-
PARTIES
petitioner/plaintiff respondent/defendant
1. The party waiving past support is
other parent
other (specify):
2. The party ordered to pay support is
3. The party ordered to pay support and the party waiving past support are the parties to this agreement.
RIGHT TO AN ATTORNEY
4. The parties understand their right to be represented by an attorney, at their expense, in connection with these proceedings.
NO TIME LIMIT FOR COLLECTION
5. The parties understand that the amounts owed for Non-Aid arrears (past-due child support ordered to be paid personally to the party
waiving support) remain owed until paid. There is no time limit for the collection of past-due support.
CONTINUING COLLECTION EFFORTS
6. All methods to collect or enforce the amounts past due may be used until the past due support is paid in full, including, but not limited
to, wage assignments, levy on assets, tax refund interception, license suspension, property liens, and contempt. The parties
understand that a waiver of support will stop all collection efforts of the support waived.
RIGHT TO DETERMINATION OF DISPUTED PAST SUPPORT
7. If the amount of past-due support is unknown or uncertain, the parties understand that they have the right to have the local child
support agency review and audit the amount due, including all amounts ordered, all payments, and all credits. The parties also
understand that if they are not satisfied with the agency's audit, they have the right to have a court hearing to determine the amount
due.
Page 1 of 4
STIPULATION AND ORDER WAIVING UNASSIGNED ARREARS
(Governmental)
Form Approved for Optional Use
Judicial Council of California
FL-626 [Rev. January 1, 2009]
www.courtinfo.ca.gov
FL-626
Instructions: This form is to be filled out if the party to whom support is owed wishes to give up the right to past-due support that is
owed to him or her. If either party has any questions about the possible consequences of this waiver, he or she should ask an
attorney. If either party has any questions about the case or the information on this form, he or she should ask the Family Law
Facilitator or the local child support agency.
Family Code, § 4503, 17526
FOR COURT USE ONLY
TELEPHONE NO.: FAX NO. (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
CASE NUMBER:
STIPULATION AND ORDER WAIVING UNASSIGNED ARREARS
(Governmental)
E-MAIL ADDRESS (Optional):
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT:
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
petitioner/plaintiff
respondent/defendant
other parent
other (specify):
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