Forms

Alternate Dispute Resolution Forms
Form Number	Title	Form	Revision Date
ADR-01	Request: ADR Procedure Selection	ADR-01.pdf ADR-01.pdf	04/2018
ADR-02	Stipulation Regarding Selection of Panel Mediator	ADR-02.pdf ADR-02.pdf	01/2023
ADR-03	Mediation Report	ADR-03.pdf ADR-03.pdf	10/2019
ADR-12	Order / Referral to ADR	ADR-12.pdf ADR-12.pdf	11/2024
ADR-13	Notice of Mediation Date	ADR-13.pdf ADR-13.pdf	01/2023
ADR-17	Mediation Confidentiality Agreement	ADR-17.pdf ADR-17.pdf	01/2023
ADR-19	Mediation Panel Application Form	ADR-19.pdf ADR-19.pdf	12/2022
ADR-20	Notice to Parties: ADA Disability Access Litigation	ADR-20.pdf ADR-20.pdf	10/2016
ADR-21	Application For Stay and Early Mediation	ADR-21.pdf ADR-21.pdf	10/2016
ADR-22	Order Granting Application For Stay and Early Mediation	ADR-22.pdf ADR-22.pdf	11/2016
ADR-23	Request by Panel Mediator to Incur Costs in Excess of $50.00	ADR-23.pdf ADR-23.pdf	07/2018
ADR-24	Request for Reimbursement of Out-of-Pocket Expenses Incurred by Panel Mediator	ADR-24.pdf ADR-24.pdf	01/2023

AO Forms
Form Number	Title	Form	Revision Date
AO-0078	Application for Judicial Branch Federal Employment	AO-078B-USDCCAC.pdf AO-078B-USDCCAC.pdf AO-078-USDCCAC.pdf AO-078-USDCCAC.pdf	10/2024
AO-088	Subpoena to Appear and Testify at a Hearing or Trial in a Civil Action	Click Here
AO-088A	Subpoena to Testify at a Deposition in a Civil Action	Click Here
AO-088B	Subpoena to Produce Documents, Information, or Objects or to Permit Inspection of Premises in a Civil Action	Click Here
AO-110	Subpoena to Testify Before a Grand Jury	Click Here
AO-120	Report on the Filing or Determination of an Action Regarding a Patent or Trademark	Click Here
AO-121	Report On the Filing Or Determination of An Action Or Appeal Regarding A Copyright	Click Here	06/2016
AO-133	Bill of Costs(Obsolete, see CV-59)	Click Here	06/2010
AO-196A	Acknowledgment of Gratuitous Services and Waiver	AO-196A.pdf AO-196A.pdf	11/2010
AO-336	Voucher Attendance Court Reporters	AO-336.pdf AO-336.pdf	09/1996
AO-436	Audio Recording Order	AO-436.pdf AO-436.pdf	04/2013
AO-440	Summons in a Civil Action	Click Here
AO-441	Summons on Third-Party Complaint	Click Here
AO-443	Warrant for the Arrest of a Witness or Material Witness in a Pending Criminal Case	Click Here
AO-451	Clerk’s Certification of a Judgment to be Registered in Another District	Click Here
AO-455	Waiver of an Indictment	Click Here

Appeals Forms
Form Number	Title	Form	Revision Date
A-02	Notice of Appeal	A-02.pdf A-02.pdf	01/2007
A-13	Ex Parte Application	A-13 ORDER.pdf A-13 ORDER.pdf A-13 ORDER.wpd A-13 ORDER.wpd A-13.pdf A-13.pdf	01/2008
A-18	Motion and Affidavit For Leave To Appeal In Forma Pauperis	A-18 Order.pdf A-18 Order.pdf A-18.pdf A-18.pdf A-18.wpd A-18.wpd	04/2010

