Fillable FINAL JUDGMENT Forms Packet (Forms Required to Prepare (California)

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FINAL JUDGMENT Forms Packet (Forms Required to Prepare (California)

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FINAL JUDGMENT
Forms Packet
(Forms Required to Prepare and file your Judgment of Dissolution or Legal Separation)
In order to determine which forms are required to complete your case, you must first
determine the status:
PETITION filed and served, no RESPONSE filed 30 days after
completed service and NO AGREEMENT =
TRUE DEFAULT CASE
PETITION filed and served, no RESPONSE filed 30 days after
completed service but a written AGREEMENT on all issues =
DEFAULT CASE
PETITION filed and served, RESPONSE filed and served, and a full
written AGREEMENT on all issues =
UNCONTESTED CASE
PETITION filed and served, RESPONSE filed and served, but NO
WRITTEN AGREEMENT on all issues =
CONTESTED CASE
Once that determination has been made, follow the checklist for your case attached. All
steps must be completed before your Judgment can be granted.
After completing the forms, make three additional copies and
submit them to the clerk’s office with self-addressed stamped
envelopes as shown on your checklist.
TRUE DEFAULT CASE
(No Response filed 30 days after completed service and no Settlement Agreement)
______________________________________________________________________________
SUMMONS
PETITION
Serve with Income and Expense
Declaration & Schedule of Assets
and Debts
PRELIMINARY DECLARATION OF DISCLOSURE
DECLARATION REGARDING
SERVICE OF DECLARATION OF
DISCLOSURE
File to show that you have complied with
Preliminary Declaration of Disclosure
PROOF OF SERVICE
Submit with one (1) self-addressed stamped
REQUEST TO ENTER DEFAULT
envelope, addressed to Respondent
DECLARATION FOR DEFAULT OR
UNCONTESTED HEARING
With attachments dealing with custody/visitation, child support, spousal
support and division of property and debts. Cannot request unless originally
requested in Petition
JUDGMENT
With two (2) self-addressed stamped envelopes,
one addressed to you and one addressed to
Respondent
NOTICE OF ENTRY OF JUDGMENT
DEFAULT CASE
(No Response filed 30 days after completed service, but the parties have a written Settlement
Agreement)
______________________________________________________________________________
SUMMONS
PETITION
Serve with Income and Expense
Declaration & Schedule of Assets
and Debts - Both parties must
comply
PRELIMINARY DECLARATION OF DISCLOSURE
Both parties must file to show that you
have both complied with Preliminary
Declaration of Disclosure
DECLARATION REGARDING SERVICE OF
DECLARATION OF DISCLOSURE
PROOF OF SERVICE
Submit with one (1) self-addressed stamped
REQUEST TO ENTER DEFAULT
envelope, addressed to Respondent
Both parties must comply or both must
sign the Waiver of Final Declaration of
Disclosure
DECLARATION REGARDING SERVICE OF
FINAL DECLARATION OF DISCLOSURE
DECLARATION FOR DEFAULT OR
UNCONTESTED HEARING
With Settlement Agreement dealing with custody/visitation, child support,
spousal support and division of property and debts. Both parties must sign
the Settlement Agreement and Respondent’s signature must be notarized.
JUDGMENT
With two (2) self-addressed stamped envelopes,
one addressed to you and one addressed to
Respondent
NOTICE OF ENTRY OF JUDGMENT
UNCONTESTED CASE
(Response filed and the parties have a written Settlement Agreement)
______________________________________________________________________________
SUMMONS
PETITION
Serve with Income and Expense
Declaration & Schedule of Assets and
Debts - Both parties must comply
PRELIMINARY DECLARATION OF DISCLOSURE
Both parties must file to show that you have
both complied with Preliminary Declaration of
Disclosure
DECLARATION REGARDING SERVICE OF
DECLARATION OF DISCLOSURE
PROOF OF SERVICE
RESPONSE
Both parties must comply or both must sign the
Waiver of Final Declaration of Disclosure
DECLARATION REGARDING SERVICE OF
FINAL DECLARATION OF DISCLOSURE
APPEARANCE, STIPULATIONS, & WAIVERS
DECLARATION FOR DEFAULT OR UNCONTESTED HEARING
With Settlement Agreement dealing with custody/visitation, child support, spousal
support and division of property and debts. Both parties must sign the Settlement
Agreement.
JUDGMENT
With two (2) self-addressed stamped envelopes, one
addressed to you and one addressed to
NOTICE OF ENTRY OF JUDGMENT
Respondent
CONTESTED CASE
(Response filed but no agreement on the issues)
______________________________________________________
SUMMONS
PETITION
Both Parties must comply
PRELIMINARY DECLARATION OF DISCLOSURE
Both parties must file to show that you have
both complied with Preliminary Declaration of
Disclosure
DECLARATION REGARDING SERVICE OF
DECLARATION OF DISCLOSURE
PROOF OF SERVICE
RESPONSE
REQUEST FOR FAMILY LAW TRIAL SETTING
DECLARATION REGARDING SERVICE OF
FINAL DECLARATION OF DISCLOSURE
Both parties must comply
MANDATORY SETTLEMENT CONFERENCE STATEMENT OR
STATEMENT OF AGREEMENT AND DISAGREEMENT
File and serve five
(5) days before MSC
TRIAL
Prepare Trial Brief and evidence
JUDGMENT
Prepared in compliance with Court’s rulings at Trial
With two (2) self-addressed stamped envelopes, one
addressed to you and one addressed to
NOTICE OF ENTRY OF JUDGMENT
Respondent
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address) Telephone Number
ATTORNEY FOR (Name):
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF VENTURA
800 SOUTH VICTORIA AVE. VENTURA, CA 93009
PLAINTIFF/PETITIONER
DEFENDANT/RESPONDENT
Date: ____________________
Tme: ____________________
Courtroom: _______________
Pro Per
REQUEST
COUNTER REQUEST FOR MANDATORY SETTLEMENT
CONFERENCE/TRIAL SETTING (FAMILY LAW)
CASE NUMBER:
Estimated trial time: ____________________
Petitioner/Respondent/Claimant herein hereby requests that a Mandatory Settlement Conference be set on a date after
______________________________ . Additionally, the following dates are unacceptable for the Mandatory Settlement
Conference: _____________________________________________ .
Names, addresses and telephone numbers of attorneys or of parties representing themselves:
For Petitioner For Claimant For Repondent
I hereby represent to the court that all essential parties have been served with process or have appeared, and declared
that this case is at issue as to all such parties; that no amended or supplemental petition or cross-petition/complaint or
other affirmative pleading remains unanswered; that, to my knowledge, other parties will not be served with a summons
prior to the time of trial; and that I know of no further pleading(s) to be filed.
Dated: _________________________________________ ____________________________________
Signature of Attorney/Party
Petitioner/Plaintiff
Respondendt/Defendant
Claimant
REQUEST FOR MANDATORY SETTLEMENT
CONFERENCE/TRIAL SETTING (FAMLY LAW)
Mandatory Form
VN086 (Rev. 01/13)
VN086
PROOF OF SERVICE BY MAIL
I am over the age of 18 and not a party to this cause. I am a resident of, or employed in, the county where this mailing
occurred. I
served the REQUEST FOR MANDATORY SETTLEMENT CONFERENCE/TRIAL SETTING (FAMILY LAW), by placing a
true
copy in a sealed envelope with postage prepaid, addressed to each person whose name and address is given below, and
depositing
the envelope in the United States mail on the date stated below.
Date of deposit: ______________________________ Place of deposit: _______________________________
City and State
I declare under penalty or perjury under the laws of the State of California that the foregoing is true and correct.
Executed on: ________________________________
___________________________________________ ___________________________________
Residence/business address of declarant Signature of declarant
NAME AND ADDRESS OF EACH PERSON TO WHOM MAILED
NOTES: Any party not in agreement with the information or estimates given in the statement shall, within 10 days after
service, serve and file a statement in his/her behalf.
Affidavit of mailing must be completed before acceptance by the Court.
All parties must complete and file all documents as provided in Local Rule 9.19.A.2 fifteen days prior to the Mandatory
Settlement Conference.
REQUEST FOR MANDATORY SETTLEMENT
CONFERENCE/TRIAL SETTING (FAMLY LAW)
Mandatory Form
VN086 (Rev. 01/13)
VN086
FL-165
FOR COURT USE ONLY
CASE NUMBER:
REQUEST TO ENTER DEFAULT
To the clerk: Please enter the default of the respondent who has failed to respond to the petition.
is attached is not attached.
A completed Property Declaration (form FL-160) is attached is not attached
(a)
there have been no changes since the previous filing.
(b)
the issues subject to disposition by the court in this proceeding are the subject of a written agreement.
(c)
there are no issues of child, spousal, or partner support or attorney fees and costs subject to determination by the court.
(d)
(e)
Date:
(TYPE OR PRINT NAME) (SIGNATURE OF [ATTORNEY FOR] PETITIONER)
Declaration
A copy of this Request to Enter Default, including any attachments and an envelope with sufficient postage, was
provided to the court clerk, with the envelope addressed as follows (address of the respondent’s attorney or, if none,
the respondent’s last known address):
a.
b.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)
FOR COURT USE ONLY
Request to Enter Default mailed to the respondent or the respondent’s attorney on (date):
Clerk, by
, Deputy
Page 1 of 2
Code of Civil Procedure, §§ 585, 587;
REQUEST TO ENTER DEFAULT
(Family Law—Uniform Parentage)
Form Adopted for Mandatory Use
Judicial Council of California
FL-165 [Rev. January 1, 2005]
Family Code, § 2335.5
1.
2. A completed Income and Expense Declaration (form FL-150) or Financial Statement (Simplified) (form FL-155)
this is an action to establish parental relationship.
there are no issues of division of community property.
the petition does not request money, property, costs, or attorney fees. (Fam. Code, § 2330.5.)
(f)
No mailing is required because service was by publication or posting and the address of the respondent remains unknown.
Default not entered. Reason:
Default entered as requested on (date):
www.courtinfo.ca.gov
3.
PETITIONER:
RESPONDENT:
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
because (check at least one of the following):
TELEPHONE NO.:
ATTORNEY FOR (Name):
FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
To keep other people from
seeing what you entered on
your form, please press the
Clear This Form button at the
end of the form when finished.
JUDICIAL SUBPOENA
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
Courtat thethe Honorable
located at
County of
o'clock in theday of noon, and at any recessedin room , on the , 20 , at
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
I
Calendar No.
