TELEPHONE NO.:
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and address):
FOR COURT USE ONLY
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:
CASE NUMBER:
TERMINATION OF STAY
STAY
OF SERVICE OF EARNINGS ASSIGNMENT ORDER
APPLICATION FOR STAY
(NOTICE: If this application is made separately from a hearing on support, you must get a hearing date from the clerk and give notice.
See below.)
I request that the court stay the service of the earnings assignment order in this case because (check one or more applicable reasons):
I have paid fully and on time the previously ordered support for the last 12 months, and I do not owe any back support
(arrearages).
1.
a cash bond with thecashI have not been subject to a support order for the last 12 months, but I have posted
2.
clerk of the court in the amount of $
, which is equal to three months' support, and I do not owe any
back support (arrearages).
Service of the earnings assignment would cause extraordinary hardship on me as follows (state reasons):
(Note: You must prove these reasons at any hearing on this application by clear and convincing evidence.)
3.
I have a written agreement with the party receiving support that provides a stay of service of the earnings assignment order. A
copy of the agreement is attached. (Note: This agreement must be signed by the local child support agency if support is
payable to a county officer designated for that purpose.)
4.
My employer or the local child support agency has been unable to deliver the support payments to the recipient for at least six
months because the recipient has not notified my employer or the local child support agency of a change of address. (Attach a
statement made under oath by employer or local child support agency.)
5.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(SIGNATURE OF APPLICANT)
(TYPE OR PRINT NAME)
NOTICE OF HEARING
A hearing on this application will be held as follows:
Room:Dept.:
Time:
a. Date:
is shown aboveb. The address of the court
is:
STAY OF SERVICE OF EARNINGS ASSIGNMENT ORDER
Family Code, §§ 5260, 5261
Form Adopted for Mandatory Use
Judicial Council of California
FL-455 [Rev. January 1, 2003]
FL-455
Page 1 of 2
www.courtinfo.ca.gov
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.