Civil Forms
Form Number	Title	Form	Revision Date
CV-001	Proof of Service of Summons (replaced by Form POS-010)	Click Here
CV-001A	Summons (replaced by Form AO-440)	Click Here
CV-004A	Ex Parte Right to Attach Order and Order for Issuance of Writ of Attachment (Resident) (Attachment)	CV-4A.pdf CV-4A.pdf	05/2018
CV-004B	Right to Attach Order After Hearing and Order for Issuance of Writ of Attachment (Attachment)	CV-4B.pdf CV-4B.pdf	05/2018
CV-004C	Notice of Attachment (Attachment)	CV-4C.pdf CV-4C.pdf	05/2018
CV-004D	Writ of Attachment (Attachment)	CV-004D.pdf CV-004D.pdf	05/2018
CV-004E	Ex Parte Right to Attach Order and Order for Issuance of Writ of Attachment (Nonresident) (Attachment)	CV-4E.pdf CV-4E.pdf	05/2018
CV-004F	Application for Right to Attach Order, Temporary Protective Order, etc. (Attachment)	CV-4F.pdf CV-4F.pdf	05/2018
CV-004G	Application for Set Aside Right to Attach Order and Release Attached Property, etc. (Attachment)	CV-4G.pdf CV-4G.pdf	05/2018
CV-004H	Application and Notice of Hearing for Order to Terminate, Modify or Vacate Temporary Protective Order (Attachment)	CV-4H.pdf CV-4H.pdf	05/2018
CV-004I	Notice of Application and Hearing for Right to Attach Order and Writ of Attachment (Attachment)	CV-004I.pdf CV-004I.pdf	05/2018
CV-004J	Order to Set Aside Attachment, to Substitute Undertaking, etc. (Attachment)	CV-4J.pdf CV-4J.pdf	05/2018
CV-004K	Notice of Opposition to Right to Attach Order and Claim of Exemption (Attachment)	CV-4K.pdf CV-4K.pdf	05/2018
CV-004L	Order to Terminate, Modify, or Vacate Temporary Protective Order (Attachment)	CV-4L.pdf CV-4L.pdf	05/2018
CV-004M	Temporary Protective Order (Attachment)	CV-4M.pdf CV-4M.pdf	05/2018
CV-004N	Undertaking by Personal Sureties (Attachment--Claim and Delivery)	CV-004N.pdf CV-004N.pdf	05/2018
CV-004O	Notice of Lien (Attachment--Enforcement of Judgment)	CV-4O.pdf CV-4O.pdf	05/2018
CV-004P	Application and Order for Appearance and Examination (Attachment-Enforcement of Judgment)	CV-4P ORDER.pdf CV-4P ORDER.pdf CV-4P.pdf CV-4P.pdf	11/2023
CV-005	Application for Permission for Electronic Filing	CV-005.pdf CV-005.pdf	02/2020
CV-009	Notice of Dismissal Pursuant To Federal Rules of Civil Procedure 41(a) or (c)	CV-09.pdf CV-09.pdf	03/2010
CV-010	Warrant for Arrest in Action in Rem	CV-010.pdf CV-010.pdf	06/2012
CV-011	Statement of Consent to Proceed Before Assigned United States Magistrate Judge Pursuant to Title 28 U.s.c. § 636(c) (For Use in Report and Recommendation Cases)	CV-11.pdf CV-11.pdf	04/2021
CV-011B	Consent To Proceed Before A United States Magistrate Judge (State/Federal Habeas Case)	CV-011B.pdf CV-011B.pdf	01/2009
CV-011C	Statement of Consent to Proceed Before a United States Magistrate Judge (Direct Assignment of Civil Cases to Magistrate Judges Program only)	CV-11C.pdf CV-11C.pdf	05/2014
CV-011D	Statement of Consent to Proceed Before a United States Magistrate Judge (Voluntary Consent List only)	CV-11D.pdf CV-11D.pdf	01/2019
CV-021	Notice of Acknowledgment of Receipt of Summons and Complaint	CV-21.pdf CV-21.pdf	02/2004
CV-023	Writ of Execution	CV-23.pdf CV-23.pdf	06/2001
CV-024	Affidavit and Request for Issuance of Writ of Execution	CV-24.pdf CV-24.pdf	06/2001
CV-027	Petition for Writ of Habeas Corpus by a Person in Federal Custody	CV-27.pdf CV-27.pdf	05/2018
CV-030	Notice of Interested Parties	CV-30.pdf CV-30.pdf	05/2013
CV-039	Notice of Lawsuit and Request for Waiver of Service of Summons	CV-39.pdf CV-39.pdf	06/2012
CV-040	Proof of Service - Acknowledgment of Service	CV-40.pdf CV-40.pdf	01/2000
CV-041A	Summons on a Third-Party Complaint (replaced by Form AO-441)	Click Here
CV-046	Writ of Venditioni	CV-46.pdf CV-46.pdf	12/1995
CV-058	Instructions for Filing a Civil Action by a Non-Prisoner	CV-58.pdf CV-58.pdf	06/2024
CV-058A	Instructions for Filing a Civil Action by a Non-Prisoner Spanish version	CV-58A.pdf CV-58A.pdf	11/2023
CV-059	Bill of Costs	CV-59.docx CV-59.docx	01/2024
CV-060	Request to Proceed in Forma Pauperis with Declaration in Support	CV-60.pdf CV-60.pdf	11/2023
CV-060P	Prisoner’s Request to Proceed Without Prepayment of Filing Fees with Declaration in Support	CV-60P.pdf CV-60P.pdf	07/2022
CV-066	Civil Rights Complaint	CV-66.pdf CV-66.pdf	07/1997
CV-066A	Instructions for Filing a Civil Rights Complaint by a Prisoner - General Instructions	CV-66A.pdf CV-66A.pdf	12/2020
CV-066B	Instructions for Filing a Civil Rights Complaint by a Prisoner - Pilot Project	CV-66B.pdf CV-66B.pdf	04/2021
CV-067	Motion to Vacate, Set Aside, or Correct Sentence by a Person in Federal Custody 28 U.S.C §2255	CV-67.pdf CV-67.pdf	05/2018
CV-069	Petition for Writ of Habeas Corpus by a Person in State Custody	CV-69.pdf CV-69.pdf	05/2018
CV-071	Civil Cover Sheet	CV-71.pdf CV-71.pdf	06/2024
CV-071A	Instructions for Civil Cover Sheets	CV-71A.pdf CV-71A.pdf	06/2024
CV-088	Wage Garnishment Package - (F.R.C.P. RULE 64)	CV-88.pdf CV-88.pdf	07/2005
CV-088A	Notice of Termination or Modification of Earnings Withholding Order (Wage Garnishment - F.R.C.P. RULE 64)	CV-88A.pdf CV-88A.pdf	06/2004
CV-088B	Employer’s Return (Wage Garnishment - F.R.C.P. RULE 64)	CV-88B.pdf CV-88B.pdf	06/2004
CV-088C	Order Determining Claim of Exemption (Wage Garnishment - F.R.C.P. RULE 64)	CV-88C.pdf CV-88C.pdf	06/2004
CV-088D	Notice of Opposition to Claim of Exemption (Wage Garnishment - F.R.C.P. RULE 64)	CV-88D.pdf CV-88D.pdf	06/2004
CV-088E	Notice of Filing of Claim of Exemption (Wage Garnishment - F.R.C.P. RULE 64)	CV-88E.pdf CV-88E.pdf	06/2004
CV-088F	Notice of Hearing on Claim of Exemption (Wage Garnishment - F.R.C.P. RULE 64)	CV-88F.pdf CV-88F.pdf	06/2004
CV-088G	Claim of Exemption and Financial Declaration (Wage Garnishment - F.R.C.P. RULE 64)	CV-88G.pdf CV-88G.pdf	07/2005
CV-099	Application of Registered Legal Services Attorney to Practice Before the Court and Proposed Order	CV-99 ORDER.pdf CV-99 ORDER.pdf CV-99 ORDER.wpd CV-99 ORDER.wpd CV-99.pdf CV-99.pdf	11/2018
CV-101	Certification of CA/CD Judgment for Registration in Another District	CV-101.pdf CV-101.pdf	06/2024
CV-108	Waiver of Service of Summons	CV-108.pdf CV-108.pdf	06/1998
CV-126	Pleading Page for a Complaint	CV-126.pdf CV-126.pdf	09/2009
CV-127	Pleading Page for a Subsequent Document	CV-127 pleading with lines.pdf CV-127 pleading with lines.pdf CV-127.pdf CV-127.pdf	09/2009
CV-132	Request for Reimbursement of Service Expenses	CV-132.pdf CV-132.pdf	07/2013
CV-137	Request for Reimbursement of Out-of-Pocket Expenses	CV-137.pdf CV-137.pdf	04/2018
CV-138	Notice of Setting of Date for Execution of Sentence on Judgment of Death	CV-138.pdf CV-138.pdf	08/2018