THE PEOPLE OF THE STATE OF NEW YORK
TO
Index No.
,
American LegalNet, Inc.
www.USCourtForms.com
Court in
Witness, Honorable , one of the Justices of the
day of , 20County,
COURT
COUNTY OF
Plaintiff(s)
-against-
Defendant(s)
:
:
:
:
:
:
:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mobile Tel. No.:
CASE NUMBER:
Memorandum of costs
Costs and disbursements are waived.
Costs and disbursements are listed as follows:
Clerk’s fees
$
(1)
(2)
$Process server’s fees ...................................
Other (specify): ................................................................................................................... ...................................
(3)
$
$
$
$
TOTAL
$
I am the attorney, agent, or party who claims these costs. To the best of my knowledge and belief, the foregoing items of
cost are correct and have been necessarily incurred in this cause or proceeding.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)
Declaration of nonmilitary status. The respondent is not in the military service of the United States as defined in section 511 et
seq. of the Servicemembers Civil Relief Act (50 U.S.C. Appen. § 501 et seq.), and is not entitled to the benefits of such act.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)
FL-165 [Rev. January 1, 2005]
REQUEST TO ENTER DEFAULT
(Family Law—Uniform Parentage)
Page 2 of 2
4.
c.
5.
a.
b.
.............................................................................................................. ................................
...............................................................................................
........................................................................................................................................ ................................
........................................................................................................................................ ................................
........................................................................................................................................
................................................................................................................................... ................................
CASE NAME (Last name, first name of each party):
Print This Form
For your protection and privacy, please press the Clear
This Form button after you have printed the form.
Clear This Form
TELEPHONE NO.: FAX NO. :
E-MAIL ADDRESS:
ATTORNEY FOR (Name):
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
CASE NUMBER:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
DECLARATION REGARDING SERVICE OF DECLARATION OF
DISCLOSURE AND INCOME AND EXPENSE DECLARATION
Final
Preliminary
Petitioner's
Respondent's
FL-141
Page 1 of 1
Form Adopted for Mandatory Use
Judicial Council of California
FL-141 [Rev. July 1, 2013]
DECLARATION REGARDING SERVICE OF DECLARATION OF
DISCLOSURE AND INCOME AND EXPENSE DECLARATION
(Family Law)
Family Code, §§ 2102, 2104,
2105, 2106, 2112
www.courts.ca.gov
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Preliminary Declaration of Disclosure (form FL-140), current* Income and Expense
Declaration (form FL-150), completed Schedule of Assets and Debts (form FL-142) or Community and Separate Property
Declarations (form FL-160) with appropriate attachments, all tax returns filed by the party in the two years before service of the
preliminary disclosures, and all other required information under Family Code section 2104 were served on:
I am the
Petitioner's
Respondent's
the other party
the other party's attorney by personal service mail
Final Declaration of Disclosure (form FL-140), current* Income and Expense Declaration
(form FL-150), completed Schedule of Assets and Debts (form FL-142) or Community or Separate Property Declarations (form
FL-160) with attachments, and the material facts and information required by Family Code section 2105 were served on:
2.
3.
Service of
4.
attorney for
petitioner respondent
in this matter.
Petitioner's
Respondent's
the other party other party's attorney by
personal service
mail
(specify):

on (date):
(specify):

on (date):
Petitioner's preliminary final
declaration of disclosure
Respondent's
a. The parties agreed to waive final declaration of disclosure requirements under Family Code section 2105(d.)
current income and expense declaration has been waived as follows:
The party has failed to comply with disclosure requirements, and the court has granted the request for voluntary waiver of
b.
on (date):
receipt under Family Code section 2107
c. This is a default proceeding that does not include a stipulated judgment or settlement agreement. Petitioner waives final
disclosure requirements under Family Code section 2110.
(date):

The waiver
is being filed at the same time as this form.
*Current is defined as completed within the past three months providing no facts have changed. (Cal. Rules of Court, rule 5.260.)
NOTE: File this document with the court.
Do not file a copy of the Preliminary or Final Declaration of Disclosure or
any attachments to either declaration of disclosure with this document.
SIGNATURE
(TYPE OR PRINT NAME)
Date:
(Form FL-144 may be used for this purpose.)
1.
PETITIONER:
1.
2.
I have served the Respondent with a preliminary Declaration of Disclosure and am now seeking a Default
Judgment.
Dated:
SIGNATURE OF PETITIONER
Dated:
SIGNATURE OF RESPONDENT
Dated:
SIGNATURE OF ATTORNEY FOR PETITIONER
Dated:
SIGNATURE OF ATTORNEY FOR RESPONDENT
Optional Form
VN131 [Rev. 07/01/03]
WAIVER OF FINAL DECLARATION OF DISCLOSURE
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address).
TELEPHONE NO.:
FOR COURT USE ONLY
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF VENTURA
CASE NUMBER:
800 SOUTH VICTORIA AVE, VENTURA CA. 93009
3855 - F ALAMO ST. SIMI VALLEY, CA. 93063-2110
RESPONDENT:
WAIVER OF FINAL DECLARATION OF DISCLOSURE
Family Code § 2105
Both parties have complied with Section 2104 and the preliminary declarations of disclosure have been
completed and exchanged.
Both parties have completed and exchanged a current income and expense declaration, that includes all
material facts and information regarding that party's earnings, accumulations, and expenses.
Both parties have fully complied with Section 2102 and have fully augmented the preliminary declaration
of disclosure, including disclosure of all material facts and information regarding the characterization of
all assets and liabilities, the valuation of all assets that are contended to be community property or in which
it is contended the community has an interest, and the amounts of all obligations that are contended to be
community obligations or for which it is contended the community has liability.
The waiver is knowingly, intelligently, and voluntarily entered into by each of the parties.
Each party understands that this waiver does not limit the legal disclosure obligations of the parties, but
rather is a statement under penalty of perjury that those obligations have been fulfilled. Each party further
understands that noncompliance with those obligations will result in the court setting aside the judgment.
I/WE DECLARE UNDER THE PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA
THAT ALL OF THE FOREGOING REPRESENTATIONS ARE TRUE AND CORRECT.
Form Approved for Optional Use
Judicial Council of California
FL-130 [Rev. January 1, 2021]
APPEARANCE, STIPULATIONS, AND WAIVERS
(Family Law—Uniform Parentage—Custody and Support)
Government Code, § 70673
FL-130
FOR COURT USE ONLY
CASE NUMBER:
PARTY WITHOUT ATTORNEY or ATTORNEY STATE BAR NO.:
NAME:
FIRM NAME:
STREET ADDRESS:
CITY: STATE: ZIP CODE:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER:
RESPONDENT:
APPEARANCE, STIPULATIONS, AND WAIVERS
1.
Appearance by respondent (you must choose one):
a.
By filing this form, I make a general appearance.
I have previously made a general appearance.
c.
I am a member of the military services of the United States of America. I have completed and attached to this form
Declaration and Conditional Waiver of Rights Under the Servicemembers Civil Relief Act of 2003 (form FL-130(A)).
b.
2.
Agreements, stipulations, and waivers (choose all that apply):
a.
The parties agree that this cause may be decided as an uncontested matter.
b.
The parties waive their rights to notice of trial, a statement of decision, a motion for new trial, and the right to appeal.
c.
This matter may be decided by a commissioner sitting as a temporary judge.
d.
The parties have a written agreement that will be submitted to the court, or a stipulation for judgment will be submitted to
the court and attached to Judgment (Family Law) (form FL-180).
e.
None of these agreements or waivers will apply unless the court approves the stipulation for judgment or incorporates
the written settlement agreement into the judgment.
f.
This is a parentage case, and both parties have signed an Advisement and Waiver of Rights Re: Determination of
Parental Relationship (form FL-235) or its equivalent.
3.
Other (specify):
Date:
(TYPE OR PRINT NAME)
(SIGNATURE OF PETITIONER)
Date:
(TYPE OR PRINT NAME)
(SIGNATURE OF RESPONDENT)
Date:
(TYPE OR PRINT NAME)
(SIGNATURE OF ATTORNEY FOR PETITIONER)
Date:
(TYPE OR PRINT NAME)
(SIGNATURE OF ATTORNEY FOR RESPONDENT)
Page 1 of 1
www.courts.ca.
g
o
v
FL-130(A)
UNDER THE SERVICEMEMBERS CIVIL RELIEF ACT OF 2003
Page 1 of 1
Form Approved for Optional Use
Judicial Council of California
FL-130(A) [New January 1, 2011]
50 U.S.C. Appen. § 501 et seq.
DECLARATION AND CONDITIONAL WAIVER OF RIGHTS
UNDER THE SERVICEMEMBERS CIVIL RELIEF ACT OF 2003
Government Code, § 70673
www.courts.ca.gov
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT:
CASE NUMBER:
DECLARATION AND CONDITIONAL WAIVER OF RIGHTS
Date:
(TYPE OR PRINT NAME)
(SIGNATURE OF RESPONDENT)
By signing this conditional waiver and attaching it to Appearance, Stipulations, and Waivers (form
FL-130), I declare that I am entitled to the benefits of the Servicemembers Civil Relief Act, title 50
United States Code Appendix, sections 501–596 (SCRA), and:
1. To permit the court to decide this cause as an uncontested matter and enter a judgment that
incorporates the terms of the written agreement made between the petitioner and me (a copy of
which is attached to this form), I make a knowing, intelligent, and voluntary conditional waiver of
the right to seek to set aside a default judgment entered against me in this matter, as provided by
section 521 of the SCRA.
3. This conditional waiver was executed during or after a period of military service.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true
and correct.
The Servicemembers Civil Relief Act of 2003 (50 U.S.C. App. §§ 501–596), formerly known as
the Soldiers' and Sailors' Civil Relief Act of 1940, is a federal law that provides protections for
military members when they enter active duty. You may obtain a copy of the act from the public
law library or from the website of the United States Department of Justice at www.justice.gov.
Notice to Servicemember
By law, a servicemember must not be charged a fee to file Appearance, Stipulations, and Waivers
(form FL-130).
Attention: Clerk of the Court
Attachment to Appearance, Stipulations, and Waivers (form FL-130)
a.
The court must enter a judgment in this case that incorporates only the terms and conditions of
the above written agreement without any change; and
Should the court enter a judgment that changes the above written agreement in any way, then I
do not waive any of my rights under the SCRA, including my right to seek to set aside the
judgment at any time.
b.
