FL-665
THIS MATTER PROCEEDED AS FOLLOWS
a. By court hearing, appearances as follows:
(2)
Petitioner/plaintiff present
(3)
(4)
(6)
(1)
Respondent/defendant present
Other parent/party present
(5)
Date:
Dept.:
Judicial officer:
Attorney present (name):
Attorney present (name):
Attorney present (name):
Local child support agency attorney (Family Code, §§ 17400, 17406) by (name):
Other (specify):
Attached is a computer printout showing the parents income and percentage of time each parent spends with the child(ren).
The printout, which shows the calculation of child support payable, will become the courts findings.
3.
4.
THE COMMISSIONER RECOMMENDS THE FOLLOWING
a. All orders previously made in this action remain in full force and effect except as modified below.
b.
are the parents of the children listed below.
The parent ordered to pay support must pay current child support as follows:
Name of child Date of birth Monthly support amount
father
mother
father
mother
(Name of parent):
(Name of parent):
(1) 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)
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.
Page 1 of 3
Family Code, § 4251
www.courts.ca.gov
Form Adopted for Alternative Mandatory Use
Instead of Form FL-692
Judicial Council of California
FL-665 [Rev. January 1, 2017]
FINDINGS AND RECOMMENDATION OF COMMISSIONER
(Governmental)
hearing this matter as a temporary judge.
1.
2.
b.
5.
petitioner/plaintiff respondent/defendant
The parent ordered to pay support is the
c.
other parent/party.
Name (specify):
objected to Commissioner (name):
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
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:
FINDINGS AND RECOMMENDATION OF COMMISSIONER
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
This recommended order is based on the attached documents (specify):
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
(1)
Other (specify):
(3)
Interest accrues on the entire principal balance owing and not on each installment as it becomes due.
(2)
day of each month
For a total of: $
payable: $
on the:
beginning (date):
(2)
Interest is not included and is not waived.
day of each month
Interest accrues on the entire principal balance owing and not on each installment as it becomes due.
Child support: $ Spousal support: $ Family support: $
Payable: $ on the:
beginning (date):
(3)
(4)
(1)
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.
The parent ordered to pay support owes support arrears as follows, as of (date):
f.
Page 2 of 3
FL-665 [Rev. January 1, 2017]
FINDINGS AND RECOMMENDATION OF COMMISSIONER
(Governmental)
e.
Any support ordered will continue until further order of court, unless terminated by operation of law.(5)
d.
(6)
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.
5.
c.
(3)
(4)
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):
(2)
FL-665
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
CASE NUMBER:
CLERKS CERTIFICATE OF MAILING OR SERVICE
I certify that I am not a party to this cause and that
1.
other parent/party
petitioner/plaintiff respondent/defendant
Mail. A true copy of this Findings and Recommendation of Commissioner was mailed first class, postage fully prepaid, in a
sealed envelope addressed as shown below, and that the request was mailed
2.
California,
Clerk, by
, Deputy
Page 3 of 3
FINDINGS AND RECOMMENDATION OF COMMISSIONER
(Governmental)
Personal service. A true copy of this Findings and Recommendation of Commissioner was handed to the
at the hearing of this matter before the commissioner.
FL-665 [Rev. January 1, 2017]
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.
m.
n.
k.
l .
The parents must notify the local child support agency in writing within 10 days of any change in residence or employment.
If "The parent ordered to pay support" box is checked in item 5d, a health insurance coverage assignment must issue.
o.
An earnings assignment order is issued.
i.
j.
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.
No provision of this judgment/order may 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.
h.
All payments, unless specified in item 5c(1) 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):
g.
COMMISSIONER
SIGNATURE FOLLOWS LAST ATTACHMENT
5.
Date:
Number of pages attached:
at (place):
on (date):
Date:
FL-665
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
CASE NUMBER:
The court further recommends (specify):
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