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HOW TO OBTAIN A JUDGMENT OF DISSOLUTION, LEGAL (California)

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Superior Court of California, County of Sacramento
Self Help Center
Page 1 of 13
03/5/2018
HOW TO OBTAIN A JUDGMENT OF DISSOLUTION,
LEGAL SEPARATION OR ANNULMENT
BY DEFAULT WITHOUT A COURT HEARING
Purpose of this Packet
This packet is designed to help you obtain a judgment by default without a court hearing. If
your spouse has not served and filed a Response and more than 30 days have passed since he or
she was served with the Summons and Petition, you are eligible to proceed by Default.
However, default is not automatic. You must file a Request to Enter Default and all of the
required judgment forms. These instructions are intended only for those cases that will proceed
all the way to judgment without a court hearing.
When you proceed by default, the Judge may only make orders about those items listed in your
Petition. For example, if you have property or debts that need to be divided or confirmed to one
spouse, and you did not list those items in the petition, you cannot address those items now.
Failure to include an asset or debt may enable your spouse to ask the Court to set aside your
judgment in the future. In order to avoid a possible set aside, be certain that all assets and debts
have been included in both your petition and your judgment. If you did not include an item you
wish the Court to address, consult with an attorney before you proceed by default.
Getting Started
You may only proceed by default if all of the following are true:
Ø
At least 31 days have elapsed since the date of service on the other party.
Ø
The Proof of Service of Summons was completed correctly by the person (some 18 years or
older who is not a party to your case) who served the documents.
Ø
The original Proof of Service of Summons has been filed.
Ø
No Response has been filed by your spouse.
Ø
Your preliminary and final financial disclosures have been served on your spouse and the
Declaration Regarding Service of Declaration of Disclosure has been filed with the Court.
Ø
Your spouse is not active duty military. (If your spouse is active duty military, seek legal
assistance from a private attorney.)
Is a Default Hearing Required?
When proceeding by Default, you may always request a Default Hearing. You may be able to
proceed without a Default Hearing if all of the following are true:
Superior Court of California, County of Sacramento
Self Help Center
Page 2 of 13
03/5/2018
Ø
You are not receiving public assistance in the form of a cash grant under TANF (formerly
AFDC) or CalWorks.
Ø
You are not seeking an initial child support or spousal support order.
Ø
You are not asking for an annulment.
These instructions will tell you how to proceed without a hearing. If you need to schedule a
default hearing, please refer to the instructions for that process.
Documents Needed to File
All forms listed in these instructions can be downloaded from the Court’s website at
www.saccourt.ca.gov.
Ø
Request to Enter Default, form FL-165
Ø
Income and Expense Declaration (if needed), form FL-150
Ø
Property Declaration (if needed), form FL-160
Ø
Declaration For Default Or Uncontested Dissolution or Legal Separation, form FL-170
Ø
Judgment, form FL-180
Ø
Notice of Entry of Judgment, form FL-190
If you have children with your spouse, you will also need:
Ø
Child Custody and Visitation Order Attachment, form FL-341
Ø
Child Support Information and Order Attachment, form FL-342
Ø
Child Support Case Registry Form, form FL-191 (if needed)
Ø
Notice of Rights and Responsibilities, form FL-192 (if needed)
In addition to the forms listed above, there are many optional Judicial Council forms that may
be included in you judgment. A complete list of all available forms can be found on the Court’s
web site.
Completing the Request to Enter Default, FL-165
In the top left box
of the document print your full name, mailing address and telephone number.
In the space next to "ATTORNEY FOR" print “Self.”
In the second box down
, the court’s name and address may already appear. If not, print the
following information:
Superior Court of California, County of Sacramento
3341 Power Inn Road
3341 Power Inn Road, Room 100
Sacramento, CA 95826
Family Relations Courthouse
Superior Court of California, County of Sacramento
Self Help Center
Page 3 of 13
03/5/2018
In the third box down
next to the word “Petitioner,” print your full name. Next to the
word “Respondent,” print your spouse’s full name.
In the fourth box from the top and to the right
, "case number" appears. Print your case number
here. You can find the case number on your Petition in approximately the same place.
Skip to item 2.
Item 2.
If you are asking the court to make child support or spousal support orders you must
attach an
Income and Expense Declaration, form FL-150,
to this form and check the box in
front of the words “is attached.” If you are receiving public assistance in the form of TANF,
CalWorks, and/or MediCal, you must complete and attach an
Income and Expense
Declaration
or
Financial Statement (Simplified), form FL-155
.
If you are not seeking support orders and you are not receiving public assistance, you may
check the box in front of the words “is not attached.”
If you listed community or separate property assets or debts on your Petition, you must attach a
Property Declaration and check the box in front of the words “is attached.” If not, check the
box in front of the words “is not attached.” If you have both community property and separate
property, you will need to prepare attachments for each (property must be separately listed for
each category).
If you checked the box “is not attached” for either Income and Expense Declaration or Property
Declaration, you will need to look at and check the appropriate box/es indicating why you did
not attach one or both, as follows:
Check box a
if you have filed an Income and Expense Declaration in the past 6 months and your
financial circumstances have not changed. The same applies to your Property Declaration, if
you have one.
Check box b
if you and your spouse have a signed and notarized written agreement addressing
all parts of the divorce or legal separation including child support, health insurance, spousal
support and property and debts. You will need to submit the agreement to the court for
signature by the Judge to make it an order.
Check box c
if you did not attach an Income and Expense Declaration and there are no issues of
child or spousal support, or attorney’s fees and costs.
Check box d
if you did not attach either the Income and Expense Declaration or the Property
Declaration, and you are not asking for any money, property, fees or costs from your spouse.
Check box e
if you do not have any property or debts that you acquired or incurred during your
marriage.
Do not check box f.
Superior Court of California, County of Sacramento
Self Help Center
Page 4 of 13
03/5/2018
Below the 6 boxes
print today’s date and your name, and then sign where indicated.
Item 3.
You must check either
box a
or
b
. If you had to have service of the Summons and
Petition done by either publication or posting, check,
box a
. For all others, check
box b
. If you
check
box b
you must provide a mailing address for your spouse. If you do not know your
spouse’s current address, print the last known address of your spouse.
Below item 3,
print today’s date and your name, and then sign where indicated.
In the bar at the top of page two,
complete the caption. Be sure to include your case number
where indicated.
Item 4.
Memorandum of Costs.
Check box 4(a)
, if your filing fees were waived by the Court. Skip
items 4(b)(1-3).
If you paid filing fees or other costs related to your court case, the Court may order your spouse
to reimburse you.
Check box 4(b)(1)
and print the amount you paid in filing fees.
Check box 4(b)(2)
and print the amount you paid in Process Server’s fees, if any.