The waiver applies only to a default judgment that incorporates the terms and conditions of
the written agreement between the petitioner and me that is titled (specify):
(1)
Stipulation for Judgment
Marital Settlement Agreement
(2)
(3)
Other (specify):
2. This waiver is conditioned as follows:
c.
To keep other people from seeing what you entered on your form, please press the Clear This Form button at the end of the form when finished.
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Both the parties have filed, or are filing concurrently, a Declaration Regarding Service of Declaration of Disclosure (form
FL-141) and an Income and Expense Declaration (form FL-150).
This matter is proceeding by default. I am the petitioner in this action, and service of the summons on respondent was
done by publication or posting under court order. Service of the preliminary Declaration of Disclosure (form FL-140) is not
required. I hereby waive receipt of the final Declaration of Disclosure (form FL-140) from the respondent.
a.
c. Uncontested
This matter is proceeding by default. I am the petitioner in this action and have filed a proof of service of the preliminary
Declaration of Disclosure (form FL-140) with the court. I hereby waive receipt of the final Declaration of Disclosure (form
FL-140) from the respondent.
Default without agreementb.
Default without agreement
There are no assets or debts to be disposed of by the court.
The community and quasi-community assets and debts are listed on the completed current Property
Declaration (form FL-160), which includes an estimate of the value of the assets and debts that I propose to
be distributed to each party. The division in the proposed Judgment (form FL-180) is a fair and equal division
of the property and debts, or if there is a negative estate, the debts are assigned fairly and equitably.
Form Approved for Mandatory Use
Judicial Council of California
FL-170 [Rev. January 1, 2020]
Family Code, § 2336
www.courts.ca.gov
Page 1 of 3
LEGAL SEPARATION
DECLARATION FOR DEFAULT OR UNCONTESTED
DISSOLUTION
FOR COURT USE ONLY
ATTORNEY FOR (name):
E-MAIL ADDRESS:
FAX NO.:TELEPHONE NO.:
ZIP CODE:STATE:CITY:
STREET ADDRESS:
FIRM NAME:
NAME:
PARTY WITHOUT ATTORNEY OR ATTORNEY
STATE BAR NUMBER:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
RESPONDENT:
PETITIONER:
CASE NUMBER:
FL-170
(NOTE: Items 1 through 12 apply to both dissolution and legal separation proceedings.)
I declare that if I appeared in court and were sworn, I would testify to the truth of the facts in this declaration.
I agree that my case will be proven by this declaration and that I will not appear before the court unless I am ordered by the court to
do so.
is true and correct.All the information in the
No response has been filed and there is no written agreement or stipulated judgment between the parties;
(2)
The following statement is true (check one):
1.
2.
3.
The default of the respondent was entered or is being requested, and I am not seeking any relief not requested in the
petition; and
Type of case (check a, b, or c):
4.
(1)
(B)
(3)
(A)
Petition
Responseamended
No response has been filed and the parties have agreed that the matter may proceed as a default matter without notice;
and
The parties have entered into a written agreement regarding their property and their marriage or domestic partnership
rights, including support, the original of which is being or has been submitted to the court. I request that the court approve
the agreement.
(2)
(1)
Both parties have appeared in the case; and
(2)
(1)
The parties have entered into a written agreement regarding their property and their marriage or domestic partnership
rights, including support, the original of which is being or has been submitted to the court. I request that the court approve
the agreement.
Declaration of disclosure (check a, b, or c):
a.
b.
c.
5.
DECLARATION FOR DEFAULT OR UNCONTESTED
DISSOLUTION OR LEGAL SEPARATION
(Family Law)
The facts that support the requested judgment are (In a default case, state your reasons below):
The current custody and visitation (parenting time) previously ordered in this case, or the current schedule is (specify):
Child support is being enforced in another case in
I request that this order be based on the
The information in the child support calculation attached to the proposed judgment is correct based on my personal
knowledge.
FL-170 [Rev. January 1, 2020]
Page 2 of 3
DECLARATION FOR DEFAULT OR UNCONTESTED
DISSOLUTION OR LEGAL SEPARATION
(Family Law)
RESPONDENT:
PETITIONER:
CASE NUMBER:
FL-170
d.
This matter is proceeding as an uncontested action. Service of the final Declaration of Disclosure (form FL-140) is
mutually waived by both parties. A waiver provision executed by both parties under penalty of perjury is contained on the
Stipulation and Waiver of Final Declaration of Disclosure (form FL-144), in the settlement agreement or proposed
judgment, or in another, separate stipulation.
has
d.
Contained on Attachment 6d.
Contained on Attachment 6c.
has not
6.
a.
Child support should be ordered as set forth in the proposed Judgment (form FL-180).
7.
changed since it was last filed with the court. (If changed, attach updated form.)
(county):
c.
The case number is (specify):
Child custody and visitation (parenting time) should be ordered as set forth in the proposed Judgment (form FL-180).
a.
b.
The information in Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) (form FL-105)
There is an existing court order for custody/parenting time in another case in
If there are minor children, check and complete item (1) if applicable and item (2) or (3):
earning ability. The facts in(3)
support of my estimate of earning ability are (specify):
(2)
Complete items (1) and (2) regarding public assistance.
(county):
The case number is (specify):
(1)
Petitioner's Respondent's
Contained on Attachment 7a(3).
b.
(1) I am receiving
am not receiving intend to apply for
To the best of my knowledge, the other party
to the local child support agency at the address set forth in the proposed judgment. A representative of the local child
support agency has signed the proposed judgment.
listed in the proposed order.
(2)
Spousal, Partner, and Family Support (If a support order or attomey fees are requested, submit a completed Income and
Expense Declaration (form FL-150) unless a current form is on file. Include your best estimate of the other party’s income.
Check at least one of the following.)
a.
b.
c.
Family support should be ordered as set forth in the proposed Judgment (form FL-180).
e.
f.
d.
8.
public assistance for the child or children
is
is not receiving public assistance.
Petitioner
Respondent is presently receiving public assistance, and all support should be made payable
I knowingly give up forever any right to receive spousal or partner support.
I ask the court to terminate forever spousal or partner support for:
Spousal support or domestic partner support should be ordered as set forth in the proposed Judgment (form FL-180)
based on the factors described in:
I ask the court to reserve jurisdiction to award spousal or partner support in the future to:
Petitioner Respondent
Petitioner Respondent
Spousal or Partner Support Declaration Attachment (form FL-157)
attached declaration (Attachment 8d)
written agreement
Other
(specify):
The facts in support of this request are on Request for Attorney's Fees and Costs Attachment (form FL-319).
FL-170 [Rev. January 1, 2020]
Page 3 of 3
DECLARATION FOR DEFAULT OR UNCONTESTED
DISSOLUTION OR LEGAL SEPARATION
(Family Law)
Date:
RESPONDENT:
PETITIONER:
CASE NUMBER:
FL-170
(TYPE OR PRINT NAME)
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
12.
requests restoration of the former name as set forth in the proposed Judgment (form FL-180)
Status only judgment: This declaration is only for the termination of marital or domestic partner status. I ask the court to
reserve jurisdiction over all other issues not requested in this declaration for later determination.
Petitioner Respondent
STATEMENTS IN THIS BOX APPLY ONLY TO DISSOLUTIONS
If this is a dissolution of a marriage or domestic partnership created in another state, the petitioner or the respondent has
been a resident of this county for at least three months and of the state of California for at least six months continuously and
immediately preceding the date of the filing of the petition for dissolution of marriage or domestic partnership.
I ask that the court grant the request for a judgment of dissolution of marriage or domestic partnership based on irreconcilable
differences and that the court make the orders set forth in the proposed Judgment (form FL-180) submitted with this declaration.
17.
15.
16.
Irreconcilable differences have led to the irremediable breakdown of the marriage or domestic partnership, and there is no
possibility of saving the marriage or domestic partnership through counseling or other means.
This declaration may be reviewed by a commissioner sitting as a temporary judge, who may determine whether to grant this
request or require my appearance under Family Code section 2336.
13.
14.
(proceedings for dissolution or nullity of marriage only).
THIS STATEMENT APPLIES ONLY TO LEGAL SEPARATIONS
I ask that the court grant the request of a judgment for legal separation based on irreconcilable differences and that the court
make the orders set forth in the proposed Judgment (form FL-180) submitted with this declaration.
I understand that a judgment of legal separation does not terminate a marriage or domestic partnership, and that I am
still married or a partner in a domestic partnership.
18.
19. Other
(specify):
(SIGNATURE OF DECLARANT)
9.
10.
The judgment should be entered nunc pro tunc for the following reasons (specify):
11.
(county):
a.
b.
A voluntary declaration of parentage or paternity is attached.
The written agreement of the parties regarding parentage is attached here (Attachment 9b) or to the proposed Judgment
(form FL-180).
Parentage was previously established by the court in
The case number is (specify):
Attorney fees should be ordered as set forth in the proposed Judgment (form FL-180).
Other (specify facts below):
Parentage of the children of the petitioner and respondent born prior to their marriage or domestic partnership should be
ordered as set forth in the proposed Judgment (form FL-180).
Form Adopted for Mandatory Use
Judicial Council of California
FL-180 [Rev. July 1, 2012]
CASE NUMBER:
JUDGMENT
NULLITYLEGAL SEPARATIONDISSOLUTION
Status only
Reserving jurisdiction over termination of marital or domestic
partnership status
Date marital or domestic partnership status ends:
Default or uncontested By declaration under Family Code section 2336This proceeding was heard as follows:
Contested
Room:Dept.:Date:
Temporary judge
Judicial officer (name):
Attorney present in court (name):
Claimant present in court (name):
c.
d.
Attorney present in court (name):
e.
The court acquired jurisdiction of the respondent on (date):
The respondent appeared.
The respondent was served with process.
THE COURT ORDERS, GOOD CAUSE APPEARING
Judgment of dissolution is entered. Marital or domestic partnership status is terminated and the parties are restored to the
status of single persons
a.
on (specify date):(1)
(2)
Judgment of nullity is entered. The parties are declared to be single persons on the ground of (specify):
b.
c.
petitioner's
e.
f.
d.
JUDGMENT
(Family Law)
Family Code, §§ 2024, 2340,
2343, 2346
www.courts.ca.gov
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER:
FL-180
TELEPHONE NO.:
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
ATTORNEY FOR (Name):
FAX NO. (Optional):
RESPONDENT:
1.
2.
3.
4.
a.
b.
Petitioner present in court
Respondent present in court Attorney present in court (name):
on a date to be determined on noticed motion of either party or on stipulation.
