State statute
Placer — Family Court Services Courtroom Worksheet
California foreclosure, tax-defaulted, court-ordered and probate-sale law and official procedures — verbatim and citable.
- Edition
- 2026-09-26
- Last updated
- 2026-09-27
- Jurisdiction
- Placer County
Placer — Family Court Services Courtroom Worksheet¶
Page 1¶
SUPERIOR COURT OF THE STATE OF CALIFORNIA, COUNTY OF PLACER CONFIDENTIAL FAMILY COURT SERVICES REFERRAL INFORMATION SHEET
Date: _______________________ Case Number: ____________________________________
PARENT Name (Please print) Date of Birth OTHR PARENT Name (Please print) Date of Birth
Mailing Address Mailing Address
City, State, Zip Code City, State, Zip Code
Telephone Number (where a message may be left): Telephone Number (where a message may be left)
Email Address Email Address
Confirm Email Address Confirm Email Address
Attorney’s Name State Bar # Attorney’s Name State Bar #
Attorney’s Full Address Attorney’s Full Address
Attorney’s Telephone Number Attorney’s Telephone Number
Attorney’s Email Address Attorney’s Email Address
Full Names of Minor Children Age Birthdate Primary Residence(s) Name of School .
(To list additional children, use back of this form)
Please list any other child custody cases involving the child(ren) filed in Placer County or any other Court, including Domestic Violence, Guardianship and/or Juvenile matters. You may also list criminal cases or other court cases that you feel are important for Family Court Services to know.
Case no.____________________________ Title of case: _________________________________________________
Case no.____________________________ Title of case: _________________________________________________
Case no.____________________________ Title of case: _________________________________________________ (Continue on the other side to list any additional cases)
Please answer the following questions: ___Yes ___No ___Not Sure
Has there been any domestic/family violence or abuse by or with the other parent?
___Yes ___No ___Not Sure 2. Is there a restraining order in place right now?
___Yes ___No ___Not Sure 3. Do you wish to meet separately from the other parent?
Form Adopted for Mandatory Use www.placer.courts.ca.gov Superior Court of California, County of Placer Form No. PL-FCS006 Effective 01-01-2026