CJA Forms
Form Number	Title	Form	Revision Date
CJA-01	CACD AUTH FORM - ASSOCIATE COUNSEL	CJA-01.docx CJA-01.docx	07/2020
CJA-02	CACD AUTH FORM - EXPERT	CJA-02.docx CJA-02.docx	08/2024
CJA-03	CACD AUTH FORM - INVESTIGATOR	CJA-03.docx CJA-03.docx	08/2024
CJA-04	CACD AUTH FORM - PARALEGAL	CJA-04.docx CJA-04.docx	08/2024
CJA-19	Notice to Court-Appointed Counsel of Public Disclosure of Attorney Fee Information	Click Here
CJA-20	Appointment of and Authority to Pay Court Appointed Counsel	Click Here
CJA-21	Authorization and Voucher for Expert and other Services	Click Here
CJA-23	Financial Affidavit	CJA-23.pdf CJA-23.pdf	04/2021
CJA-24	Authorization and Voucher for Payment of Transcript	Click Here
CJA-26	Supplemental Information Statement for a Compensation Claim in Excess of the Statutory Case Compensation Maximum: District Court	CJA-26.docx CJA-26.docx	11/2019
CJA-30	Death Penalty Proceedings: Appointment of and Authority to Pay Court Appointed Counsel	Click Here
CJA-31	Death Penalty Proceedings: Ex Parte Request for Authorization and Voucher for Expert and Other Services	Click Here