Judgment of legal separation is entered.
This judgment will be entered nunc pro tunc as of (date):
Jurisdiction is reserved over all other issues, and all present orders remain in effect except as provided below.
This judgment
The restraining orders are contained on page(s) of the attachment. They expire on (date):
MARRIAGE OR PARTNERSHIP OF
former name is restored to (specify):respondent's
Judgment on reserved issues
f. Other (specify name):
g.
Judgment on reserved issues.
h. This judgment contains provisions for child support or family support. Each party must complete and file with the court a
Child Support Case Registry Form (form FL-191) within 10 days of the date of this judgment. The parents must notify the
court of any change in the information submitted within 10 days of the change, by filing an updated form. The Notice
of Rights and Responsibilities—Health-Care Costs and Reimbursement Procedures and Information Sheet on Changing a
Child Support Order (form FL-192) is attached.
Page 1 of 2
contains personal conduct restraining orders
modifies existing restraining orders.
a.
b.
E-MAIL ADDRESS (Optional):
The
Agreement in court
To keep other people from
seeing what you entered on
your form, please press the
Clear This Form button at the
end of the form when finished.
FL-180 [Rev. July 1, 2012]
JUDICIAL OFFICER
Date:
Number of pages attached:
Parentage is established for children of this relationship born prior to the marriage or domestic partnership
CASE NAME (Last name, first name of each party):
CASE NUMBER:
k.
Child support is ordered as set forth in the attached
Previously established in another case. Case number: Court:
j.
l.
Child custody and visitation (parenting time) are ordered as set forth in the attached
Spousal, domestic partner, or family support is ordered:
As set forth in the attached Spousal, Partner, or Family Support Order Attachment (form FL-343).
Each attachment to this judgment is incorporated into this judgment, and the parties are ordered to comply with each attachment's
provisions. Jurisdiction is reserved to make other orders necessary to carry out this judgment.
5.
JUDGMENT
(Family Law)
Page 2 of 2
4.
Stipulation to Establish or Modify Child Support and Order (form FL-350).
SIGNATURE FOLLOWS LAST ATTACHMENT
Stipulation and Order for Custody and/or Visitation of Children (form FL-355).
Reserved for future determination as relates to petitioner respondent
Other (specify):o.
(2)
(3)
(2)
(3)
(4)
(1)
(3)
(4)
Property division is ordered as set forth in the attached
m.
Settlement agreement, stipulation for judgment, or other written agreement.
Other (specify):
Property Order Attachment to Judgment (form FL-345).
(1)
(2)
(3)
Dissolution or legal separation may automatically cancel the rights of a spouse or domestic partner under the other spouse's or
domestic partner's will, trust, retirement plan, power of attorney, pay-on-death bank account, transfer-on-death vehicle registration,
survivorship rights to any property owned in joint tenancy, and any other similar property interest. It does not automatically cancel the
rights of a spouse or domestic partner as beneficiary of the other spouse's or domestic partner's life insurance policy. You should
review these matters, as well as any credit cards, other credit accounts, insurance policies, retirement plans, and credit reports, to
determine whether they should be changed or whether you should take any other actions.
An earnings assignment may be issued without additional proof if child, family, partner, or spousal support is ordered.
Any party required to pay support must pay interest on overdue amounts at the "legal rate," which is currently 10 percent.
A debt or obligation may be assigned to one party as part of the dissolution of property and debts, but if that party does not pay the
debt or obligation, the creditor may be able to collect from the other party.
NOTICE
FL-180
i.
Name
Birthdate
The children of this marriage or domestic partnership are:
(2)
(1)
Attorney fees and costs are ordered as set forth in the attached
n.
Attorney Fees and Costs Order (form FL-346).
Other (specify):
(2)
(3)
Other (specify):
As set forth in the attached settlement agreement, stipulation for judgment, or other written agreement.
(5)
Jurisdiction terminated to order spousal or partner support to petitioner respondent
(2)
Settlement agreement, stipulation for judgment, or other written agreement which contains the information
required by Family Code section 3048(a).
(1)
Settlement agreement, stipulation for judgment, or other written agreement which contains the declarations
required by Family Code section 4065(a).
(1)
Child Custody and Visitation Order Attachment (form FL-341).
Child Support Information and Order Attachment (form FL-342).
Previously established in another case. Case number: Court:
(4)
Settlement agreement, stipulation for judgment, or other written agreement.
(1)
For your protection and privacy, please press the Clear This Form
button after you have printed the form.
Print This Form
Save This Form
Clear This Form
MARRIAGE OF _________________________________ CASE NUMBER ________________________
MARITAL SETTLEMENT AGREEMENT
The parties to this agreement acknowledge that with this agreement they intend to resolve all issues remaining in their
case and that although this agreement may not be an exactly equal division of their assets and debts, they waive any
inequality in the interest of reaching a full and final resolution of their matter. The parties hereby agree that the following
may be incorporated into a Final Judgment.
1. CHILD CUSTODY AND SUPPORT [check one]
We have no minor children together, therefore this section does not apply.
The minor children are:_______________________________________________________________________
________________________________________________________________________________________________.
A. CUSTODY:
Legal Custody shall be awarded to
the parties jointly OR to the ___________________________________.
Physical Custody shall be awarded to
the parties jointly OR to the _________________________________.
Custodial time for the ______________________ shall be:
per the Mediation Agreement / Order filed on _____________________________________________________.
OR
as follows:_________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
The residence of the minor children shall not be changed from California County of Ventura
____________________________ without prior agreement of the parties or court order.
The parties agree that this court has jurisdiction over the issue of child custody as California is the home state of
the children, that they personally executed this agreement and understand their custodial rights and waive any
further hearing on this issue, and agree that the United States is the country of habitual residence of the children.
They acknowledge that they are aware that a violation of this custodial order may result in civil or criminal
penalties. [Family Code Section 3048]
B. SUPPORT: If there are minor children of this relationship, the court MUST issue orders regarding child support
unless a case is already in effect through the Department of Child Support Services:
The Department of Child Support Services is enforcing an existing child support order in case number
_______________. Child support is reserved to that case. No other orders regarding child support are needed.
MARITAL SETTLEMENT AGREEMENT
Optional Form
VN185 (Rev. 7/11)
Page 1 of 4
VN185
If there is no DCSS case, check ONE of the following:
The parties agree to Guideline Child Support per the attached Dissomaster. Guideline support is $____________per
month payable by the ______________________ to the _______________________.
The parties agree to a Non-Guideline Child Support Order in the amount of $_______________ per month payable by
the ___________________ to the ___________________, and all the following are true:
The parties are fully informed of their rights concerning child support
The amount is being agreed to without coercion or duress
The needs of the children will be adequately met by this order
Neither parent is receiving public assistance for these children and no application is pending.
No change of circumstances is needed to raise the order to Guideline.
Child support ordered under this section shall be paid ½ on the first and ½ on the 15
th
of each month commencing
__________________ and shall continue until the supported child dies, emancipates, reaches the age of 18 or, if still a
full-time high school student, age 19 or graduation, whichever first occurs.
In the event that there is a contract between a party receiving support and a private child support collector, the party
ordered to pay support must pay the fee charged by the private child support collector. This fee must not exceed 33 1/3
percent of the total amount of past due support nor may it exceed 50 percent of any fee charged by the private child
support collector. The money judgment created by this provision is in favor of the private child support collector and the
party receiving support jointly.
C. MEDICAL INSURANCE: The __________________ shall maintain health insurance for the minor children. Any
uncovered health care expenses shall be paid equally by the parties.
D. CHILD CARE: Child care to allow either parent to work shall be paid as follows:
included in the child support order above
paid equally by the parties directly to the day care provider.
other ______________________________________________________________________________________.
E. DEPENDENT EXEMPTIONS: The _________________ shall be allowed to claim ________________________
[name children] as dependents for tax filing purposes. If necessary, the custodial parent shall execute IRS form 8332 to
release the exemptions.
2. SPOUSAL / PARTNER SUPPORT [check one]
Both parties waive receipt of spousal / partner support now and forever. The court terminates jurisdiction to award
spousal support to either party now or at any time in the future.
MARITAL SETTLEMENT AGREEMENT
Optional Form
VN185 (Rev. 7/11)
Page 2 of 4
The court reserves jurisdiction over the issue of spousal / partner support and may make an order for support in
the future upon properly noticed motion by either party.
The _______________ shall pay to the _______________ the sum of $__________ per month payable ½ on the
first and ½ on the 15
th
of each month commencing ______________________ and continuing until death of either party,
remarriage of supported spouse / partner, further order of the court or until __________________ at which time support
shall terminate. This order is appropriate based on the length of marriage / domestic partnership, age and earning
capacity of the parties and other relevant factors.
3. DIVISION OF PROPERTY AND DEBTS:
The PETITIONER is awarded the following as Petitioner’s sole and separate property and RESPONDENT hereby
waives any interest therein:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
The RESPONDENT is awarded the following as Respondent’s sole and separate property and PETITIONER hereby
waives any interest therein:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
PETITIONER shall pay, assume and hold RESPONDENT harmless from the following debts:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
RESPONDENT shall pay, assume and hold PETITIONER harmless from the following debts:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
MARITAL SETTLEMENT AGREEMENT
Optional Form
VN185 (Rev. 7/11)
Page 3 of 4
4. OTHER ORDERS: The parties agree to the following additional orders:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Both parties acknowledge that they have read and understand this Marital Settlement Agreement consisting of four pages
and ________ attached pages. This agreement shall be incorporated into a Final Judgment and made an Order of the
Court.
Dated:______________ _________________________________________
PETITIONER
Dated:______________ _________________________________________
RESPONDENT [If no Response has been filed, the
Respondent’s signature must be notarized. Attach notary
page.]
MARITAL SETTLEMENT AGREEMENT
Optional Form
VN185 (Rev. 7/11)
Page 4 of 4
In re Marriage of _____________________ Case Number __________________
ATTACHMENT TO JUDGMENT
(Property and Debt)
1. Petitioner shall be awarded the following as his / her sole and separate property:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
2. Respondent shall be awarded the following as his / her sole and separate property:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
3. Petitioner shall pay the following community obligations and hold Respondent harmless
therefrom: _______________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
4. Respondent shall pay the following community obligations and hold Petitioner harmless
therefrom: _______________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
5. Other orders:_____________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Optional Form ATTACHMENT TO FAMILY LAW JUDGMENT (PROPERTY AND DEBT) Page one of one
VN186 New 01/01/06
d.
a.
