Fillable FL-616 SUPERIOR COURT OF CALIFORNIA, COUNTY OF (California)

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FL-616 SUPERIOR COURT OF CALIFORNIA, COUNTY OF (California)

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DECLARATION FOR AMENDED PROPOSED JUDGMENT
GOVERNMENTAL AGENCY (under Family Code §§ 17400, 17406): TELEPHONE AND FAX NOS.:
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT:
DECLARATION FOR AMENDED PROPOSED JUDGMENT
CASE NUMBER:
The local child support agency is providing enforcement services in this case.
a Summons and Complaint Regarding Parental Obligations (form FL-600) was filed requesting On (date):
the Obligor pay child support based on the California support guideline. The amount of the support requested was based on the
Obligor's gross monthly income as follows (check one):
Presumed income as provided by law.
a.
per month.
Known income of: $
b.
Since the service of the Summons and Complaint Regarding Parental Obligations (form FL-600)
the local child support agency has received additional income information that would result in a different support order.
According to this information, Obligor's gross monthly income is: $
a.
Obligor's income has become unknown.
b.
An amended proposed judgment is attached.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(SIGNATURE OF DECLARANT)
(TYPE OR PRINT NAME)
Family Code, § 17400,
17406
Form Adopted for Mandatory Use
Judicial Council of California
FL-616 [Rev. January 1, 2003]
STREET ADDRESS:
3.
4.
1.
2.
3.
FL-616
Obligee's gross monthly income is: $
Other (specify):
c.
Page 1 of 2
www.courtinfo.ca.gov
(Governmental)
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PETITIONER/PLAINTIFF:
CASE NUMBER:
RESPONDENT/DEFENDANT:
OTHER PARENT:
I served this declaration and the attached amended proposed judgment on the Obligor.
a.
Personal delivery. I personally delivered this declaration and judgment to the Obligor as follows:
(1) Name:
(2) Address where delivered:
(3) Date of delivery:
(4) Time of delivery:
b.
Mail. I deposited this declaration and judgment in the United States mail, in a sealed envelope with postage
fully prepaid. I used first-class mail. The envelope was addressed and mailed as follows:
(1) Name:
(2) Address:
(3) Date of mailing:
(4) Place of mailing (city and state):
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(SIGNATURE OF PERSON WHO SERVED OBLIGOR)
(TYPE OR PRINT NAME)
I served this declaration and the attached amended proposed judgment on the other parent.
Personal delivery. I personally delivered this declaration and judgment to the other parent as follows:
a.
(1) Name:
(2) Address where delivered:
(3) Date of delivery:
(4) Time of delivery.
Mail. I deposited this declaration and judgment in the United States mail, in a sealed envelope with postage
fully prepaid. I used first-class mail. The envelope was addressed and mailed as follows:
b.
(1) Name:
(2) Address:
(3) Date of mailing:
(4) Place of mailing (city and state):
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(SIGNATURE OF PERSON WHO SERVED OTHER PARENT)
(TYPE OR PRINT NAME)
DECLARATION FOR AMENDED PROPOSED JUDGMENT
FL-616 [Rev. January 1, 2003]
PROOF OF SERVICE
5.
6.
Page 2 of 2
(Governmental)
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FL-616 SUPERIOR COURT OF CALIFORNIA, COUNTY OF (California)

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Completed 23 March 2022

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