Criminal Forms
Form Number	Title	Form	Revision Date
CR-003	Affidavit of Surety(ies) (Property)	CR-03.pdf CR-03.pdf	12/2005
CR-004	Affidavit of Surety (No Justification)	CR-04.pdf CR-04.pdf	02/2009
CR-005	Short Form Deed of Trust and Assignment of Rents	CR-05.pdf CR-05.pdf	05/2018
CR-007	Affidavit Re Appearance Bond (Cash Security)	CR-07.pdf CR-07.pdf	09/2019
CR-010	Advisement of Constitutional and Statutory Rights	CR-10 SP.pdf CR-10 SP.pdf CR-10.pdf CR-10.pdf	09/2018
CR-014	Designation and Appearance of Counsel	CR-14.pdf CR-14.pdf	01/2007
CR-015	Notice To District Court Of Related Criminal Duty Filing	CR-15.pdf CR-15.pdf	09/2024
CR-019	Waiver of Trial by Jury and Waiver of Special Findings of Fact	CR-19.pdf CR-19.pdf CR-19.wpd CR-19.wpd	09/1997
CR-020	Instructions for Posting a Third Party Surety Appearance Bond	CR-20.pdf CR-20.pdf	07/2016
CR-021	Subpoena in a Criminal Case	CR-21.pdf CR-21.pdf	01/2024
CR-031	Affidavit of Third-Party Custodian	CR-31.pdf CR-31.pdf	03/2015
CR-032	Waiver of Right to Counsel	CR-32.pdf CR-32.pdf	06/2007
CR-035	Waiver of Defendant's Presence	CR-35.pdf CR-35.pdf	03/2007
CR-037	Declaration Re Passport and Other Travel Documents	CR-37.pdf CR-37.pdf	05/2015
CR-043	Notice Directing Defendant to Appear for Arraignment Calendar	CR-43.pdf CR-43.pdf	11/2023
CR-044	Statement of Defendant's Constitutional Rights	CR-44.pdf CR-44.pdf	09/1997
CR-052	Affidavit Re: Out- of- District Warrant	CR-52.pdf CR-52.pdf	03/2020
CR-054	Statement of Compliance with Local Criminal Rules 46-5 and 46-6	CR-54.pdf CR-54.pdf	12/2003
CR-057	Waiver of Indictment	CR-57.pdf CR-57.pdf	06/2014
CR-063	Notice to Court of Complex Criminal Case	CR-63.pdf CR-63.pdf	09/2014
CR-064	Report Commencing Criminal Action	CR-64.pdf CR-64.pdf	09/2020
CR-072	Case Summary	CR-72.pdf CR-72.pdf	06/2023
CR-088	Application for Review/Reconsideration of Order Setting Conditions of Release/Detention, (18 U.S.C. §3142) and Request for Hearing	CR-88.pdf CR-88.pdf	10/2024
CR-088A	Notification Re: Application for Bail Review or Reconsideration of Order Setting Conditions of Release or Detention, (18 U.S.C. §3142)	CR-88A.pdf CR-88A.pdf	10/2009
CR-097	Referral for Consideration of Placement in the Tattoo Removal Program	CR-97.pdf CR-97.pdf	02/2009
CR-110	Waiver of a Preliminary Hearing	CR-110.pdf CR-110.pdf	06/2012