(name):
will be as follows:
The parties will go to child custody mediation or child custody recommending counseling at (specify date, time, and
No Visitation (Parenting Time)
Visitation (Parenting Time) for the
petitioner
respondent other
location):
-page document 6HHWKHDWWDFKHG
b.
c.
e.
Reasonable right of visitation to the party without physical custody (not appropriate in cases involving domestic
violence)
(1)
at
(day of week) (time)
from
1st 2nd 3rd 4th 5th weekend of the month
p.m./ if applicable, specify:a.m.
at
(day of week) (time)
to
a.m.
p.m./ if applicable, specify:
after school
start of school
after school
start of school
(Note: The first weekend of the month is the first weekend with a Saturday.)
(date):
Weekends starting
(b)
(a)
having the initial fifth weekend, which starts (date):
The parties will alternate the fifth weekends, with the
other parent/party
respondent
petitioner
even numbered months.odd
The other parent/partyrespondentpetitioner will have the
CHILD CUSTODY AND VISITATION (PARENTING TIME)
ORDER ATTACHMENT
Family Code, §§ 3020, 3022, 3025,
3040–3043, 3048, 3100, 6340, 7604
www.courts.ca.gov
Form Approved for Optional Use
Judicial Council of California
FL-341 [Rev. July 1, 2016]
5.
7.
Page 1 of 3
Penalties for violating this order. If you violate this order, you may be subject to civil or criminal penalties, or both.
4.
6.
THIS IS A COURT ORDER.
CHILD CUSTODY AND VISITATION (PARENTING TIME) ORDER ATTACHMENT
TO
Stipulation and Order fo Custody and/or Visitation of Children (form FL-355)
Findings and Order After Hearing (form FL-340) Judgment (form FL-180) Judgment (form FL-250)
2WKHUVSHFLI\
1.
2.
Jurisdiction. This court has jurisdiction to make child custody orders in this case under the Uniform Child Custody Jurisdiction and
Enforcement Act (Fam. Code, §§ 3400–3465).
Notice and opportunity to be heard. The responding party was given notice and an opportunity to be heard, as provided by the
laws of the State of California.
3. Country of habitual residence. The country of habitual residence of the child or children in this case is
(specify):
2WKHU
WKH8QLWHG6WDWHV
Child Custody. Custody of the minor children of the parties is awarded as follows:
Child abduction prevention. There is a risk that one of the parties will take the children out of California without the other
party's permission. (Child Abduction Prevention Orders Attachment (form FL-341(B)) must be attached and must be obeyed.)
Visitation (Parenting Time)
Child's Name
Legal custody to: (person who makes
decisions about health, education, etc.)
Birth Date
Physical custody to:
(person with whom child lives)
FL-341
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
fifth weekend in
10.
a.
c.
b.
(specify):
the state of California.
the following counties
other places
(specify):
9.
b.
c.
d.
a.
(address):
(specify):
Transportation to begin the visits will be provided by the
Transportation from the visits will be provided by the
The exchange point at the beginning of the visit will be at
The exchange point at the end of the visit will be at
During the exchanges, the party driving the children will wait in the car and the other party will wait in his or her
home (or exchange location) while the children go between the car and the home (or exchange location).
Other (specify):
other
respondentpetitioner
(address):
(specify):
other
respondentpetitioner
The children must be driven only by a licensed and insured driver. The car or truck must have legal child restraint
devices.
f.
g.
e.
8.
(specify):
FL-341 [Rev. July 1, 2016]
(You must attach Supervised Visitation Order (form FL-341(A).)
must have written permission from the other parent or a court order to take the children out of
The
(name):
will have supervised visitation (parenting time) with the minor children according to the schedule set forth on page 1.
(2)
Alternate weekends starting
(date):
at
(day of week) (time)
from
a.m.
p.m./ if applicable, specify:
at
(day of week)
to a.m.
p.m./ if applicable, specify:
after school
start of school
after school
start of school
after school
start of school
after school
start of school
(time)
(3)
(date):
Weekdays starting
at
(day of week) (time)
from
at
(day of week) (time)
to
(4)
Other visitation (parenting time) days and restrictions are:
listed in Attachment 7e(4) (form
as follows:
MC-025 may be used for this purpose)
p.m./ if applicable, specify:
a.m.
a.m.
p.m./ if applicable, specify:
e.
Visitation (Parenting Time) (continued)
Supervised visitation (parenting time). Until
Transportation for visitation (parenting time)
further order of the court other
other
respondentpetitioner
Travel with children. The
petitioner respondent other parent/party
(name):
CHILD CUSTODY AND VISITATION (PARENTING TIME)
ORDER ATTACHMENT
Page 2 of 3
THIS IS A COURT ORDER.
FL-341
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
7.
12.
13.
15.
attached schedule. (Additional Provisions—Physical Custody Attachment (form FL-341(D)
) may be used for this purpose.)
(Joint Legal Custody Attachment (form FL-341(E)
) may be used for this purpose.)
11. The children will spend holiday time as listed
Holiday Schedule Attachment (form FL-341(C)
) may be used for this purpose.)
Other (specify):
FL-341 [Rev. July 1, 2016]
CHILD CUSTODY AND VISITATION (PARENTING TIME)
ORDER ATTACHMENT
Page 3 of 3
THIS IS A COURT ORDER.
Holiday schedule.
EHORZ
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The parties will follow the additional custody provisions listed
Additional custody provisions.
EHORZ LQWKH
The parties will share joint legal custody as listedJoint legal custody.
LQWKHDWWDFKHGVFKHGXOHEHORZ
14. Access to children's records. Both the custodial and noncustodial parent have the right to access records and information
about their minor children (including medical, dental, and school records) and consult with professionals who are providing services
to the children.
FL-341
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
FL-341(A)
CASE NUMBER:
PETITIONER/PLAINTIFF:
OTHER PARENT/PARTY:
RESPONDENT/DEFENDANT:
SUPERVISED VISITATION ORDER
Attachment to Child Custody and Visitation (Parenting Time) Order Attachment (form FL-341)
1.
abduction of child(ren)
sexual abuse
physical abuse
domestic violence
drug abuse
alcohol abuse
neglect
(specify):

2.
The court finds, under Family Code section 3100, that the best interest of the child(ren) requires that visitation by
THE COURT MAKES THE FOLLOWING ORDERS
3.
CHILD(REN) TO BE SUPERVISED
Child's Name SexAgeBirth Date
4.
TYPE
a.
Supervised visitation
b.
Supervised exchange only
5.
SUPERVISED VISITATION PROVIDER
a.
Professional (individual provider or supervised visitation center)
b.
Nonprofessional
6.
AUTHORIZED PROVIDER
Name TelephoneAddress
Any other mutually agreed-upon third party as arranged.
7.
DURATION AND FREQUENCY OF VISITS (see form FL-341 for specifics of visitation):
8.
PAYMENT RESPONSIBILITY % % %
Petitioner:
Respondent:
9.
Petitioner will contact professional provider or supervised visitation center no later than
(date):
Respondent will contact professional provider or supervised visitation center no later than
(date):
THE COURT FURTHER ORDERS
10.
Page 1 of 1
SUPERVISED VISITATION ORDER
Family Code, §§ 3100, 3031
www.courts.ca.gov
Date:
JUDICIAL OFFICER
Form Adopted for Mandatory Use
Judicial Council of California
FL-341(A) [Rev. January 1, 2015]
Evidence has been presented in support of a request that the contact of
with the child(ren) be supervised based upon allegations of
Petitioner Respondent
Other Parent/Party
disputes these allegations and the court reserves the findings on
these issues pending further investigation and hearing or trial.
Petitioner
Respondent Other Parent/Party
must, until further order of the court, be limited to contact
supervised by the person(s) set forth in item 6 below pending further investigation and hearing or trial.
Petitioner Respondent Other Parent/Party
Other Parent/Party:
Other Parent/party will contact professional provider or supervised visitation center no later than
(date):
FL-342
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
CASE NUMBER:
CHILD SUPPORT INFORMATION AND ORDER ATTACHMENT
TO
THE COURT USED THE FOLLOWING INFORMATION IN DETERMINING THE AMOUNT OF CHILD SUPPORT:
1.
2.
Gross monthly
income
Net monthly
income
Receiving
TANF/CaIWORKS
Each parent’s monthly income is as follows:
Imputation of income. The court finds that the
and has based the support order upon this imputed income.
3.
%
%
4.
Hardships for the following have been allowed in calculating child support:
Petitioner/
plaintiff
Respondent/
defendant
Approximate ending time
for the hardship
a.
b.
c.
THE COURT ORDERS
5.
6.
a. Base child support
(date): and continuing until further order of the court, or until the child marries, dies, is emancipated, reaches
age 19, or reaches age 18 and is not a full-time high school student, whichever occurs first, as follows:
Payable to (name):
Date of birth Monthly amount
Payable
Child’s name
%
must pay child support beginning
has the capacity to earn:
a.
b.
Other parent/
party
a.
b.
Petitioner/plaintiff: $
Respondent/defendant: $
Other parent/party: $
$
$
$
$
$
$
$
$
$
$
$
$
Number of children who are the subjects of the support order (specify):
Approximate percentage of time spent with petitioner/plaintiff:
Respondent/defendant:
Other parent/party:
The low-income adjustment applies.
Other minor children:
Extraordinary medical expenses:
Catastrophic losses:
Child support
Petitioner/plaintiff
Respondent/defendant Other parent/party
Petitioner/plaintiff
Respondent/defendant
Other parent/party
Hardships
Children of this relationship
Income
Low-income adjustment
Findings and Order After Hearing (form FL-340)
Restraining Order After Hearing (CLETS-OAH) (form DV-130)
Judgment (form FL-180)
$
per
(specify):
on the 1st of the month
Other
a.
b.
other (specify):
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Judgment (form FL-250)
A printout of a computer calculation and findings is attached and incorporated in this order for all required items not filled out
below.
one-half on the 1st and one-half on the 15th of the month
THIS IS A COURT ORDER.
Page 1 of 3
CHILD SUPPORT INFORMATION AND ORDER ATTACHMENT
Form Adopted for Mandatory Use
Judicial Council of California
FL-342 [Rev. January 1, 2020]
Family Code, §§ 4055-4069
www.courts.ca.gov
Page 2 of 3
THIS IS A COURT ORDER.
This order does not meet the child support guideline set forth in Family Code section 4055. Non-Guideline Child Support
Findings Attachment ( ) is attached.
