FL-630
a.
NOTICE: THIS IS A
b.
This matter proceeded as follows:
Judgment entered under Family Code section 17430.
By court hearing, appearances as follows:
a.
b.
(2)
Other parent/party present
(3)
(4)
(6)
(1)
Petitioner/plaintiff present
Respondent/defendant present
(5)
Date: Dept.: Judicial officer:
Attorney present (name):
Attorney present (name):
Attorney present (name):
Local child support agency attorney (Family Code, §§ 17400,17406) (name):
3.
4.
5.
THE COURT ORDERS
The parent ordered to pay support must pay current child support as follows:
Name of child
Date of birth
Monthly support amount
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.
Family Code, §§17400,17402,
17404,17430
www.courts.ca.gov
JUDGMENT REGARDING PARENTAL OBLIGATIONS
(Governmental)
1.
2.
c.
6.
b.
Form Adopted for Alternative Mandatory Use
Instead of Form FL-692
Judicial Council of California
FL-630 [Rev. January 1, 2017]
The parent ordered to pay support is the
Regarding Parental Obligations will be entered by the court and will become legally binding unless you fill out and file
the Answer to Complaint or Supplemental Complaint Regarding Parental Obligations (Governmental) (form FL-610)
with the court clerk within 30 days of the date you were served with the Summons and Complaint or Supplemental
Complaint Regarding Parental Obligations (Governmental) (form FL-600). If you need form FL-610, you may get one
from the local child support agency’s office, the court clerk, or the family law facilitator. The family law facilitator will
help you fill out the forms. To file the answer, follow the procedures listed in the attached instructions.
This order is based on the attached documents (specify):
NOTICE: THIS IS A JUDGMENT. It is now legally binding.
AMENDED PROPOSED JUDGMENT. This Judgment
PROPOSED
respondent/defendant
other parent/party.
Petitioner/plaintiff
Respondent/defendant
Other parent/party are the parents of the children named in
GOVERNMENTAL AGENCY (under Family Code, §§ 17400, 17406):
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
FOR COURT USE ONLY
CASE NUMBER:
JUDGMENT REGARDING PARENTAL OBLIGATIONS
AMENDED
SUPPLEMENTAL
petitioner/plaintiff
Page 1 of 3
item 6b below.
a.
Attached is a computer printout showing the parents’ incomes and percentage of time each parent spends with the children.
The printout, which shows the calculation of child support payable, will become the court’s findings.
This order is based on presumed income for the parent ordered to pay support under Family Code section 17400.
Other (specify):
FL-630
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
CASE NUMBER:
(3)
Any support ordered will continue until further order of court, unless terminated by operation of law.
(4)
6.
(5)
The parent ordered to pay support must pay child support for the past periods and in the amounts set forth below:
Name of child Date of birth Period of support Amount
d.
Page 2 of 3
FL-630 [Rev. January 1, 2017]
JUDGMENT REGARDING PARENTAL OBLIGATIONS
(Governmental)
(1)b.
c.
The parent ordered to pay support
The parent receiving support must (1) provide and maintain health insurance
(2)
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.
When a person who has been ordered to pay child support is in jail or prison or is involuntarily institutionalized for any
period of more than 90 days in a row, the child support order is temporarily stopped. However, the child support order will
not be stopped if the person who owes support has the financial ability to pay that support while in jail, prison, or an
institution. It will also not be stopped if the reason the person is in jail, prison, or an institution is because the person didn't
pay court ordered child support or committed domestic violence against the supported person or child. The child support
order starts again on the first day of the month after the person is released from jail, prison, or an institution.
(6)
day of each monthFor a total of: $ payable on the:
beginning (date):
Other (specify):
The low-income adjustment applies.
The low-income adjustment does not apply because (specify reasons):
Mandatory additional child support.
one-half or % or
other parent
State Disbursement Unit child-care provider.
(specify amount): $
per month of the costs.
Payments must be made to the
The parent ordered to pay support must pay reasonable uninsured health-care costs for the children, as follows:
Payments must be made to the other parent
State Disbursement Unit
health-care provider.
one-half or % or
(specify amount): $
per month of the costs.
The parent ordered to pay support must pay additional monthly support for reasonable child-care costs, as follows:
(b)
(a)
The form Notice of Rights and Responsibilities (Health-Care Costs and Reimbursement Procedures) and Information Sheet on
Changing a Child Support Order (form FL-192) is attached.
JUDICIAL OFFICER
SIGNATURE FOLLOWS LAST ATTACHMENT
Approved as conforming to court order.
(SIGNATURE OF ATTORNEY FOR THE PARENT ORDERED TO PAY SUPPORT)
Page 3 of 3FL-630 [Rev. January 1, 2017]
JUDGMENT REGARDING PARENTAL OBLIGATIONS
(Governmental)
j.
k.
l.
m.
The parents must notify the local child support agency in writing within 10 days of any change in residence or employment.
n.
If "The parent ordered to pay support" box is checked in item 6c, a health insurance coverage assignment must issue.
6.
An earnings assignment order is issued.
h.
i.
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 this is a judgment on a Supplemental Complaint, it does not modify or supersede any prior judgment or order for support or
arrearage, unless specifically provided.
No provision of this judgment can operate to limit any right to collect the principal (total amount of unpaid support) or to charge
and collect interest and penalties as allowed by law. All payments ordered are subject to modification.
e.
f.
g.
(1)
Other (specify):
(2)
day of each month
(3)
Interest accrues on the entire principal balance owing and not on each installment as it becomes due.
All payments, unless specified in item 6b(1) above, must be made to the State Disbursement Unit at the address listed below
(specify address):
Date:
Number of pages attached:
Date:
For a total of: $ payable: $
on the:
beginning (date):
d.
FL-630
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
CASE NUMBER:
The following person (the "other parent/party") is added as a party to this action (name):
The court further orders (specify):
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