Check box 4(b)(3)
and print the amount of any other fees you incurred in the filing and
processing of your case. Do not include any lost earnings for time you took off work. Add the
amounts listed in items 4(b)(1) through 4(b)(3) and print the sum on the “Total” line.
Read
item c.
Below item c
print today’s date and your name, then sign where indicated.
Item 5
.
Declaration of Non-Military Status.
If your spouse is active duty military, you may not be able to proceed with a default judgment.
Read
item 5
Below item 5,
if your spouse is not active duty military, print today’s date and your name, then
sign where indicated.
If your spouse is active duty military, do not continue. Seek legal assistance.
Completing the Income and Expense Declaration, form FL-150
Instructions for this form are contained in a separate packet. You may obtain the packet from
the court’s web site.
Superior Court of California, County of Sacramento
Self Help Center
Page 5 of 13
03/5/2018
Completing the Property Declaration, form FL-160
If you requested on your Petition that the court make orders dividing separate or community
property, you must complete a Property Declaration describing the separate and/or community
property. You may only propose a division of the property listed on your Petition.
In the top left box
of the document print your full name, mailing address and telephone number.
In the space next to “ATTORNEY FOR” print “Self.”
In the second box down
, the court’s name and address may already appear. If not, print the
following information:
Superior Court of California, County of Sacramento
3341 Power Inn Road
3341 Power Inn Road, Room 100
Sacramento, CA 95826
Family Relations Courthouse
In the third box down
next to the word “Petitioner,” print your full name. Next to the word
“Respondent,” print your spouse’s full name.
In the fourth box from the top
, check the box in front of the word “Petitioner’s.” Then check the
box identifying whether you are filling this form out to identify community (or quasi-
community) property, or separate property. If you are doing both, you will fill out two forms,
one for community property and one for separate property. Do not list community property and
separate property on the same form.
In the fourth box down and to the right
, print your case number.
In the column labeled “BRIEF DESCRIPTION,”
list each item or group of property or debt in
the appropriate category. Many items may be described as a group or set, for example,
“Household furniture” is usually acceptable rather than describing every chair, table and bed.
However, you may wish to list separately any items of particular value, (whether monetary or
sentimental). Continue on the back of the form. If there is not enough room to list your
property and debts, you may complete and attach a
Continuation of Property Declaration
(form
FL-161).
In the column labeled “GROSS FAIR MARKET VALUE,”
print the current fair market value of
each asset that you listed in the first column. The fair market value is the amount you believe
you could sell the item for in its current condition. A few items, such as real property, tend to
increase in value over time. Most other items decrease in value as they are used. If the assets to
be divided are considerable, you may wish to consult a professional in determining the value of
your assets. Items that are solely debts, such as credit card balances, have no fair market value.
Superior Court of California, County of Sacramento
Self Help Center
Page 6 of 13
03/5/2018
In the column labeled “AMOUNT OF DEBT,”
print the amount of debt, if any, that currently
remains on each item you listed.
In the column labeled “NET FAIR MARKET VALUE,”
calculate and print the net fair market
value by subtracting the amount of debt from the gross fair market value. In some instances, the
net fair market value of an asset may be negative.
In the two columns labeled “PROPOSAL FOR DIVISION AWARD TO,”
you will fill in your
proposed division of property. How you do it will depend on whether this declaration is for
separate property or community:
Separate Property:
If you checked the “
SEPARATE PROPERTY DECLARATION
,” box near
the top of the form, you are using the declaration to divide separate property. Separate property
are those assets and debts that were acquired before the date of marriage or after the date of
separation (both should be listed on your petition), or were acquired by gift or inheritance. To
propose your division of these items, print the net fair market value of each item in the column
for the person the property is to be confirmed to. If an item is your separate property, write the
dollar amount in the “PETITIONER” column. If an item is your spouse’s separate property,
write the dollar amount in the “RESPONDENT” column. Be sure to write debts as negative
numbers.
Community Property:
If you checked the “
COMMUNITY PROPERTY DECLARATION
,” box
near the top of the form, you are using the declaration to propose a division of community
property. In California, assets and debts acquired during marriage are considered to be the
community property of the marriage, and each spouse is entitled to half upon dissolution.
Propose a division of property by writing the dollar amount of each party’s proposed share in
the “PETITIONER” and “RESPONDENT” columns. The total of these two columns for each
item should equal the net fair market value you listed. Each asset or debt does not need to be
divided in half. You may unequally divide each asset, provided that when the division is
complete each party would have an equal share of the total community property or debt.
Please note that item 10, includes “
TAX REFUNDS
.” List a tax refund only if an anticipated tax
refund has yet to be paid. Do not list a tax refund that has already been paid, and instead
include any remainder as part of the “5. SAVINGS, CHECKING, CREDIT UNION, CASH”
category.
On line 14
, total up each of the columns, being sure to add the amounts from both sides of the
form. If you have more debts than assets, it is possible that your net fair market value total may
be negative.
If you are proposing a division of community property the column totals for Petitioner and
Respondent should be equal or favor the Respondent.
On line 15,
check the box if you attached a
Continuation of Property Declaration
form (FL-
161).
Superior Court of California, County of Sacramento
Self Help Center
Page 7 of 13
03/5/2018
Read the declaration at the bottom of the page,
then print the date and your name in the space
provided and sign where indicated.
Completing the Declaration For Default Or Uncontested Dissolution or Legal Separation,
form FL-170
In the top left box
of the document print your full name, mailing address and telephone number.
In the space next to "ATTORNEY FOR" print “Self.”
In the second box down
, the court’s name and address may already appear. If not, print the
following information:
Superior Court of California, County of Sacramento
3341 Power Inn Road
3341 Power Inn Road, Room 100
Sacramento, CA 95826
Family Relations Courthouse
In the third box down
next to the word “Petitioner,” print your full name, and next to the word
“Respondent,” print your spouse’s full name.
In the fourth box from the top
, check the appropriate box for either Dissolution or Legal
Separation.
In the second box on the right
, print your case number. You can find the case number on your
Petition in approximately the same place.
Read
items 1
and
2
.
Item 3.
Check the box for Petition.
Check box 4(a)
.
This states that your spouse did not file a Response and you are not asking the
court to order anything that is not on your Petition.
Check box 4(a)(3)(A)
if there is no assets or debts to divided.
Check box 4(a)(3)(B
) if you have property to be divided. You must complete a Property
Declaration (FL-160) showing your proposed division of the community property.
Box4(b)
is used if your spouse did not file a Response but you and your spouse have entered
into a Marital Settlement Agreement. If this is true in your case, these instructions will not be
sufficient to complete the process and you should consult a private attorney.
Box4(c)
is used if your spouse filed a Response and you and your spouse have entered into a
Marital Settlement Agreement. If this is true in your case, these instructions will not be
sufficient to complete the process and you should consult a private attorney.