(1)
(2)
their respective places of employment or self-employment. Both parties are ordered to cooperate in the presentation, collection,
and reimbursement of any health-care claims. The parent ordered to provide health insurance must seek continuation of
coverage for the child after the child attains the age when the child is no longer considered eligible for coverage as a dependent
under the insurance contract, if the child is incapable of self-sustaining employment because of a physically or mentally
disabling injury, illness, or condition and is chiefly dependent upon the parent providing health insurance for support and
maintenance.
d.
7. Health-care expenses
Health insurance coverage for the minor children of the parties must be maintained by the
a.
per month.
per month.
per month.
per month.
per month.
per month.
if available at no or reasonable cost through
(2)
Reasonable uninsured health-care costs for the children
per month.
per month.
per month.
Mandatory additional child support
THE COURT FURTHER ORDERS
per month child-care costs.
(d)
(c)
6.
(1)
Child-care costs related to employment or reasonably necessary job training
per month
per month
child-care costs.
child-care costs.
(a)
(b)
e.
Total child support per month: $
$
$
$
$
$
$
$
$
$
$
$
$
Mandatory additional child support
Additional child support
Non-Guideline Order
Petitioner/plaintiff must pay:
Respondent/defendant must pay:
Other parent/party must pay:
Costs to be paid as follows
(specify):
(d)
(c)
(a)
(b)
Petitioner/plaintiff must pay:
Respondent/defendant must pay:
Other parent/party must pay:
Costs to be paid as follows
(specify):
(d)
(c)
(a)
(b)
Petitioner/plaintiff must pay:
Respondent/defendant must pay:
Other parent/party must pay:
Costs to be paid as follows
(specify):
(d)
(c)
(a)
(b)
Petitioner/plaintiff must pay:
Respondent/defendant must pay:
Other parent/party must pay:
Costs to be paid as follows
(specify):
Costs related to the educational or other special needs of the children
Travel expenses for visitation
petitioner/plaintiff
respondent/defendant other parent/party
% of total or
% of total or
% of total or
% of total or
% of total or
% of total or
% of total or
% of total or
% of total or
% of total or
% of total or
% of total or
b.
c.
at a reasonable cost at this time.
petitioner/plaintiff
respondent/defendant other parent/party
The party providing coverage must assign the right of reimbursement to the other party.
Health insurance is not available to the
8.
Earnings assignment
An earnings assignment order is issued. Note: The payor of child support is responsible for the payment of support directly to the
recipient until support payments are deducted from the payor’s wages and for payment of any support not paid by the assignment.
c.
b.
CHILD SUPPORT INFORMATION AND ORDER ATTACHMENT
FL-342 [Rev. January 1, 2020]
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
CASE NUMBER:
FL-342
form FL-342
(
A
)
Page 3 of 3
THIS IS A COURT ORDER.
Notices
a.
Notice of Rights and Responsibilities (Health-Care Costs and Reimbursement Procedures) and Information Sheet on Changing
a Child Support Order ( ) must be attached and is incorporated into this order.
Child Support Case Registry Form
Both parties must complete and file with the court a Child Support Case Registry Form ( ) within 10 days of the date of
this order. Thereafter, the parties must notify the court of any change in the information submitted within 10 days of the change by
filing an updated form.
NOTICE: Any party required to pay child support must pay interest on overdue amounts at the legal rate, which is currently
10 percent per year.
11.
12.
13.
If this form is attached to Restraining Order After Hearing ( ), the support orders issued on this form (form FL-342)
remain in effect after the restraining orders issued on form DV-130 end.
b.
is ordered to seek employment with the
following terms and conditions:
Petitioner/plaintiff Other parent/party
Respondent/defendant
Employment search order (Family Code § 4505)
10.
9.
In the event that there is a contract between a party receiving support and a private child support collector, the party ordered to pay
support must pay the fee charged by the private child support collector. This fee must not exceed 33 1/3 percent of the total
amount of past due support nor may it exceed 50 percent of any fee charged by the private child support collector. The money
judgment created by this provision is in favor of the private child support collector and the party receiving support, jointly.
Other orders (specify):
CHILD SUPPORT INFORMATION AND ORDER ATTACHMENT
FL-342 [Rev. January 1, 2020]
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
CASE NUMBER:
FL-342
form FL-191
form FL-19
2
form DV130
THIS IS A COURT ORDER.
Page 1 of 3
Form Approved for Optional Use
Judicial Council of California
FL-343 [Rev. January 1, 2021]
SPOUSAL, DOMESTIC PARTNER, OR FAMILY SUPPORT ORDER ATTACHMENT
(Family Law)
Family Code, §§ 150, 299,
3651,3653, 3654, 4320,
4330, 4337
FL-343
PETITIONER:
RESPONDENT:
CASE NUMBER:
SPOUSAL, DOMESTIC PARTNER, OR FAMILY SUPPORT ORDER ATTACHMENT
TO
Findings and Order After Hearing (form FL-340)
Judgment (form FL-180)
Restraining Order After Hearing (CLETS-OAH) (form DV-130)
Other (specify):
Parties' Stipulation (Written Agreement) dated
THE COURT FINDS
THE PARTIES STIPULATE (AGREE)
(specify):
Specify if this attachment is about an order for temporary support or a judgment for permanent support (check either 1 or 2 below).
1.
This attachment relates to temporary spousal or domestic partner support.
a.
This order attachment modifies an order or agreement for temporary support entered on
(date):
b.
Net income. The parties' monthly income and deductions are as follows (complete (1), (2), or both):
(2) Respondent:
receiving TANF/CaIWORKS
$
$
$$
Total
gross monthly
income
Total
monthly
deductions
Total
hardship
deductions
Net monthly
disposable
income
(1) Petitioner:
receiving TANF/CaIWORKS
$
$
$
$
c.
A printout of a computer calculation of the parties' financial circumstances is attached for all required items not filled out
above (for temporary support only).
2.
This attachment relates to a judgment for permanent spousal or domestic partner support.
a.
This order attachment modifies a judgment entered on
(date):
b.
The parties were married for (specify):
months
and
years.
c.
The parties were registered as domestic partners or the equivalent for (specify):
months
and
years.
Family Code section 4320 factors (check either (1) or (2) below, then complete (3)).
d.
(1)
The parties agreed to some or all of the factors as stated in Spousal or Domestic Partner Support Declaration
Attachment (form FL-157) or in a similar written declaration filed with the court.
(2)
The court considered the parties' declarations and supporting documents regarding each Family Code section
4320 factor as stated in testimony, in Spousal or Domestic Partner Support Declaration Attachment (form
FL-157), or in a similar written declaration filed with the court.
(3)
The parties' agreement, or the court's findings, on Family Code section 4320 factors are (specify):
(B)
included in
Spousal or Domestic Partner Support Factors Under Family Code Section 4320—Attachment
(form ).
(C)
specified below:
(A)
included in Attachment 2d(3)(A).
www.courts.ca.
g
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FL-349
THIS IS A COURT ORDER.
Page 2 of 3
FL-343 [Rev. January 1, 2021]
SPOUSAL, DOMESTIC PARTNER, OR FAMILY SUPPORT ORDER ATTACHMENT
(Family Law)
FL-343
PETITIONER:
RESPONDENT:
CASE NUMBER:
f.
The standard of living established during the marriage or domestic partnership was (describe):
See Attachment 2f.
g.
The Court finds that the parties have knowingly, intelligently, and voluntarily entered into a stipulation.
2.
e.
The parties are both self-supporting.
3.
Jurisdiction
a.
The issue of support for the petitioner respondent is reserved for later determination.
b.
The court terminates jurisdiction over the issue of support for the petitioner respondent.
c.
The court's jurisdiction over the issue of support will end on
(specify date):
4.
Support amount and payment terms
a. The
petitioner respondent
must pay to the
petitioner respondent
as
temporary
permanent
spousal support
family support
domestic partner support
the following amount each month: $
b.
Support payments will begin (date):
c.
Support payments are:
(1)
payable through
(specify end date):
(2)
payable
on the:
day of each month.
(3)
Other (specify):
d.
Support must be paid by
check, money order, or cash
other method (specify):
a.
An earnings assignment for the support will issue as requested by
Note: The payor of spousal, family, or domestic partner support is responsible for the payment of support directly to the
recipient until support payments are deducted from the earnings, and for any support not paid by the assignment.
petitioner respondent.
b.
Service of the earnings assignment is stayed provided the payor is not more than (specify number):
days late
in paying spousal, family, or domestic partner support.
5.
Earnings assignment
Termination (end) of support6.
a. By law, unless the parties otherwise agree in writing, the support payor's obligation to pay support will end when either party
dies or the support payee remarries or registers a new domestic partnership.
b.
Parties' agreement
The parties agree that the support payor's obligation to pay support will not end as described in 6a. Instead, the support
payor's obligation to pay support will continue until (specify below the terms of your agreement about when the support
payee's obligation to pay support will end):
Page 3 of 3
FL-343 [Rev. January 1, 2021]
SPOUSAL, DOMESTIC PARTNER, OR FAMILY SUPPORT ORDER ATTACHMENT
(Family Law)
FL-343
PETITIONER:
RESPONDENT:
CASE NUMBER:
7.
Family support orders. This order is for family support.
a.
Both parties must complete and file with the court a Child Support Case Registry Form (form ) within 10 days of
the date of this order.
b.
The parents must notify the court of any change of information submitted within 10 days of the change by filing an updated
form.
A Notice of Rights and Responsibilities (Health-Care Costs and Reimbursement Procedures) and Information Sheet on
Changing a Child Support Order (form FL-192) must be attached to the court order.
c.
8.
Notice of change of employment
The parties must inform each other in writing within 10 days of any change of employment, and include the new employer’s
name, address, and telephone number.
9.
Duty to become self-supporting
a.
Notice: It is the goal of this state that each party must make reasonable good-faith efforts to become self-supporting as
provided in Family Code section 4320. Failure to make reasonable good-faith efforts may be one of the factors
considered by the court as a basis for modifying or terminating support.
b.
The petitioner respondent should make reasonable good-faith efforts to become self-supporting.
c.
Other (specify):
10.
Attachment to Restraining Order After Hearing (form DV-130)
a.
This form is attached to Restraining Order After Hearing (CLETS-OAH) (Order of Protection) (form DV-130).
b.
The orders issued on this form (FL-343) do not expire on termination of the restraining orders issued on form DV-130.
11.
Other orders or agreements (specify):
NOTICE: Any party required to pay support must pay interest on overdue amounts at the “legal” rate, which is currently
10 percent.
