FILING CODE: FCC

Case Number: _________________________

(to be assigned by the Clerk’s Office)

CLARK COUNTY, NEVADA

FAMILY COURT COVER SHEET

PARTIES:
Plaintiff/Petitioner Defendant/Respondent/Co-Petitioner/Protected Person
Last Name: Serna Ortiz Last Name: Pureco
First Name: Obed Middle Name: First Name: Joanna Middle Name:
Mailing Address: 2855 N Walnut rd Mailing Address: 1551 W Rialto
City, State, Zip: Las vegas nevada 89115 City, State, Zip: Fontana Ca 92335
Phone #: (951) 438-6777 Date of Birth: 1/12/1984 Phone #: (951)480-0125 Date of Birth: 9/27/1994
Email Address: Deboortiz84@[Link] Email Address:

Attorney Information not applicable Attorney Information not applicable

Name: Bar No. Name: Bar No:

Address: Address:
City, State, Zip: City, State, Zip:
Phone #: Phone #:

CASE TYPE: (Check only one box only for the primary type of case you are filing)
MISC. DOMESTIC RELATIONS
DISSOLUTION GUARDIANSHIP OTHER
PETITIONS
Guardianship of an Adult DA Child Support
Annulment Adoption –Minor
Person DA – UIFSA
Divorce –No minor child(ren) Adoption –Adult
Estate DA – Child Support In State
Divorce –With minor child(ren) Child Custody (non-divorce)
Person and Estate
Foreign Decree Child Support (private party)
DA Child Dependency
Joint Petition –No minor child(ren) Mental Health
Guardianship of a Minor DA – Abuse/Neglect
Joint Petition – With minor child(ren) Name Change
Person DA – No Fault
Separate Maintenance Paternity
Estate DA – Other (identify)
Permission to Marry
Person and Estate __________________
Temporary Protective Order (TPO)
Termination of Parental Rights
Guardianship Trust Juvenile
(private party)
Emancipation
Termination of Parental Rights
(State initiated)
Visitation (non-divorce)
Other (identify) __________________

CHILDREN INVOLVED IN THIS CASE (if applicable)

Last Name First Name Middle Name Date of Birth Relationship

1. Serna Ortiz Alfonso Javier 01/26/2018 Son

2. Serna Ortiz Emily Rose 07/09/2019 Daughter
3.

4.

5.

6.

7.

8.

Does this family have any other current or past case(s) in the Clark County Family Court or Juvenile Court?
YES NO

_________________________________ /S/
__________________________________ ________________
Your Printed Name Your Signature Date

Nevada AOC – Research & Statistics Unit Revised 03/2019

Pursuant to NRS 3.275