Superior Court of California, County of Sacramento
Self Help Center
Page 8 of 13
03/5/2018
Check box 5(b)
.
This states that you have completed and served your Preliminary Declaration
of Disclosure and you are waiving the receipt of the final Declaration of Disclosure from your
spouse. Note, you must complete your preliminary and final Declaration of Disclosures and
serve them on your spouse before you can continue with this process.
.
In the boxes at the top of page two,
complete the caption. Be sure to include your case number
where indicated.
C
heck box 6 and complete items 6(a) to 6(d) i
f you have minor children with your spouse.
Check box 7 and complete items 7(a)
to 7(c) Note, if you or your spouse are on public
assistance you must request a default hearing and therefore do not complete the rest of this
form. Instead, follow the instructions for requesting a default hearing.
Check box 8(a)
if you want to give up your right to receive spousal support (alimony) from your
spouse. You may want to seek legal advice before you make this decision.
Check box 8(b)
if you do not want spousal support now, but want to preserve your right to
receive it in the future. Print your name next to the word “(name):”
Check box 8(c) if you would like the court end the spousal support award to your spouse ; you
will also need to check either the box for “petitioner” or “respondent” to indicate your spouse’s
party designation.
Check box 8(d)
if you checked
box 7(e)
on your Petition and are now asking for spousal support
to be paid by one of the parties. You will need to complete and attach to your Judgment the
Spousal, Partner or Family Support Order Attachment, form FL-343. In addition, you will need
to complete a Spousal or Partner Support Declaration, form FL-157 and check the box at 8(d) to
indicate that you completed and attached the form.
Check box 8(e)
if you are asking for family support to be paid by one of the parties. Family
support may not be right for your situation. You should seek legal assistance before asking the
court to order family support instead of child support and spousal support.
In the boxes at the top of page two,
complete the caption. Be sure to include your case number
where indicated.
Check box 9
if you have minor children with your spouse that were born prior to your date of
marriage. In addition, check either 9(a) or 9(b) to indicate how parentage was established.
Box 10
will most likely not affect you unless you hired an attorney at some point in this case.
However, if you requested that your spouse pay your attorneys fees in your Petition, check box
10 and check the box to indicate that you are completing form FL-319 or check the box to
indicate that you are providing the specify facts in the space provided at item 10.
Superior Court of California, County of Sacramento
Self Help Center
Page 9 of 13
03/5/2018
Box 11
only applies to those cases where a special hearing has been held and the Judge has
ordered that the Judgment be entered back to a specified date. This is only done in special cases
and requires the filing of a separate motion.
Check box 12
for Petitioner if you are asking to have your former name restored. You may not
ask to have Respondent’s former name restored. Each party must make this request on his or
her own.
Read
items 13, 14, 15
and 16
.
Compete Item 17. (Dissolution cases only)
if the only thing you are trying to accomplish at this
time is to terminate your marital status and you would like the court to decide all other issues,
such as child custody and division of property, at a later date.
Read item 18
if you are asking for a legal separation only.
At the bottom of the page,
print the date and your name where indicated and sign your name to
the right.
Completing the Judgment, form FL-180
Whether or not you are going to have a default hearing, you will need to complete a Judgment.
If you want your divorce to be final as soon as possible, you will want to take a partially
completed Judgment with you to your hearing.
In the top left box
of the document print your full name, mailing address and telephone number.
In the space next to "ATTORNEY FOR" print “Self.”
In the second box down
, the court’s name and address may already appear. If not, print the
following information:
Superior Court of California, County of Sacramento
3341 Power Inn Road
3341 Power Inn Road, Room 100
Sacramento, CA 95826
Family Relations Courthouse
In the third box down
next to the word “Petitioner,” print your full name, and next to the word
“Respondent,” print your spouse’s full name.
In the fourth box down
,
under the word ”Judgment,” check the appropriate box for Dissolution,
Legal Separation or Nullity (A nullity or annulment judgment cannot be granted without a
hearing). If you checked the box for Dissolution, you will need to indicate the date marital
status ends. If 6 months and a day have not passed since the day your spouse was served with
your Summons and Petition, print the date that will be 6 months and one day from the date your
spouse was served. This date can be found on your Proof of Service of Summons. If more than
six months have passed since your spouse was served, print “Upon Entry of This Judgment.”
Superior Court of California, County of Sacramento
Self Help Center
Page 10 of 13
03/5/2018
In the second box from the top on the right,
print your case number. You can find the case
number on your Petition in approximately the same place.
Check box 1
if you have a restraining order against your spouse. If the restraining order
contains personal conduct orders, also check the next box to the left of box 1. Print the page
numbers of the attachment for the restraining order and the date it will expire in the space
provided. You will have several pages of attachments unless there are no issues of custody,
support, property or restraining orders. The Judgment itself is page 1, so the first page of your
restraining order (or other attachment if you do not have a restraining order) will be page 2.
Box 2
indicates how this case came before the Judge. Check the box for “default or
uncontested.” If you are proceeding without a hearing, also check the box for “by declaration
under Family Code section 2336.”
Boxes 2(a-f)
apply only to hearings.
Item 3.
Print the date your spouse was served your Summons and Petition and check the box
next to the words “Respondent was served with process.”
Item 4.
Check
box 4(a)
if you are seeking a dissolution of marriage. Thereafter, check
box
4(a)(1)
and print the same date you did in the fourth box at the top of the page.
Check box 4(b)
if this is a legal separation.
Item 4(c)
only applies to nullity cases.
Item 4(d)
only applies to those cases where a special hearing has been held and the Judge has
ordered that the Judgment be entered back to a specified date. This is only done in special cases
and requires the filing of a separate motion.
Check box 4(f)
if you asked for your former name to be restored on your Petition. Print your
former name in the space provided. Be sure to ask the Judge to restore your former name if you
are going to a default hearing. If you did not ask for your former name restored on your
Petition, but would now like to go back to your former name, leave this space blank. Once your
Judgment has been signed by the Judge, there is a simple process for having your former name
restored. Staff of the Self Help Center can assist you with this process once your Judgment is
signed by the Judge.
Check box 4(g)
if this is a status only Judgment, or if the Judge has reserved jurisdiction over
some issues so that they can be decided at a later date.
Check box 4(h)
if you have minor children of your marriage. You must attach a “Notice of
Rights and Responsibilities/Information Sheet on Changing a Child Support Order,” form FL-
192, as the last page of your Judgment. Complete the “Child Support Case Registry,” form FL-
191, and submit it to the Court with (but not attached to) your Judgment.
Superior Court of California, County of Sacramento
Self Help Center
Page 11 of 13
03/5/2018
In the boxes at the top of page two,
complete the caption. Be sure to include your case number
where indicated.
Check boxes 4(i) and 4(i)(1)
if you have children of this relationship. You will need to list the
children by name and provide their date of birth in the space provided at item 4(i).