THIS IS A COURT ORDER.
FL-191
Form Approved for Optional Use
Judicial Council of California
FL-192 [Rev. January 1, 2021]
Family Code, §§ 4062, 4063
NOTICE OF RIGHTS AND RESPONSIBILITIES
Health-Care Costs and Reimbursement Procedures
FL-192
NOTICE OF RIGHTS AND RESPONSIBILITIES
Health-Care Costs and Reimbursement Procedures
IF YOU HAVE A CHILD SUPPORT ORDER THAT INCLUDES A PROVISION FOR THE
REIMBURSEMENT OF A PORTION OF THE CHILD'S OR CHILDREN'S HEALTH-CARE COSTS
AND THOSE COSTS ARE NOT PAID BY INSURANCE, THE LAW SAYS:
1. Notice. You must give the other parent an itemized
statement of the charges that have been billed for any health-
care costs not paid by insurance. You must give this
statement to the other parent within a reasonable time, but no
more than 30 days after those costs were given to you.
2. Proof of full payment. If you have already paid all of the
uninsured costs, you must (1) give the other parent proof that
you paid them and (2) ask for reimbursement for the other
parent's court-ordered share of those costs.
3. Proof of partial payment. If you have paid only your share
of the uninsured costs, you must (1) give the other parent
proof that you paid your share, (2) ask that the other parent
pay his or her share of the costs directly to the health-care
provider, and (3) give the other parent the information
necessary for that parent to be able to pay the bill.
4. Payment by notified parent. If you receive notice from a
parent that an uninsured health-care cost has been incurred,
you must pay your share of that cost within the time the court
orders; or if the court has not specified a period of time, you
must make payment (1) within 30 days from the time you were
given notice of the amount due, (2) according to any payment
schedule set by the health-care provider, (3) according to a
schedule agreed to in writing by you and the other parent, or
(4) according to a schedule adopted by the court.
5. Disputed charges. If you dispute a charge, you may file a
motion in court to resolve the dispute, but only if you pay that
charge before filing your motion. If you claim that the other
party has failed to reimburse you for a payment, or the other
party has failed to make a payment to the provider after proper
notice has been given, you may file a motion in court to resolve
the dispute. The court will presume that if uninsured costs have
been paid, those costs were reasonable. The court may award
attorney fees and costs against a party who has been
unreasonable.
6. Court-ordered insurance coverage. If a parent provides
health-care insurance as ordered by the court, that insurance
must be used at all times to the extent that it is available for
health-care costs.
a.
Burden to prove. The party claiming that the coverage is
inadequate to meet the child's needs has the burden of
proving that to the court.
b. Cost of additional coverage. If a parent purchases health-
care insurance in addition to that ordered by the court, that
parent must pay all the costs of the additional coverage. In
addition, if a parent uses alternative coverage that costs
more than the coverage provided by court order, that parent
must pay the difference.
7. Preferred health providers. If the court-ordered coverage
designates a preferred health-care provider, that provider
must be used at all times consistent with the terms of the
health insurance policy. When any party uses a health-care
provider other than the preferred provider, any health-care
costs that would have been paid by the preferred health
provider if that provider had been used must be the sole
responsibility of the party incurring those costs.
Page 1 of 2
www.courts.ca.
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FL-192 [Rev. January 1, 2021]
NOTICE OF RIGHTS AND RESPONSIBILITIES
Health-Care Costs and Reimbursement Procedures
Page 2 of 2
FL-192
INFORMATION SHEET ON CHANGING A CHILD SUPPORT ORDER
General Information
The court has just made a child support order in your case. This order will remain the same unless a party to the action requests that
the support be changed (modified). An order for child support can be modified only by filing a motion to change child support and
serving each party involved in your case. If both parents and the local child support agency (if it is involved) agree on a new child
support amount, you can complete, have all parties sign, and file with the court a Stipulation to Establish or Modify Child Support and
Order ( ) or Stipulation and Order (Governmental) ( ).
When a Child Support Order May Be Modified
The court takes several things into account when ordering the payment of child support. First, the number of children is considered.
Next, the net incomes of both parents are determined, along with the percentage of time each parent has physical custody of the
children. The court considers both parties’ tax filing status and may consider hardships, such as a child of another relationship. An
existing order for child support may be modified when the net income of one of the parents changes significantly, the parenting
schedule changes significantly, or a new child is born.
Examples
•
You have been ordered to pay $500 per month in child support. You lose your job. You will continue to owe $500 per month, plus
10 percent interest on any unpaid support, unless you file a motion to modify your child support to a lower amount and the court
orders a reduction.
•
You are currently receiving $300 per month in child support from the other parent, whose net income has just increased
substantially. You will continue to receive $300 per month unless you file a motion to modify your child support to a higher amount
and the court orders an increase.
•
You are paying child support based upon having physical custody of your children 30 percent of the time. After several months it
turns out that you actually have physical custody of the children 50 percent of the time. You may file a motion to modify child
support to a lower amount.
How to Change a Child Support Order
To change a child support order, you must file papers with the court. Remember: You must follow the order you have now.
What forms do I need?
If you are asking to change a child support order, you must fill out one of these forms:
•
, Request for Order or
•
, Notice of Motion and Motion for Simplified Modification of Order for Child, Spousal, or Family Support
You must also fill out one of these forms:
•
, Income and Expense Declaration or
•
, Financial Statement (Simplified)
What if I am not sure which forms to fill out?
Talk to the family law facilitator at your court.
After you fill out the forms, file them with the court clerk and ask for a hearing date. Write the hearing date on the form.
The clerk may ask you to pay a filing fee. If you cannot afford the fee, fill out these forms, too:
•
, Request to Waive Court Fees
•
, Order on Court Fee Waiver (Superior Court)
You must serve the other parent. If the local child support agency is involved, serve it too.
This means someone 18 or over—not you—must serve the other parent copies of your filed court forms at least 16 court days before
the hearing. Add 5 calendar days if you serve by mail within California (see Code of Civil Procedure section 1005 for other situations).
Court days are weekdays when the court is open for business (Monday through Friday except court holidays). Calendar days include
all days of the month, including weekends and holidays. To find court holidays, go to .
The server must also serve blank copies of these forms:
•
, Responsive Declaration to Request for Order and , Income and Expense Declaration,or
•
, Financial Statement (Simplified)
Then the server fills out and signs a Proof of Service ( or ). Take this form to the clerk and file it.
Go to your hearing and ask the judge to change the support. Bring your tax returns from the last two years and your last two
months' pay stubs. The judge will look at your information, listen to both parents, and make an order. After the hearing, fill out:
•
, Findings and Order After Hearing and
•
, Child Support Information and Order Attachment
Need help?
Contact the in your county or call your county's bar association and ask for an experienced family lawyer.
form FL-350
form FL-625
Form FL-300
Form FL-390
Form FL-150
Form FL-155
Form FW-001
Form FW-003
www.courts.ca.gov/holida
y
s.htm
Form FL-320
form FL-150
Form FL-155
form FL-330
form FL-335
Form FL-340
Form FL-342
famil
y
law facilitato
r
FL-190
FOR COURT USE ONLY
PETITIONER:
RESPONDENT:
CASE NUMBER:
NOTICE OF ENTRY OF JUDGMENT
You are notified that the following judgment was entered on (date):
1. Dissolution
2. Dissolution—status only
Dissolution—reserving jurisdiction over termination of marital status or domestic partnership
3.
4. Legal separation
Nullity
5.
Parent-child relationship6.
7.
Judgment on reserved issues
Other (specify):
8.
Date:
Clerk, by
, Deputy
—NOTICE TO ATTORNEY OF RECORD OR PARTY WITHOUT ATTORNEY—
Under the provisions of Code of Civil Procedure section 1952, if no appeal is filed the court may order the exhibits destroyed or
otherwise disposed of after 60 days from the expiration of the appeal time.
I certify that I am not a party to this cause and that a true copy of the Notice of Entry of Judgment was mailed first class, postage
fully prepaid, in a sealed envelope addressed as shown below, and that the notice was mailed
Effective date of termination of marital or domestic partnership status (specify):
WARNING: Neither party may remarry or enter into a new domestic partnership until the effective date of the termination
of marital or domestic partnership status, as shown in this box.
CLERK’S CERTIFICATE OF MAILING
Date:
Clerk, by
, Deputy
Page 1 of 1
NOTICE OF ENTRY OF JUDGMENT
(Family Law—Uniform Parentage—Custody and Support)
Family Code, §§ 2338, 7636,7637
Form Adopted for Mandatory Use
Judicial Council of California
FL-190 [Rev. January 1, 2005]
at (place):
on (date):
, California,
www.courtinfo.ca.gov
STATEMENT IN THIS BOX APPLIES ONLY TO JUDGMENT OF DISSOLUTION
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
Name and address of petitioner or petitioner's attorney Name and address of respondent or respondent's attorney
TELEPHONE NO.:
ATTORNEY FOR (Name):
FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
To keep other people from
seeing what you entered on
your form, please press the
Clear This Form button at the
end of the form when finished.
For your protection and privacy, please press the Clear
This Form button after you have printed the form.
JUDICIAL SUBPOENA
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
Courtat thethe Honorable
located at
County of
o'clock in theday of noon, and at any recessedin room , on the , 20 , at
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
I
Calendar No.
THE PEOPLE OF THE STATE OF NEW YORK
TO
Index No.
,
American LegalNet, Inc.
www.USCourtForms.com
Court in
Witness, Honorable , one of the Justices of the
day of , 20County,
COURT
COUNTY OF
Plaintiff(s)
-against-
Defendant(s)
:
:
:
:
:
:
:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mobile Tel. No.:
Print This Form
Clear This Form
FL-191
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
COURT PERSONNEL:
STAMP DATE RECEIVED HERE
DO NOT FILE
CHILD SUPPORT CASE REGISTRY FORM
CASE NUMBER:
Mother First form completed
Father
THIS FORM WILL NOT BE PLACED IN THE COURT FILE. IT WILL BE
MAINTAINED IN A CONFIDENTIAL FILE WITH THE STATE OF CALIFORNIA.
Notice: Pages 1 and 2 of this form must be completed and delivered to the court along with the court order for support.
Pages 3 and 4 are instructional only and do not need to be delivered to the court. If you did not file the court order, you must
complete this form and deliver it to the court within 10 days of the date on which you received a copy of the support order.
Any later change to the information on this form must be delivered to the court on another form within 10 days of the
change. It is important that you keep the court informed in writing of any changes of your address and telephone number.
