Form Adopted for Alternative Mandatory Use
Instead of Form FL-615, FL-625, FL-630, FL-665, or FL-687
Judicial Council of California
FL-692 [Rev. January 1, 2020]
MINUTES AND ORDER OR JUDGMENT
(Governmental)
Family Code, §§17400, 17406
www.courts.ca.gov
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
PETITIONER/PLAINTIFF:
FOR COURT USE ONLY
FL-692
MINUTES
ORDER
RECOMMENDED ORDER
JUDGMENT
CASE NUMBER:
Page 1 of 4
This form may be used for preparation of court minutes and/or as an alternative to form FL-615, FL-625, FL-630, FL-665, or FL-687. If
this form is prepared as both court minutes and an alternative to one of these forms, then the parties do not need to prepare any
additional form of order.
By stipulation
Uncontested
Contested
1.
a.
b. CommissionerJudge pro Tempore
Petitioner/plaintiff present
Respondent/defendant presente.
Other parent/party presentf.
c.
d.
i.
The parent ordered to pay support for purposes of this order is theh.
g.
Date: Time: Department:
Judicial officer (name):
Court reporter (name):
Court clerk (name):
Interpreter(s) present (name):
for (name):
(specify language):
Attorney present (name):
Attorney present (name):
Attorney present (name):
Attorney for local child support agency (name):
Other (specify):
2.
b.
This matter is taken off calendar.
This entire matter is denied with without prejudice.
This matter is continued at the request of thec. petitioner/plaintiff
respondent/defendant other parent/party
Petitioner/plaintiff Other parent/party is ordered to appear at that date and time.Respondent/defendant
Date: Time: Department:
(specific issues):
to
local child support agency
a.
This is a recommended order/judgment based on the objection of (specify name):
3.
d.
Order of examination4.
The petitioner/plaintiff respondent/defendant
was sworn and examined.
Examination was held outside of court.
5.
a.
The parties are referred to family court services or mediation.
The court takes the following matters under submission (specify):
Respondent/defendant is referred to the family law facilitator.Other parent/partyPetitioner/plaintiff
Other (specify):
b.
THE COURT FINDS
Other parent/party was was not6. Petitioner/plaintiff
served regarding this matter.
admits 7. denies parentage.
8.
This matter proceeded as follows:
Referrals
c.
Other parent/party
other (specify):
Respondent/defendant
Petitioner/plaintiff Respondent/defendant
other parent/party.
respondent/defendantpetitioner/plaintiff
The parents of the children named below in item 14a are (specify names):
FL-692 [Rev. January 1, 2020]
MINUTES AND ORDER OR JUDGMENT
(Governmental)
Page 2 of 4
FL-692
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
PETITIONER/PLAINTIFF:
CASE NUMBER:
9. Petitioner/plaintiff Other parent/party has read, understands, and has signed
the Advisement and Waiver of Rights for Stipulation (Governmental) (form FL-694). He or she gives up those rights and freely
agrees that a judgment may be entered in accordance with these findings.
This order is is not based on the guideline.
The attached Guideline Findings Attachment (Governmental) ( ) is incorporated into these findings.
e.
belowThe child support agreed to by the parents is
above the statewide child support guideline.
parties have been fully informed of their rights concerning child support. Neither party is acting out of duress or coercion.
Neither party is receiving public assistance, and no application for public assistance is pending. The needs of the children
will be adequately met by this agreed-upon amount of child support. The order is in the best interest of the children. If the
order is below the guideline, no change of circumstance will be required for the court to modify this order. If the order is
above the guideline, a change of circumstance will be required for the court to modify this order.
f.
11.
interest not computed and not waived.including interest
THE COURT ORDERS
All orders previously made in this action must remain in full force and effect except as specifically modified below.
13. Genetic testing must be coordinated by the local child support agency.
a.
Petitioner/plaintiff Mother of the children
b.
and the minor children must each submit to genetic testing as directed by the local child support agency.
Other (specify):
The parent ordered to pay support must reimburse the local child support agency for genetic testing costs of: $
Respondent/defendant
14.
The parent ordered to pay support is the parent of the children listed below and must pay current child support for them.
The court finds that there is sufficient evidence that the parent ordered to pay support is the parent of the children
listed below and therefore there is sufficient evidence to enter a support order.
Monthly basic support amount
Name of child
Date of birth
Additional children are listed on an attached page.
Other (specify):
The parent ordered to pay support must pay additional support monthly for the following (specify):
b.
c.
d.
e.
10. a.
b.
12.
A printout, which shows the calculation of child support payable, is attached and must become the court's findings.d.
a.
c.
Guideline support amount: $
Arrearages from (specify date):
through (specify date):
are: $
Respondent/defendant
The amount of support that would have been ordered under the guideline formula is: $
per month. The
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.
The low-income adjustment applies.
The low-income adjustment does not apply because (specific reasons):
State Disbursement Unitother parentPayments must be made to the
Payments must be made to the
percent of said costs.
one-half
(specify percent):
(specify amount): $
percent of said costs.