Check box 4(j)(2) if you checked box 4(i )
and the Judge has made a new custody and/or
visitation order and complete the Child Custody and Visitation Order Attachment” or form FL-
341.
Check box 4(k)(4)
if the Judge has confirmed an existing order and also include the case number
and the name of the court that made the order in the space provided. You will need to attach a
copy of the entire order to this Judgment.
Check box 4(k)(2) if you checked box 4(k)
and the Judge made a new child support order. By
checking this box you will need to complete a “Child Support Information and Order
Attachment ” of form FL-342.
The remaining items are explained later. You should complete any necessary attachments
before continuing.
Completing the Child Custody And Visitation Order Attachment, form FL-341
Use this attachment if child custody or visitation orders were requested in your petition. Refer
to the petition and include only those things which you requested.
In the boxes at the top of the page
, print the names of the parties and the case number. This is
known as the “caption.”
Directly below the words, “CHILD CUSTODY AND VISITATION (PARENTING TIME)
ORDER ATTACHMENT,” check the box for Attachment to “Judgment (form FL-180).”
Read items 1-4. Check the box at item 3 that indicates the country where the child(ren)
habitually reside. If the children reside outside of the United States, check the box for “other
(specify) and print the county in the space provided.
Complete all portions of items 5 through 14 that correspond with the orders requested in your
petition.
Go Back to the Judgment Now
Item 4l.
Spousal support must be addressed for both parties. Re-read your petition to see if you
asked the court for spousal support orders. If you did, or if you did not but now want spousal
support, you should seek legal advice before proceeding. If you marked the box to request that
the court terminate jurisdiction to order spousal support for your spouse you may ask the same
for yourself as well. To terminate spousal support, check
box 4(l)(2)
and select the a party
Superior Court of California, County of Sacramento
Self Help Center
Page 12 of 13
03/5/2018
(Petitioner and/or Respondent) you wish to have support terminated.
Complete item 4(m)
if you requested a property division in your petition.
Check box 4(o)
if you and your spouse have children together that were born prior to your
marriage.
Check box 4(n) and completed items (1) to (3)
if you are requesting attorney fees.
Box 4(o).
This area is for any other orders requested on your petition.
Item 5.
Print the number of pages you are attaching to the judgment. Be sure to include the
“Notice of Rights and Responsibilities/Information Sheet on Changing a Child Support Order”
(form FL-192) if you checked box 4(h) on your Judgment.
Completing the Notice of Entry of Judgment, form FL-190
In the top left box
print your full name, mailing address and telephone number. In the space
next to “ATTORNEY FOR” print “Self.”
In the second box down
,
the court’s name and address may already appear. If not, print the
following information:
Superior Court of California, County of Sacramento
3341 Power Inn Road
3341 Power Inn Road, Room 100
Sacramento, CA 95826
Family Relations Courthouse
In the third box down
next to the word “Petitioner,” print your full name, and next to the word
“Respondent,” print your spouse’s full name.
In the fourth box from the top and to the right
print your case number. You can find the case
number on your Petition in approximately the same place.
Items 1-8.
Check the box that is appropriate to your case. Check
box 1
for Dissolution,
box 4
for Legal Separation, or
box 5
for Nullity. Be sure to check one box only.
In the box that says “Statements in this box apply only to Judgments of Dissolution,” print the
date your divorce will be final. You will find the date in your Judgment on
line 4(a)(1)
. If you
are not seeking a divorce, leave this space blank.
Further down the page
near the bottom you will find 2 brackets just under “Date:” and “Clerk,
by.” Print your name and mailing address inside the bracket on the left and print your spouse’s
name and mailing address inside the bracket on the right.
Superior Court of California, County of Sacramento
Self Help Center
Page 13 of 13
03/5/2018
All child support in California must be paid by wage assignment and processed through the
State Disbursement Unit (SDU). In order to ensure that your child support payments will be
properly credited and paid, you must complete a “Child Support Case Registry Form,” FL-191,
if your judgment contains a child support order, even if it is $0 or “reserved.” Turn in the
completed Child Support Case Registry Form with the rest of your judgment documents.
Filing Your Papers
Make two copies of all the documents you completed. Attach your Income and Expense
Declaration and/or your Property Declaration, if needed, to the Request to Enter Default.
Address a stamped envelope to your spouse (unless you checked
Box 3a
on the Request to Enter
Default) and clip it to the Request to Enter Default.
Attach all completed attachments to your completed Judgment. If there are minor children of
this relationship you must attach the
Notice of Rights and Responsibilities, form FL-192
to
the end of your Judgment.
Address a large 9x12” envelope to yourself with enough postage to mail all of the forms and
copies back to you. Address a legal-sized #10 envelope to your spouse with enough postage for
the Court to mail him or her a copy of the Notice of Entry of Judgment only. Use the exact
same addresses that you printed at the bottom of the Notice of Entry of Judgment. If you
checked
box 3(a)
on the Request to Enter Default, you will only need one envelope, addressed
to yourself, as no copies will be mailed to your spouse.
Group the forms together so that the original of each document is on top of its own copies. You
may submit your documents and envelopes by mail or in the drop box located near the front
entrance of the courthouse.
Your signed, filed endorsed copy of the judgment will be returned to you by mail in the
envelope you provided once it has been approved and signed by the Judge. The review process
may take several weeks. One copy of the judgment is for your records. You must have another
adult serve the second copy on your spouse by mail or in person. Once this is done, have the
server complete a proof of service form and return it to you for filing with the court. The terms
of your judgment cannot be enforced until the proof of service has been filed with the court.
FL-165
FOR COURT USE ONLY
CASE NUMBER:
REQUEST TO ENTER DEFAULT
To the clerk:
Please enter the default of the respondent who has failed to respond to the petition.
is attached is not attached.
A completed
Property Declaration
(form FL-160) is attached is not attached
(a)
there have been no changes since the previous filing.
(b)
the issues subject to disposition by the court in this proceeding are the subject of a written agreement.
(c)
there are no issues of child, spousal, or partner support or attorney fees and costs subject to determination by the court.
(d)
(e)
Date:
(TYPE OR PRINT NAME) (SIGNATURE OF [ATTORNEY FOR] PETITIONER)
Declaration
A copy of this
Request to Enter Default,
including any attachments and an envelope with sufficient postage, was
provided to the court clerk, with the envelope addressed as follows
(address of the respondent’s attorney or, if none,
the respondent’s last known address):
a.
b.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)
FOR COURT USE ONLY
Request to Enter Default
mailed to the respondent or the respondent’s attorney on
(date):
Clerk, by
, Deputy
Page 1 of 2
Code of Civil Procedure, §§ 585, 587;
REQUEST TO ENTER DEFAULT
(Family Law—Uniform Parentage)
Form Adopted for Mandatory Use
Judicial Council of California
FL-165 [Rev. January 1, 2005]
Family Code, § 2335.5
1.