General Forms
Form Number	Title	Form	Revision Date
G-001	Request for Approval of Substitution or Withdrawal of Counsel	G-01 ORDER.docx G-01 ORDER.docx G-01 ORDER.pdf G-01 ORDER.pdf G-01.pdf G-01.pdf	03/2024
G-002	Sealed Case Cover Sheet (New Action)	G-02.pdf G-02.pdf	01/2005
G-004	Warrant For Arrest	G-04.pdf G-04.pdf	01/2024
G-005	Application to Access Media Workroom	G-05.pdf G-05.pdf	04/2024
G-006	Notice of Change of Attorney Business or Contact Information	G-06.pdf G-06.pdf	02/2020
G-009	Application and Order for Writ of Habeas Corpus Ad Prosequendum/Ad Testificandum	G-09 ORDER.wpd G-09 ORDER.wpd G-09.pdf G-09.pdf	10/2006
G-009A	Writ of Habeas Corpus	G-09A.pdf G-09A.pdf	09/1997
G-012	Stipulation and Order Releasing Exhibits to Agent or Designated Custodian	G-12.pdf G-12.pdf	08/1997
G-014	Exhibit Tags (Plaintiff G-14A, Defendant G-14B & Joint G-14C)	G-14A.pdf G-14A.pdf G-14B.pdf G-14B.pdf G-14C.pdf G-14C.pdf	01/2023
G-018	Abstract of Judgment/Order	G-18.pdf G-18.pdf	06/2021
G-030	Records Request Form - Federal Agency Only	G-30.pdf G-30.pdf	09/2004
G-056	Records Request Form - Public	G-56.pdf G-56.pdf	09/2004
G-058	Application and Agreement To Use Court Facility	G-58.pdf G-58.pdf Internal Supplement to Policy for Use of Court Facilities.pdf Internal Supplement to Policy for Use of Court Facilities.pdf	04/2017
G-060	Application for Admission to the Bar of the Central District of California	G-60.pdf G-60.pdf	10/2023
G-063	Request for Attorney Admission Information	G-63.pdf G-63.pdf	11/2023
G-064	Application of Non-Resident Attorney to Appear in a Specific Case	G-64 ORDER.docx G-64 ORDER.docx G-64 ORDER.pdf G-64 ORDER.pdf G-64 ORDER.wpd G-64 ORDER.wpd G-64.pdf G-64.pdf	10/2023
G-072	Schedule of Fees	G-72.pdf G-72.pdf	03/2024
G-092	Notice of Manual Filing or Lodging	G-92.pdf G-92.pdf	06/2015
G-096	Request and Authorization to Incur Transportation Expenses	G-96.pdf G-96.pdf	08/2018
G-101	Student Application to Appear Under the Student Practice Rule & Proposed Order (Local Civil Rule 83-4)	G-101 ORDER.pdf G-101 ORDER.pdf G-101 ORDER.wpd G-101 ORDER.wpd G-101.pdf G-101.pdf	03/2009
G-115	Transcript Redaction Request	G-115.pdf G-115.pdf	05/2008
G-120	Transcript Order Form	G-120.pdf G-120.pdf	08/2021
G-122	Application for Accommodations for Trial Participants with Communications Disabilites, Jurors, and Members of the Public	G-122.pdf G-122.pdf	04/2018
G-122A	Guidelines for Providing Accommodations for Trial Participants with Communications Disabilities, Jurors, and Members of the Public	G-122A.pdf G-122A.pdf	06/2014
G-123	Notice of Appearance or Withdrawal of Counsel	G-123.pdf G-123.pdf	09/2017
G-124	Application for Refund of Fees; Order Thereon	G-124.pdf G-124.pdf	12/2017
G-126	Transcript Designation Form	G-126.pdf G-126.pdf	10/2015
G-127	Lawyer Representative Request And Authority To Incur Travel Expenses	G-127.pdf G-127.pdf	09/2023
G-128	Lawyer Representative Request For Reimbursement Of Travel Expenses	G-128.pdf G-128.pdf	09/2023
G-129	Application for Ninth Circuit Judicial Conference Lawyer Representatives	G-129.pdf G-129.pdf	03/2023

