1.
Total amount unpaid (arrears) is at least:
2.
Date of order:
Payable by
Payable to
Total amount unpaid (arrears) is at least:
Payment of
Written notice of my intent to seek an earnings assignment was
a.
(1)
(2)
(3)
(4)
(specify):
by first class mail.
by personal service.
contained in the support order described in item 1 or 2.
other
Payable by (party):
Date of birth Monthly amountChild’s name
Payable to (party):
The amount of arrears stated in items 1f and 2d
(If penalties are not included, they are not waived.)
3.
b.
FL-430
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
TELEPHONE NO.:
FAX NO. (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARTY/PARENT:
FOR COURT USE ONLY
CASE NUMBER:
TERMINATE AN EARNINGS ASSIGNMENT ORDER
EX PARTE APPLICATION TO
MODIFY, OR
ISSUE,
(date):
Spousal or domestic partner support
family support was ordered as follows:
$
as of (date):
$
as of (date):
petitioner
other parent
other
respondent
respondent
(specify):
Interest and penalties
does
does not include interest at the legal rate. (If interest
does does not include penalties at the legal rate.
4.
(Complete for support ordered before July 1, 1990, only)
petitioner
child support
given at least 15 days before the date of filing this application
5.
An earnings assignment order has not been issued for support ordered after July 1, 1990.
Page 1 of 3
Family Code, §§ 3901, 5230, 5240, 5252
www.courts.ca.gov
EX PARTE APPLICATION TO ISSUE, MODIFY, OR
TERMINATE AN EARNINGS ASSIGNMENT ORDER
Form Adopted for Mandatory Use
Judicial Council of California
FL-430 [Rev. January 1, 2014]
E-MAIL ADDRESS (Optional):
b. c.
f.
d.
a.
b.
c.
d.a.
e.
The amount of arrears stated in items 1f and 2d
is not included, it is not waived.)
a.
b.
APPLICANT DECLARES
is overdue in the sum of at least one month's payment.
spousal or partner support
Child support was ordered as follows on
waived (explain):
7.
The local child support agency is no longer enforcing the current support obligation in this case but is required to
collect and enforce any arrears owing.
MODIFICATION OF CHILD SUPPORT EARNINGS ASSIGNMENT ORDER
Past due support has been paid in full, including any interest due.
TERMINATION OF CHILD SUPPORT EARNINGS ASSIGNMENT ORDER
The modified earnings assignment order is requested because (check all that apply):
ISSUANCE OF EARNINGS ASSIGNMENT ORDER
per month current spousal or domestic partner support.
a.
b.
d.
e.
g.
Total deductions per month:
c.
per month current child support.
per month current family support.
per month child support arrears.
per month spousal or domestic partner support arrears.
per month family support arrears.
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARTY/PARENT:
FL-430
CASE NUMBER:
$
6.
f.
$
The support arrears in this case are paid in full, including interest.
The earnings assignment order must be conformed to the most recent support order as follows (specify):
b.
c.
d.
e.
8.
The earnings assignment order for child support should be terminated because (check all that apply):
a.
b.
d.
f.
g.
h.
i.
There is no current support order.
The child reached age 18 and completed the 12th grade on
The child reached 18 and is no longer a full-time high school student as of
The child died on
The child married on
The child went on active duty with the armed forces of the United States on
details):
The child received a declaration of emancipation under Family Code section 7122 (name each child and give
(date):
(date):
(date):
(date):
(date):
EX PARTE APPLICATION TO ISSUE, MODIFY, OR
TERMINATE AN EARNINGS ASSIGNMENT ORDER
FL-430 [Rev. January 1, 2014]
Page 2 of 3
One or more of the following children listed in the child support order are emancipated (support is no longer
required by law) as of the following dates (name each emancipated child and date of emancipation):
a.
e.
The child reached age 19.
$
$
$
$
$
The existing earnings assignment order for child support should be modified as follows (specify):
Other (specify):
I request an earnings assignment order issue for the following monthly deductions:
c.
9.
MODIFICATION OF SPOUSAL, DOMESTIC PARTNER, OR FAMILY SUPPORT EARNINGS ASSIGNMENT ORDER
TERMINATION OF SPOUSAL, DOMESTIC PARTNER, OR FAMILY SUPPORT EARNINGS ASSIGNMENT ORDER
The modified earnings assignment order is requested because (check all that apply):
8.
(continued)
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
j.
l.
k.
(specify):
The State Disbursement Unit has been unable to deliver payment for a period of six months due to the failure
of the support recipient to notify the State Disbursement Unit of a change in his or her address.
The previous stay of the earnings assignment was improperly terminated
The existing earnings assignment order for spousal, domestic partner, or family support should be changed as follows
a.
b.
The support arrears in this case are paid in full, including interest.
The earnings assignment order must be conformed to the most recent support order as follows (specify):
c.
Past due support has been paid in full, including any interest due.
10.
The earnings assignment order for spousal, domestic partner, or family support should be terminated because (specify):
a.
b.
c.
d.
e.
f.
There is no current support order.
The supported spouse or domestic partner remarried or registered a domestic partnership on
The supported spouse or partner died on
By terms of the current order, spousal, partner, or family support terminated on
A previous stay of wage assignment was improperly terminated (specify):
(date):
(date):
(date):
g.
h.
The has been unable to deliver payment for a period of six
months due to the failure of the support recipient to notify that employer or the State Disbursement Unit of a
change in his or her address.
State Disbursement Unit
employer
SIGNATURE
(TYPE OR PRINT NAME)
Date:
Other (specify):
Other (specify):
Other (specify):
EX PARTE APPLICATION TO ISSUE, MODIFY, OR
TERMINATE AN EARNINGS ASSIGNMENT ORDER
FL-430 [Rev. January 1, 2014]
Page 3 of 3
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARTY/PARENT:
FL-430
CASE NUMBER:
(specify):
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