2. A completed
Income and Expense Declaration
(form FL-150) or
Financial Statement (Simplified)
(form FL-155)
this is an action to establish parental relationship.
there are no issues of division of community property.
the petition does not request money, property, costs, or attorney fees. (Fam. Code, § 2330.5.)
(f)
No mailing is required because service was by publication or posting and the address of the respondent remains unknown.
Default
not
entered. Reason:
Default entered as requested on
(date):
www.courtinfo.ca.gov
3.
PETITIONER:
RESPONDENT:
ATTORNEY OR PARTY WITHOUT ATTORNEY
(Name, State Bar number, and address):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
because
(check at least one of the following):
TELEPHONE NO.:
ATTORNEY FOR
(Name):
FAX NO.
(Optional):
E-MAIL ADDRESS
(Optional):
Sacramento
3341 Power Inn Road
Sacramento, CA 95826
William R. Ridgeway Family Relations Courthouse
CASE NUMBER:
Memorandum of costs
Costs and disbursements are waived.
Costs and disbursements are listed as follows:
Clerk’s fees
$
(1)
(2)
$Process server’s fees ...................................
Other
(specify): ...................................................................................................................
...................................
(3)
$
$
$
$
TOTAL
$
I am the attorney, agent, or party who claims these costs. To the best of my knowledge and belief, the foregoing items of
cost are correct and have been necessarily incurred in this cause or proceeding.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)
Declaration of nonmilitary status.
The respondent is not in the military service of the United States as defined in section 511 et
seq. of the Servicemembers Civil Relief Act (50 U.S.C. Appen. § 501 et seq.), and is not entitled to the benefits of such act.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)
FL-165 [Rev. January 1, 2005]
REQUEST TO ENTER DEFAULT
(Family Law—Uniform Parentage)
Page 2 of 2
4.
c.
5.
a.
b.
.............................................................................................................. ................................
...............................................................................................
........................................................................................................................................ ................................
........................................................................................................................................ ................................
........................................................................................................................................
................................................................................................................................... ................................
CASE NAME
(Last name, first name of each party):
(If you need more space to answer any questions on this form, attach an 8 1/2-by-11-inch sheet of paper and write the
question number before your answer.)
1.
Employment
(Give information on your current job or, if you're unemployed, your most recent job.)
Form Adopted for Mandatory Use
Judicial Council of California
FL-150 [Rev. January 1, 2019]
INCOME AND EXPENSE DECLARATION
Family Code, §§ 2030–2032, 2100–2113,
3552, 3620–3634, 4050–4076, 4300–4339
www.courts.ca.gov
Page 1 of 4
Employer:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
FOR COURT USE ONLY
CASE NUMBER:
INCOME AND EXPENSE DECLARATION
PARTY WITHOUT ATTORNEY OR ATTORNEY
STATE: ZIP CODE:CITY:
STREET ADDRESS:
FIRM NAME:
NAME:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (
name
):
STATE BAR NUMBER:
FL-150
Attach copies
of your pay
stubs for last
two months
(black out
Social
Security
numbers).
a.
Employer's address:
b.
Employer's phone number:
c.
Occupation:
d.
Date job started:
e.
If unemployed, date job ended:
f.
g. I work about hours per week.
h. I get paid $ gross (before taxes)
(If you have more than one job, attach an 8 1/2-by-11-inch sheet of paper and list the same information as above for your other
jobs. Write "Question 1—Other Jobs" at the top.)
2.
Age and education
My age is
(specify):
a.
b.
I have completed high school or the equivalent:
Yes
No
If no, highest grade completed
(specify):
Number of years of college completed
(specify):
c.
Degree(s) obtained
(specify):
Number of years of graduate school completed
(specify):
d.
Degree(s) obtained
(specify):
e. I have: professional/occupational license(s)
(specify):
vocational training
(specify):
3.
Tax information
a.
I last filed taxes for tax year
(specify year):
b. My tax filing status is
single
head of household married, filing separately
married, filing jointly with
(specify name):
c. I file state tax returns in California other
(specify state):
I claim the following number of exemptions (including myself) on my taxes
(specify):
d.
Other party's income.
I estimate the gross monthly income (before taxes) of the other party in this case at
(specify):
$
4.
This estimate is based on
(explain):
Number of pages attached:
I declare under penalty of perjury under the laws of the State of California that the information contained on all pages of this form and
any attachments is true and correct.
(SIGNATURE OF DECLARANT)
Date:
(TYPE OR PRINT NAME)
per month per week
per hour.
Sacramento
William R. Ridgeway Family Relations Courthouse
Sacramento, CA 95814
3341 Power Inn Road
3341 Power Inn Road
Spousal support
Spousal support that I pay by court order from a different marriage ..........................
Attach copies of your pay stubs for the last two months and proof of any other income. Take a copy of your latest federal tax
return to the court hearing.
(Black out your Social Security number on the pay stub and tax return.)
Income
(For average monthly, add up all the income you received in each category in the last 12 months
and divide the total by 12.)
FL-150 [Rev. January 1, 2019]
Page 2 of 4
INCOME AND EXPENSE DECLARATION
All other property,
(estimate fair market value minus the debts you owe)
.....c. real and personal
*
Check the box if the spousal support order or judgment was executed by the parties and the court before January 1, 2019, or if a court-ordered change
maintains the spousal support payments as taxable income to the recipient and tax deductible to the payor.
$
FL-150
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
5.
Salary or wages (gross, before taxes).....................................................................................................a.
Overtime (gross, before taxes)................................................................................................................b.
Commissions or bonuses.........................................................................................................................c.
Public assistance (for example: TANF, SSI, GA/GR) ..................................d.
e.
Partner supportf.
currently receiving
f
rom this marriage
from a different marriage
from this domestic partnership from a different domestic partnership
Pension/retirement fund payments..........................................................................................................g.
Social Security retirement (not SSI).........................................................................................................h.
Disability:i. Social Security (not SSI)
State disability (SDI) Private insurance
Unemployment compensation.................................................................................................................j.
Workers' compensation............................................................................................................................k.
l
. Other (military allowances, royalty payments)
(specify):
Investment income
(Attach a schedule showing gross receipts less cash expenses for each piece of property.)
6.
Dividends/interest....................................................................................................................................a.
Rental property income...........................................................................................................................b.
Trust income............................................................................................................................................c.
d. Other
(specify):
Income from self-employment, after business expenses for all businesses
.........................................7.
I am the owner/sole proprietor business partner other
(specify):
Number of years in this business
(specify):
Name of business
(specify):
Type of business
(specify):
Attach a profit and loss statement for the last two years or a Schedule C from your last federal tax return. Black out your
Social Security number. If you have more than one business, provide the information above for each of your businesses.
Additional income.
