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
FL-170 [Rev. January 17, 2020]
Page 2 of 3
DECLARATION FOR DEFAULT OR UNCONTESTED
DISSOLUTION OR LEGAL SEPARATION
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.
Contained on Attachment 6d.
Contained on Attachment 6c.
Child support should be ordered as set forth in the proposed Judgment (form FL-180).
changed since it was last filed with the court. (If changed, attach updated form.)
The case number is (specify):
Child custody and visitation (parenting time) should be ordered as set forth in the proposed Judgment (form FL-180).
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):
Complete items (1) and (2) regarding public assistance.
The case number is (specify):
Contained on Attachment 7a(3).
(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.
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.)
Family support should be ordered as set forth in the proposed Judgment (form FL-180).
public assistance for the child or children
is not receiving public assistance.
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:
Spousal or Partner Support Declaration Attachment (form FL-157)
attached declaration (Attachment 8d)