Human Resources
Form Number	Title	Form	Revision Date
HR-34A	Intern I.D. Card Application/Background Check	HR-34A.pdf HR-34A.pdf	05/2018

Interpreter Forms
Form Number	Title	Form	Revision Date
I-2	Contract Interpreter Invoice	I-2.pdf I-2.pdf	01/2024
I-4	Contract Court Interpreter Request to be Included in the Local Roster	I-4.pdf I-4.pdf	10/2019

Magistrate Forms
Form Number	Title	Form	Revision Date
M-14	Waiver of Rights (Out of District Cases)	M-14.pdf M-14.pdf	09/2009
M-23	Motion and Affidavit for Leave to Appeal in Forma Pauperis: 28 U.S.C. 753(f), 28 U.S.C. 1915 from Judgment Rendered by a Magistrate Judge in a Criminal Case & Order	M-23.pdf M-23.pdf M-23A.pdf M-23A.pdf	12/2011
M-29	Consent to Appear by Video Conference and/or Waiver of Defendant's Presence at CVB Proceedings	M-29.pdf M-29.pdf	08/2023
M-41	Statement of Procedures and Advisement of Rights Re: Arraignment of Violation Notice Offenses - Central Violations Bureau	M-41.pdf M-41.pdf	06/2023
M-59	Application by Defendant for Travel Expenses Pursuant to 18 U.S.C. §4285	M-59.pdf M-59.pdf	03/2016
M-61	Order for Appearance of Defendant and for Transportation Expenses Pursuant to 18 U.S.C. §4285	M-61.pdf M-61.pdf	03/2016
M-71	Consent to Proceed before a Magistrate Judge in a Class A Misdemeanor Case	M-71.pdf M-71.pdf	06/1998

Miscellaneous
Form Number	Title	Form	Revision Date
Extern Packet	Extern Packet	Extern-Intern-Volunteer Packet.pdf Extern-Intern-Volunteer Packet.pdf	08/2022
Advisory Opinion No. 81	Committee on Codes of Conduct Advisory Opinion No. 81	Advisory Opinion No. 81.pdf Advisory Opinion No. 81.pdf	07/2011
Notice of Filing 1326 Case	Notice of Filing 1326 Case	Notice of Filing 1326 Case.pdf Notice of Filing 1326 Case.pdf	03/2012

Pro Se Clinic Forms
Form Number	Title	Form	Revision Date
1	Pro Se Clinic Forms	Click Here

Pro Se Packets
Form Number	Title	Form	Revision Date
1	State Habeas Corpus Packet	State Habeas Corpus Packet.pdf State Habeas Corpus Packet.pdf	06/2024
2	Federal Habeas Corpus Packet	Federal Habeas Corpus Packet.pdf Federal Habeas Corpus Packet.pdf	06/2024
3	2255 Motion Packet	2255 Motion Packet.pdf 2255 Motion Packet.pdf	06/2024
4	Prisoner Civil Rights Packet	Prisoner Civil Rights Complaint–Non-Pilot Project Packet.pdf Prisoner Civil Rights Complaint–Non-Pilot Project Packet.pdf Prisoner Civil Rights Complaint-Pilot Project Packet.pdf Prisoner Civil Rights Complaint-Pilot Project Packet.pdf	12/2020
5	Civil Action by Non-Prisoner Packet	Civil Action by Non-Prisoner Packet.pdf Civil Action by Non-Prisoner Packet.pdf	06/2024

Probation Forms
Form Number	Title	Form	Revision Date
1	Presentence Interview Forms	Presentence Interview Forms.pdf Presentence Interview Forms.pdf	06/2010
2	Presentence Financial Forms with Net Worth Short Form	Presentence Financial Forms with Net Worth Short Form USPO .pdf Presentence Financial Forms with Net Worth Short Form USPO .pdf	06/2010
3	PrePlea Consent Form	PROB-13E.pdf PROB-13E.pdf	07/2009

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