I received one-time money (lottery winnings, inheritance, etc.) in the last 12 months
(specify source and
amount):
8.
Change in income.
My financial situation has changed significantly over the last 12 months because
(specify):
9.
10.
Deductions
Required union dues....................................................................................................................................................a.
Required retirement payments (not Social Security, FICA, 401(k), or IRA)..................................................................b.
Medical, hospital, dental, and other health insurance premiums
(total monthly amount)
.............................................
c.
Child support that I pay for children from other relationships.......................................................................................d.
e.
Partner support that I pay by court order from a different domestic partnership..........................................................f.
Necessary job-related expenses not reimbursed by my employer
(attach explanation labeled "Question 10g")
.........
g.
11.
Assets
Cash and checking accounts, savings, credit union, money market, and other deposit accounts...............................a.
Stocks, bonds, and other assets I could easily sell.......................................................................................................b.
$
$
$
$
$
$
$
$
$
$
$
$
Last month
Average
monthly
$
$
$
$
$
Last month
Total
federally taxable*
federally tax deductible*
$
$
$
$
$
$
$
$
$
The following people live with me:
FL-150 [Rev. January 1, 2019]
Page 3 of 4
INCOME AND EXPENSE DECLARATION
FL-150
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
12.
Attorney fees
(This information is required if either party is requesting attorney fees):
15.
a.
b.
c.
d.
My attorney's hourly rate is
(specify):
I confirm this fee arrangement.
Average monthly expenses
13. Estimated expenses
Actual expenses Proposed needs
Installment payments and debts not listed above
14.
To date, I have paid my attorney this amount for fees and costs
(specify):
$
The source of this money was
(specify):
I still owe the following fees and costs to my attorney
(specify total owed):
$
(SIGNATURE OF DECLARANT)
Date:
(TYPE OR PRINT NAME)
Name
Age
How the person is
related to me
(ex: son)
That person's gross
monthly income
Pays some of the
household expenses?
a.
b.
c.
d.
e.
Yes
No
Yes No
Yes No
Yes No
Yes No
a. Home:
(1) Rent or
mortgage..........
$
$
$
$
$
$
If mortgage:
(a) average principal:
$
(b) average interest:
$
(2) Real property taxes..................................
(3) Homeowner's or renter's insurance
(if not included above)..............................
(4) Maintenance and repair...........................
b. Health-care costs not paid by insurance........
c. Child care.......................................................
$
d. Groceries and household supplies.................
$
e. Eating out.......................................................
$
f. Utilities (gas, electric, water, trash)................
$
g. Telephone, cell phone, and e-mail.................
$
$
h. Laundry and cleaning.....................................
i. Clothes...........................................................
$
j. Education.......................................................
$
k. Entertainment, gifts, and vacation..................
$
l
.
Auto expenses and transportation
(insurance, gas, repairs, bus, etc.).................
$
m. Insurance (life, accident, etc.; do not include
auto, home, or health insurance)...................
$
$
$
$
$
n. Savings and investments...............................
o. Charitable contributions..................................
p. Monthly payments listed in item 14
(itemize below in 14 and insert total here).....
q. Other
(specify):
r.
TOTAL EXPENSES
(a–q)
(do not add in
the amounts in a(1)(a) and (b))
$
s.
Amount of expenses paid by others
Paid to For Amount Balance Date of last payment
$
$
$
$
$
$
$
$
$
$
$
$
CHILD SUPPORT INFORMATION
(NOTE: Fill out this page only if your case involves child support.)
FL-150 [Rev. January 1, 2019]
Page 4 of 4
INCOME AND EXPENSE DECLARATION
FL-150
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
a.
b.
d.
(Do not include the amount your employer pays.)
Number of children
16.
I do I do not
I have
(specify number):
children under the age of 18 with the other parent in this case.a.
Name of insurance company:
The monthly cost for the
children's
health insurance is or would be
(specify):
$
The children spend percent of their time with me and percent of their time with the other parent.b.
Children's health-care expenses
17.
have health insurance available to me for the children through my job.
c.
Additional expense for the children in this case
18.
Childcare so I can work or get job training....................................................................a.
Children's health care not covered by insurance...........................................................b.
Travel expenses for visitation........................................................................................c.
Special hardships.
I ask the court to consider the following special financial circumstances19.
Extraordinary health expenses not included in 18b...................................a.
Major losses not covered by insurance
(examples: fire, theft, other
insured loss)
...............................................................................................
b.
Expenses for my minor children who are from other relationships and
are living with me..................................................................................
c.
d.
Children's educational or other special needs
(specify below):.....................................
(attach documentation of any item listed here, including court orders):
(1)
Names and ages of those children
(specify):
(2)
Child support I receive for those children...............................................(3)
20.
(If you're not sure about percentage or it has not been agreed on, please describe your parenting schedule here.)
Address of insurance company:
Amount per month
Other information I want the court to know concerning support in my case
(specify):
The expenses listed in a, b, and c create an extreme financial hardship because
(explain):
Amount per month
For how many months?
$
$
$
$
$
$
$
$
FL-160
ATTORNEY FOR (name):
E-MAIL ADDRESS:
FAX NO.:TELEPHONE NO.:
STATE: ZIP CODE:CITY:
STREET ADDRESS:
FIRM NAME:
NAME:
PARTY WITHOUT ATTORNEY OR ATTORNEY
STATE BAR NUMBER:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
CASE NUMBER:
PETITIONER'S
RESPONDENT'S
COMMUNITY AND QUASI-COMMUNITY PROPERTY DECLARATION
SEPARATE PROPERTY DECLARATION
See Instructions on page 4 for information about completing this form. For additional space, use Continuation of Property Declaration
(form FL-161).
A
B C - D = E
F
ITEM BRIEF DESCRIPTION
NO.
DATE
ACQUIRED
GROSS FAIR
MARKET
VALUE
AMOUNT
OF DEBT
NET FAIR
MARKET
VALUE
PROPOSAL FOR DIVISION
Award or Confirm to:
PETITIONER RESPONDENT
1. REAL ESTATE $ $ $ $ $
2. HOUSEHOLD FURNITURE,
FURNISHINGS, APPLIANCES
3. JEWELRY, ANTIQUES, ART,
COIN COLLECTIONS, etc.
4. VEHICLES, BOATS, TRAILERS
5. SAVINGS ACCOUNTS
6. CHECKING ACCOUNTS
Page 1 of 4
Form Approved for Mandatory Use
Judicial Council of California
FL-160 [Rev. July 1, 2016]
PROPERTY DECLARATION
(Family Law)
Family Code, §§ 115, 2104, 2500-2660
www.courts.ca.gov
Sacramento
William R. Ridgeway Family Relations Courthouse
3341 Power Inn Road
A
B C - D = E
F
ITEM BRIEF DESCRIPTION
NO.
