousal support? YES NO If yes, amount requested: $

c. Is either party seeking to modify the current order or terminate the court’s jurisdiction over spousal support?

YES NO. If yes, proposed modification/reason for termination:

Page 1 of 2

Form Approved for Mandatory Use
ALA FL-041 [Rev. 07-01-2014]	CASE MANAGEMENT CONFERENCE QUESTIONNAIRE
	CASE MANAGEMENT CONFERENCE QUESTIONNAIRE

ALA FL-041

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

CASE NUMBER:

d. Is either party claiming spousal support arrearages/over-payment? YES

If yes, amount claimed to be owed: $ __________________ amount claimed overpaid: $ _______________

5.Property

a. Do the parties have any community property to divide? YES NO


If yes:	Real property ______ FMV____________ Debt_____________
	Pensions ____________________________________________
	Stock/stock options____________________________________
	Vehicles_____________________________________________
	Gold/jewelry__________________________________________
	Other property valued above $5,000.00_______________________________________________
b. Are there community debts?		YES	NO
If yes:	Credit card debt_______________________________________
	Student loans_________________________________________
	Tax liabilities__________________________________________
	Promissory notes______________________________________
	Other debts exceeding $1,000.00__________________________

c. Have real property appraisals been completed? YES	NO
d. Have pensions been joined? YES NO
e. Is there a dispute over the valuation date of any asset?	YES	NO

f.Does either party claim any significant separate property assets? YES NO If yes, state the nature and extent of said assets:

g.Is either party requesting reimbursement for payments made on community debt or use of community property? YES NO Amount requested ____________

6.Discovery

a.Discovery remaining: Interrogatories Depositions Document production

b.Estimated date of completion:

c.Are experts retained or expected to be retained? YES NO

If yes, what is the nature of the expertise of the expert(s)?
Child custody evaluator	Real estate appraiser	Accountant
Business valuator	Vocational evaluator	Other (specify):
Are or will the retained or expected experts be appointed under Evidence Code section 730?			YES	NO

d.Other discovery to be undertaken (specify):

7.Mandatory Declaration of Disclosure (for dissolution, legal separation, and nullity cases only)

a.Petitioner has served respondent with preliminary final declaration of disclosure

b.Respondent has served petitioner with preliminary final declaration of disclosure

8. Party intends to request bifurcation of the following issue(s) (specify):

9. Parties or counsel have met to discuss settlement. YES NO

	How many times in person (specify):	by phone (specify):
10.	Estimated time for trial (specify hours or days):
11.	Non-expert witnesses (number):	(names):
12.	Expert witnesses (number):	(names):

13. Please attach all case management orders you request be made.

Date:	_________________________________________________________
	ATTORNEY FOR PETITIONER RESPONDENT OTHER

Page 2 of 2

Form Approved for Mandatory Use
ALA FL-041 [Rev. 07-01-2014]	CASE MANAGEMENT CONFERENCE QUESTIONNAIRE
	CASE MANAGEMENT CONFERENCE QUESTIONNAIRE

Question	Answer
Form Name	Form Ala Fl 041
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	ala fl 041, form ala fl 041, 041 questionnaire f fill, ala alameda case

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