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Local Forms

Filings with the Court may require state-wide Judicial Council and/or court-specific forms. Judicial Council forms can be found on the California Court's website.
Judicial Council Forms

Local Forms can be viewed and downloaded from the tables below. Forms can also be obtained at the filing window at the Hall of Justice.

Note: Law prohibits the clerks of Lassen Superior Court from giving legal advice and filling out forms or legal documents. If you are proceeding in pro per (representing yourself), you may have legal questions. Get assistance from the Self-Help Center

Local Forms

M/O – M = Mandatory Local Form • O = Optional Local Form | I = Informational

Form # Name Date Rev M/O
LSC-APL-100 Appeal Facsimile Transmission Cover Sheet 01/23 M

Form # Name Date Rev M/O
LSC-CIV-025 Delay Reduction Program Notice 07/22 M
LSC-CIV-050 Name Change - Criminal History Assessment 07/22 M
LSC-CIV-100 Statement Requesting Presense of a Court Reporter 07/22 M

Form # Name Date Rev M/O
LSC-CRIM-025 Plea in Absentia 05/22 M
LSC-CRIM-100 Petition for Resentencing - Response and Order 07/22 M
LSC-CRIM-200 Community Service Work Time Sheet & Instructions 07/23 M
LSC-CRIM-201 Community Service / Volunteer Work Agencies 07/23 I
PRU-100 DUI Advisement of Rights, Waiver, and Plea
(First Offense Only – Vehicle Code § 23152)		 01/20 M
PRU-101 DUI Advisement of Rights, Waiver, and Plea
(Vehicle Code § 23152)		 01/20 M
PRU-102 Addendum to DUI Advisement of Rights, Waiver, and Plea 01/20 O
PRU-103 DUI Advisement of Rights, Waiver, and Plea
(Vehicle Code § 23153)		 01/20 O
PRU-106 Advisement of Rights, Waiver, and Plea
(Vehicle Code § 14601 et seq.; Vehicle Code § 12500(a))		 01/20 O
PRU-200 Misdemeanor Advisement of Rights, Waiver, and Plea 01/20 O
PRU-202 Addendum to Advisement, Waiver, and Plea
Driver's License Suspension (Vehicle Code §§ 13201.5, 13202.5, 13202.6)		 01/12 M
PRU-1000 Advisement of Rights, Waiver and Plea
Deferred Entry of Judgement (Penal Code § 1000 et seq.)		 01/20 M
PRU-1210 Advisement of Rights, Waiver, and Plea for Felonies and/or Misdemeanors - Proposition 36
(Penal Code § 1210 et seq.)		 01/12 M

Form # Name Date Rev M/O
LSC-FL-100 Family Law Case Management: Status Conference Statement 07/22 M
LSC-FL-101 Family Law Case Management: Settlement Conference Statement 07/22 M
LSC-FL-120 Declaration of Notice Regarding Request for Ex-Parte Orders 07/22 M
LSC-FL-200 Consent for Court Assignment (Family Law) 03/23 M

Form # Name Date Rev M/O
LSC-JUR-100 Request for Permanent Medical Excuse from Jury Service 04/22 M
LSC-JUR-101 Request for Excuse from Jury Service - Age 04/22 O
LSC-JUR-102 Public Transit Reimbursement Request 01/23 M

Form # Name Date Rev M/O
LSC-JVDP-100 Certification of Competency to Practice in Juvenile Dependency Court 07/22 M

Form # Name Date Rev M/O
LSC-MIS-025 Request for CourtCall Telephonic Appearance 01/23 M
LSC-MIS-100 Research and Copy Request Form 07/22 M
LSC-MIS-200 Request for Appointment of Official Reporter Pro Tempore 07/22 M
LSC-MIS-300 Stipulation for Court Commissioner to Act As Temporary Judge 05/22 M
LSC-MIS-400 Request/Notification for Courtroom Audio/Visual Presentation Equipment 05/22 M

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