DATE
ACQUIRED
GROSS FAIR
MARKET
VALUE
AMOUNT
OF DEBT
NET FAIR
MARKET
VALUE
PROPOSAL FOR DIVISION
Award or Confirm to:
PETITIONER RESPONDENT
7. CREDIT UNION, OTHER
$ $ $ $ $
DEPOSITORY ACCOUNTS
8. CASH
9. TAX REFUND
10. LIFE INSURANCE WITH CASH
SURRENDER OR LOAN VALUE
11. STOCKS, BONDS, SECURED
NOTES, MUTUAL FUNDS
12. RETIREMENT AND PENSIONS
13. PROFIT-SHARING, IRAS,
DEFERRED COMPENSATION,
ANNUITIES
14. ACCOUNTS RECEIVABLE,
UNSECURED NOTES
15. PARTNERSHIP, OTHER
BUSINESS INTERESTS
16. OTHER ASSETS
17. ASSETS FROM CONTINUATION
SHEET
18. TOTAL ASSETS
Page 2 of 4
PROPERTY DECLARATION
(Family Law)
FL-160
FL-160 [Rev. July 1, 2016]
A B C D
ITEM DEBTS—
NO. SHOW TO WHOM OWED
DATE INCURRED TOTAL OWING
PROPOSAL FOR DIVISION
Award or Confirm to:
PETITIONER RESPONDENT
19. STUDENT LOANS
$ $ $
20. TAXES
21. SUPPORT ARREARAGES
22. LOANS—UNSECURED
23. CREDIT CARDS
24. OTHER DEBTS
25. OTHER DEBTS FROM
CONTINUATION SHEET
26. TOTAL DEBTS
Page 3 of 4
PROPERTY DECLARATION
(Family Law)
FL-160
SIGNATURE
(TYPE OR PRINT NAME)
Date:
I declare under penalty of perjury under the laws of the State of California that, to the best of my knowledge, the foregoing is a true
and correct listing of assets and obligations and the amounts shown are correct.
A Continuation of Property Declaration (form FL-161) is attached and incorporated by reference.
FL-160 [Rev. July 1, 2016]
click to sign
signature
click to edit
INFORMATION AND INSTRUCTIONS FOR COMPLETING FORM FL-160
Property Declaration (form FL-160) is a multipurpose form, which may be filed with the court as an attachment to a
Petition or Response or served on the other party to comply with disclosure requirements in place of a Schedule of
Assets and Debts (form FL-142). Courts may also require a party to file a Property Declaration as an attachment to a
Request to Enter Default (form FL-165) or Judgment (form FL-180).
When filing a Property Declaration with the court, do not include private financial documents listed below.
Identify the type of declaration completed
1. Check "Community and Quasi-Community Property Declaration" on page 1 to use Property Declaration (form FL-160)
to provide a combined list of community and quasi-community property assets and debts. Quasi-community property is
property you own outside of California that would be community property if it were located in California.
2. Do not combine a separate property declaration with a community and quasi-community property declaration. Check
"Separate Property Declaration" on page 1 when using Property Declaration to provide a list of separate property
assets and debts.
Description of the Property Declaration chart
Pages 1 and 2
1. Column A is used to provide a brief description of each item of separate or community or quasi-community property.
2. Column B is used to list the date the item was acquired.
3. Column C is used to list the item's gross fair market value (an estimate of the amount of money you could get if you
sold the item to another person through an advertisement).
4. Column D is used to list the amount owed on the item.
5. Column E is used to indicate the net fair market value of each item. The net fair market value is calculated by
subtracting the dollar amount in column D from the amount in column C ("C minus D").
6. Column F is used to show a proposal on how to divide (or confirm) the item described in column A.
Page 3
1. Column A is used to provide a brief description of each separate or community or quasi-community property debt.
2. Column B is used to list the date the debt was acquired.
3. Column C is used to list the total amount of money owed on the debt.
4. Column D is used to show a proposal on how to divide (or confirm) the item of debt described in column A.
When using this form only as an attachment to a Petition or Response
1. Attach a Separate Property Declaration (form FL-160) to respond to item 9. Only columns A and F on pages 1 and 2
and columns A and D on page 3 are required.
2. Attach a Community or Quasi-Community Declaration (form FL-160) to respond to item 10, and complete column A on
all pages.
When serving this form on the other party as an attachment to Declaration of Disclosure (form FL-140)
1. Complete columns A through E on pages 1 and 2, and columns A through C on page 3.
2. Copies of the following documents must be attached and served on the other party:
(a) For real estate (item 1): deeds with legal descriptions and the latest lender's statement.
(b) For vehicles, boats, trailers (item 4): the title documents.
(c) For all bank accounts (item 5, 6, 7): the latest statement.
(d) For life insurance policies with cash surrender or loan value (item 10): the latest declaration page.
(e) For stocks, bonds, secured notes, mutual funds (item 11): the certificate or latest statement.
(f) For retirement and pensions (item 12): the latest summary plan document and latest benefit statement.
(g) For profit-sharing, IRAs, deferred compensation, and annuities (item 13): the latest statement.
(h) For each account receivable and unsecured note (item 14): documentation of the account receivable or note.
(i) For partnerships and other business interests (item 15): the most current K-1 and Schedule C.
(j) For other assets (item 16): the most current statement, title document, or declaration.
(k) For support arrearages (item 21): orders and statements.
(l) For credit cards and other debts (items 23 and 24): the latest statement.
3. Do not file copies of the above private financial documents with the court.
When filing this form with the court as a attachment to Request to Enter Default (FL-165) or Judgment (FL-180)
Complete all columns on the form.
For more information about forms required to process and obtain a judgment in dissolution, legal separation, and nullity
cases, see http://www.courts.ca.gov/8218.htm.
Page 4 of 4
PROPERTY DECLARATION
(Family Law)
FL-160
FL-160 [Rev. July 1, 2016]
Form Adopted for Mandatory Use
Judicial Council of California
FL-180 [Rev. July 1, 2012]
CASE NUMBER:
JUDGMENT
NULLITYLEGAL SEPARATIONDISSOLUTION
Status only
Reserving jurisdiction over termination of marital or domestic
partnership status
Date marital or domestic partnership status ends:
Default or uncontested By declaration under Family Code section 2336This proceeding was heard as follows:
Contested
Room:Dept.:Date:
Temporary judge
Judicial officer
(name):
Attorney present in court
(name):
Claimant present in court
(name):
c.
d.
Attorney present in court
(name):
e.
The court acquired jurisdiction of the respondent on
(date):
The respondent appeared.
The respondent was served with process.
THE COURT ORDERS, GOOD CAUSE APPEARING
Judgment of dissolution is entered. Marital or domestic partnership status is terminated and the parties are restored to the
status of single persons
a.
on
(specify date):
(1)
(2)
Judgment of nullity is entered. The parties are declared to be single persons on the ground of
(specify):
b.
c.
petitioner's
e.
f.
d.