ModificationInitial child support or family support orderb.
Total monthly base current child or family support amount ordered for children listed below, plus any monthly amount ordered
payable on past-due support:
(1) Current
base child
support:
(2) Additional
monthly
support:
Person required to pay child or family support (name):
Relationship to child (if applicable):
Person or agency to receive child or family support payments (name):
TYPE OR PRINT IN INK
Page 1 of 4
Family Code, § 4014
Form Adopted for Mandatory Use
Judicial Council of California
FL-191 [Rev. July 1, 2005]
CHILD SUPPORT CASE REGISTRY FORM
www.courtinfo.ca.gov
Change to previous information
Relationship to child (specify):
TELEPHONE NO.: FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT:
(5)
ordered but stayed until (date):
Wage withholding was
Support order information (this information is on the court order you are filing or have received).
ordered
(3) Total
past-due
support:
$
$
$
Date order filed:
1.
3.
2.
a.
c.
Child Support:
Family Support:
Spousal Support:
$0 (zero) order
Reserved order
(4) Payment
on past-
due support:
$
Current
base family
support:
Additional
monthly
support:
Total
past-due
support:
$
$
$
$0 (zero) order
Reserved order
Payment
on past-
due support:
$
Current
spousal
support:
Total
past-due
support:
$
$
$0 (zero) order
Reserved order
Payment
on past-
due support:
$
To keep other people from
seeing what you entered
on your form, please
press the Clear This Form
button at the end of the
form when finished.
JUDICIAL SUBPOENA
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
Courtat thethe Honorable
located at
County of
o'clock in theday of noon, and at any recessedin room , on the , 20 , at
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
I
Calendar No.
THE PEOPLE OF THE STATE OF NEW YORK
TO
Index No.
,
American LegalNet, Inc.
www.USCourtForms.com
Court in
Witness, Honorable , one of the Justices of the
day of , 20County,
COURT
COUNTY OF
Plaintiff(s)
-against-
Defendant(s)
:
:
:
:
:
:
:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mobile Tel. No.:
You are required to complete the following information about yourself. You are not required to provide information about the other
person, but you are encouraged to provide as much as you can. This form is confidential and will not be filed in the court file. It will be
maintained in a confidential file with the State of California.
Father’s name:
Date of birth:
Social security number:
Street address:
City, state, zip code:
Mailing address:
Driver’s license number:
State:
Telephone number:
Self-employedEmployed Not employed
g.
Employer’s name:
Street address:
City, state, zip code:
Telephone number:
7.
A restraining order, protective order, or nondisclosure order due to domestic violence is in effect.
Father
Mother
Children
The order protects:
Father
Mother
From:
The restraining order expires on (date):
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME) (SIGNATURE OF PERSON COMPLETING THIS FORM)
Page 2 of 4
CHILD SUPPORT CASE REGISTRY FORM
FL-191 [Rev. July 1, 2005]
a.
b.
c.
5.
a.
b.
c.
d.
e.
f.
Mother’s name:
Date of birth:
Social security number:
Street address:
City, state, zip code:
Mailing address:
City, state, zip code:
Driver’s license number:
State:
Telephone number:
Self-employedEmployed Not employed
g.
Employer’s name:
Street address:
City, state, zip code:
Telephone number:
a.
b.
c.
6.
d.
e.
f.
City, state, zip code:
PETITIONER/PLAINTIFF:
CASE NUMBER:
RESPONDENT/DEFENDANT:
OTHER PARENT:
The child support order is for the following children:
Date of birth
Social security number
a.
b.
Additional children are listed on a page attached to this document.
Child’s name
4.
c.
INFORMATION SHEET FOR CHILD SUPPORT CASE REGISTRY FORM
(Do NOT deliver this Information Sheet to the court clerk.)
Please follow these instructions to complete the Child Support Case Registry Form (form FL-191) if you do not have an attorney to
represent you. Your attorney, if you have one, should complete this form.
Both parents must complete a Child Support Case Registry Form. The information on this form will be included in a national database
that, among other things, is used to locate absent parents. When you file a court order, you must deliver a completed form to the court
clerk along with your court order. If you did not file a court order, you must deliver a completed form to the court clerk WITHIN 10 DAYS
of the date you received a copy of your court order. If any of the information you provide on this form changes, you must complete a
new form and deliver it to the court clerk within 10 days of the change. The address of the court clerk is the same as the one shown for
the superior court on your order. This form is confidential and will not be filed in the court file. It will be maintained in a confidential file
with the State of California.
INSTRUCTIONS FOR COMPLETING THE CHILD SUPPORT CASE REGISTRY FORM (TYPE OR PRINT IN INK):
If the top section of the form has already been filled out, skip down to number 1 below. If the top section of the form is blank, you
must provide this information.
Page 1, first box, top of form, left side
: Print your name, address, telephone number, fax number, and e-mail address, if any, in this box.
Attorneys must include their State Bar identification numbers.
Page 1, second box, top of form, left side
: Print the name of the county and the court’s address in this box. Use the same address for
the court that is on the court order you are filing or have received.
Page 1, third box, top of form, left side: Print the names of the petitioner/plaintiff, respondent/defendant, and other parent in this box.
Use the same names listed on the court order you are filing or have received.
Page 1, fourth box, top of form, left side
: Check the box indicating whether you are the mother or the father. If you are the attorney for
the mother, check the box for mother. If you are the attorney for the father, check the box for father. Also, if this is the first time you
have filled out this form, check the box by "First form completed.” If you have filled out form FL-191 before, and you are changing any
of the information, check the box by “Change to previous information.”
Page 1, first box, right side
: Leave this box blank for the court’s use in stamping the date of receipt.
Page 1, second box, right side
: Print the court case number in this box. This number is also shown on the court papers.
Instructions for numbered paragraphs:
Enter the date the court order was filed. This date is shown in the “COURT PERSONNEL: STAMP DATE RECEIVED HERE" box
on page 1 at the top of the order on the right side. If the order has not been filed, leave this item blank for the court clerk to fill in.
If the court order you filed or received is the first child or family support order for this case, check the box by “Initial child support
or family support order." If this is a change to your order, check the box by “Modification.”
Information regarding the amount and type of support ordered and wage withholding is on the court order you are filing or have
received.
If your order provides for any type of current support, check all boxes that describe that support. For example, if your order
provides for both child and spousal support, check both of those boxes. If there is an amount, put it in the blank provided. If
the order says the amount is reserved, check the “Reserved order” box. If the order says the amount is zero, check the “$0
(zero) order" box. Do not include child care, special needs, uninsured medical expenses, or travel for visitation here These
amounts will go in (2). Do NOT complete the Child Support Case Registry form if you receive spousal support only.
If your order provides for a set monthly amount to be paid as additional support for such needs as child care, special needs,
uninsured medical expenses or travel for visitation check the box in Item 2 and enter the monthly amount. For example, if
your order provides for base child support and in addition the paying parent is required to pay $300 per month, check the box
in item 2 underneath the "Child Support" column and enter $300. Do NOT check this box if your order provides only for a
payment of a percentage, such as 50% of the childcare.
Page 3 of 4
CHILD SUPPORT CASE REGISTRY FORM
FL-191 [Rev. July 1, 2005]
1. a.
b.
c.
(1)
(2)
Write the name of the person who is supposed to pay child or family support.
Write the name of the person or agency supposed to receive child or family support payments.
List the full name, date of birth, and social security number for each child included in the support order. If there are more than five
children included in the support order, check the box below item 4e and list the remaining children with dates of birth and social
security numbers on another sheet of paper. Attach the other sheet to this form.
The local child support agency is required, under section 466(a)(13) of the Social Security Act, to place in the records pertaining to
child support the social security number of any individual who is subject to a divorce decree, support order, or paternity determination
or acknowledgment. This information is mandatory and will be kept on file at the local child support agency.
Top of page 2, box on left side: Print the names of the petitioner/plaintiff, respondent/defendant, and other parent in this box. Use the
same names listed on page 1.
Top of page 2, box on right side
: Print your court case number in this box. Use the same case number as on page 1, second box,
right side.
You are required to complete information about yourself. If you know information about the other person, you may also fill in what you
know about him or her.
If you are the father in this case, list your full name in this space. See instructions for a–g under item 6 below.
If you are the mother in this case, list your full name in this space.
List the street address, city, state, and zip code where you want your mail sent, if different from the address where you live.
Indicate whether you are employed, not employed, self-employed, or by checking the appropriate box. If you are employed, write
the name, street address, city, state, zip code, and telephone number where you work.
If there is a restraining order, protective order, or nondisclosure order, check this box.
Check the box beside the parent who is restrained.
Write the date the restraining order expires. See the restraining order, protective order, or nondisclosure order for this date.
If you are in fear of domestic violence, you may want to ask the court for a restraining order, protective order, or nondisclosure order.
You must type or print your name, fill in the date, and sign the Child Support Case Registry Form under penalty of perjury. When you
sign under penalty of perjury, you are stating that the information you have provided is true and correct.
CHILD SUPPORT CASE REGISTRY FORM
FL-191 [Rev. July 1, 2005]
Page 4 of 4
If your order provides for a specific dollar amount to be paid towards any past due support, check the box in Item 4 that states
the type of past due support and enter the amount. For example, the court ordered $350 per month to be paid on the past due
child support, you would check the box in Item 4 in the "Child Support" column and enter $350.
If your order determined the amount of past due support, check the box in Item 3 that states the type of past due support and
enter the amount. For example, if the court determined that there was $5000 in past due child support and $1000 in past due
spousal support, you would check the box in item 3 in the "Child Support" column and enter $5000 and you would also check
the box in item 3 in the "Spousal Support" column and enter $1000.
(3)
(4)
2. a.
b.
3. a.
b.
4.
Write the relationship of that person to the child.
Write the relationship of that person to the child.
6.
5.
Check the box beside each person who is protected by the restraining order.
List your date of birth.
Write your social security number.
List the street address, city, state, and zip code where you live.
Write your driver's license number and the state where it was issued.
List the telephone number where you live.
7.
a.
b.
c.
d.
e.
f.
g.
a.
b.
c.
Check the "ordered" box if wage withholding was ordered with no conditions. Check the box "ordered but stayed until" if wage
withholding was ordered but is not to be deducted until a later date. If the court delayed the effective date of the wage
withholding, enter the specific date. Check only one box in this item.
(5)
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FINAL JUDGMENT Forms Packet (Forms Required to Prepare (California)

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Completed 9 March 2021

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