(specify percent):
(specify amount): $
The parent ordered to pay support must pay reasonable uninsured health-care costs for the children of
other parent
health-care provider.State Disbursement Unit
one-half
Payments must be made to the
one-half
State Disbursement Unit child-care provider.other parent
The parent ordered to pay support must pay additional support monthly for actual child-care costs of
(specify percent):
(specify amount): $
percent of said costs.
form FL-693
FL-692
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
PETITIONER/PLAINTIFF:
CASE NUMBER:
FL-692 [Rev. January 1, 2020]
MINUTES AND ORDER OR JUDGMENT
(Governmental)
Page 3 of 4
The parent ordered to pay support may claim the children for tax purposes as long as all child support payments are current
as of the last day of the year for which the exemptions are claimed.
16.
petitioner/plaintiff17.
other parent/party
Petitioner/plaintiff Respondent/defendant
spousal support family support
18. The parent ordered to pay support must pay child support for the following past periods and in the following amounts:
Name of child
Period of support
Amount
a.
Other (specify):
Interest accrues on the entire principal balance owing and not on each installment as it becomes due.
c.
b. day of each month
For a total of: $ payable: $ on the:
beginning (date):
a.
b. Interest is not computed and is not waived.
day of each monthc.
Interest accrues on the entire principal balance owing and not on each installment as it becomes due.
d.
Child support: $ Spousal support: $ Other: $
Payable: $
beginning (date):
on the:
Family support: $
19.
day of each month.
Other parent/party must pay to
respondent/defendant
as
14.
15. The parent ordered to pay support The parent receiving support must (1) provide and maintain health insurance
coverage for the children if available at no or reasonable cost and keep the local child support agency informed of the
availability of the coverage (the cost is presumed to be reasonable if it does not exceed 5 percent of gross income to add a
child); (2) if health insurance is not available, provide coverage when it becomes available; (3) within 20 days of the local
child support agency’s request, complete and return a health insurance form; (4) provide to the local child support agency all
information and forms necessary to obtain health-care services for the children; (5) present any claim to secure payment or
reimbursement to the other parent or caretaker who incurs costs for health-care services for the children; and (6) assign any
rights to reimbursement to the other parent or caretaker who incurs costs for health-care services for the children. 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.
f. day of each month
g.
Any support ordered will continue until further order of court, unless terminated by operation of law.h.
per month, beginning (date):
payable on the:
The parent ordered to pay support owes support arrears as follows, as of (date):
For a total of: $
payable on the:
$
No provision of this judgment can operate to limit any right to collect all sums owing in this matter as otherwise provided by law.20.
The low-income adjustment applies.
The low-income adjustment does not apply because (specific reasons):
beginning (date):
FL-692
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
PETITIONER/PLAINTIFF:
CASE NUMBER:
FL-692 [Rev. January 1, 2020]
MINUTES AND ORDER OR JUDGMENT
(Governmental)
Page 4 of 4
27.
a.
b.
Service is stayed until (date):
Bail is set in the amount of: $
28.
29.
all issuesThe court reserves jurisdiction over
the issues of (specify):
30.
The Notice of Rights and Responsibilities (Health-Care Costs and Reimbursement Procedures) and Information Sheet on
Changing a Child Support Order (form FL-192) are attached and incorporated.
32.
33.
The parents must notify the local child support agency in writing within 10 days of any change in residence or employment.
31.
must seek employment for
jobs per week and report those job applications and results to the court and the local
child support agency at the continuance date. These job applications are to be made in person, not by phone, fax, or e-mail.
25.
For purposes of the licensing issue only, the parent ordered to pay support is found to be in compliance with the support
order in this action. The local child support agency must issue a release of license(s).
Notwithstanding any noncompliance issues with the support order in this action, the court finds that the needs of the party
ordered to pay support warrant a conditional release. The local child support agency must issue a release of license(s). Such
release is effective only as long as the parent ordered to pay support complies with all payment terms of this order.
26.
34.
An earnings assignment order is issued.
22.
23.
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.
If "The parent ordered to pay support" box is checked in item 15, a health insurance coverage assignment must issue.
24.
Job search. (Specify name(s)):
at least least (specify number):
The court retains jurisdiction to make orders retroactive to (date):
21.
All payments, unless specified in items 14b, c, and d above, must be made to the State Disbursement Unit at the address listed
below (specify address):
The following person (the "other parent/party") is added as a party to this action (name):
A warrant of attachment/bench warrant issues for (specify name):
The court further orders (specify):
Approved as conforming to court order.
(SIGNATURE OF ATTORNEY FOR THE PARENT ORDERED TO PAY SUPPORT)
(SIGNATURE OF ATTORNEY FOR LOCAL CHILD SUPPORT AGENCY)
Date:
JUDICIAL OFFICER
Signature follows last attachment.
Number of pages attached:
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