JUDGMENT
(Family Law)
Family Code, §§ 2024, 2340,
2343, 2346
www.courts.ca.gov
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER:
FL-180
TELEPHONE NO.:
ATTORNEY OR PARTY WITHOUT ATTORNEY
(Name, State Bar number, and address):
ATTORNEY FOR
(Name):
FAX NO.
(Optional):
RESPONDENT:
1.
2.
3.
4.
a.
b.
Petitioner present in court
Respondent present in court Attorney present in court
(name):
on a date to be determined on noticed motion of either party or on stipulation.
Judgment of legal separation is entered.
This judgment will be entered nunc pro tunc as of
(date):
Jurisdiction is reserved over all other issues, and all present orders remain in effect except as provided below.
This judgment
The restraining orders are contained on page(s) of the attachment. They expire on
(date):
MARRIAGE OR PARTNERSHIP OF
former name is restored to
(specify):
respondent's
Judgment on reserved issues
f. Other
(specify name):
g.
Judgment on reserved issues.
h. This judgment contains provisions for child support or family support. Each party must complete and file with the court a
Child Support Case Registry Form
(form FL-191) within 10 days of the date of this judgment. The parents must notify the
court of any change in the information submitted within 10 days of the change, by filing an updated form. The
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.
Page 1 of 2
contains personal conduct restraining orders
modifies existing restraining orders.
a.
b.
E-MAIL ADDRESS
(Optional):
The
Agreement in court
Sacramento
3341 Power Inn Road
Sacramento, CA 95826
William R. Ridgeway Family Relations Courthouse
click to sign
signature
click to edit
FL-180 [Rev. July 1, 2012]
JUDICIAL OFFICER
Date:
Number of pages attached:
Parentage is established for children of this relationship born prior to the marriage or domestic partnership
CASE NAME
(Last name, first name of each party):
CASE NUMBER:
k.
Child support is ordered as set forth in the attached
Previously established in another case. Case number: Court:
j.
l.
Child custody and visitation (parenting time) are ordered as set forth in the attached
Spousal, domestic partner, or family support is ordered:
As set forth in the attached
Spousal, Partner, or Family Support Order Attachment
(form FL-343).
Each attachment to this judgment is incorporated into this judgment, and the parties are ordered to comply with each attachment's
provisions. Jurisdiction is reserved to make other orders necessary to carry out this judgment.
5.
JUDGMENT
(Family Law)
Page 2 of 2
4.
Stipulation to Establish or Modify Child Support and Order
(form FL-350).
SIGNATURE FOLLOWS LAST ATTACHMENT
Stipulation and Order for Custody and/or Visitation of Children
(form FL-355).
Reserved for future determination as relates to petitioner respondent
Other
(specify):
o.
(2)
(3)
(2)
(3)
(4)
(1)
(3)
(4)
Property division is ordered as set forth in the attached
m.
Settlement agreement, stipulation for judgment, or other written agreement.
Other
(specify):
Property Order Attachment to Judgment
(form FL-345).
(1)
(2)
(3)
Dissolution or legal separation may automatically cancel the rights of a spouse or domestic partner under the other spouse's or
domestic partner's will, trust, retirement plan, power of attorney, pay-on-death bank account, transfer-on-death vehicle registration,
survivorship rights to any property owned in joint tenancy, and any other similar property interest. It does not automatically cancel the
rights of a spouse or domestic partner as beneficiary of the other spouse's or domestic partner's life insurance policy. You should
review these matters, as well as any credit cards, other credit accounts, insurance policies, retirement plans, and credit reports, to
determine whether they should be changed or whether you should take any other actions.
An earnings assignment may be issued without additional proof if child, family, partner, or spousal support is ordered.
Any party required to pay support must pay interest on overdue amounts at the "legal rate," which is currently 10 percent.
A debt or obligation may be assigned to one party as part of the dissolution of property and debts, but if that party does not pay the
debt or obligation, the creditor may be able to collect from the other party.
NOTICE
FL-180
i.
Name Birthdate
The children of this marriage or domestic partnership are:
(2)
(1)
Attorney fees and costs are ordered as set forth in the attached
n.
Attorney Fees and Costs Order
(form FL-346).
Other
(specify):
(2)
(3)
Other
(specify):
As set forth in the attached settlement agreement, stipulation for judgment, or other written agreement.
(5)
Jurisdiction terminated to order spousal or partner support to petitioner respondent
(2)
Settlement agreement, stipulation for judgment, or other written agreement which contains the information
required by Family Code section 3048(a).
(1)
Settlement agreement, stipulation for judgment, or other written agreement which contains the declarations
required by Family Code section 4065(a).
(1)
Child Custody and Visitation Order Attachment
(form FL-341).
Child Support Information and Order Attachment
(form FL-342).
Previously established in another case. Case number: Court:
(4)
Settlement agreement, stipulation for judgment, or other written agreement.
(1)
d.
a.
(name):
will be as follows:
The parties will go to child custody mediation or child custody recommending counseling at (specify date, time, and
No Visitation (Parenting Time)
Visitation (Parenting Time) for the
petitioner
respondent other
location):
-page document See the attached
b.
c.
e.
Reasonable right of visitation to the party without physical custody (not appropriate in cases involving domestic
violence)
(1)
at
(day of week) (time)
from
1st 2nd 3rd 4th 5th weekend of the month
p.m./ if applicable, specify:a.m.
at
(day of week) (time)
to
a.m.
p.m./ if applicable, specify:
after school
start of school
after school
start of school
(Note: The first weekend of the month is the first weekend with a Saturday.)
(date):
Weekends starting
(b)
(a)
having the initial fifth weekend, which starts (date):
The parties will alternate the fifth weekends, with the
other parent/party
respondent
petitioner
even numbered months.odd
The other parent/party respondentpetitioner will have the
CHILD CUSTODY AND VISITATION (PARENTING TIME)
ORDER ATTACHMENT
Family Code, §§ 3020, 3022, 3025,
3040–3043, 3048, 3100, 6340, 7604
www.courts.ca.gov
Form Approved for Optional Use
Judicial Council of California
FL-341 [Rev. July 1, 2016]
5.
7.
Page 1 of 3
Penalties for violating this order. If you violate this order, you may be subject to civil or criminal penalties, or both.
4.
6.
THIS IS A COURT ORDER.
CHILD CUSTODY AND VISITATION (PARENTING TIME) ORDER ATTACHMENT
TO
Stipulation and Order fo Custody and/or Visitation of Children (form FL-355)
Findings and Order After Hearing (form FL-340) Judgment (form FL-180) Judgment (form FL-250)
Other (specify):
1.
2.
Jurisdiction. This court has jurisdiction to make child custody orders in this case under the Uniform Child Custody Jurisdiction and
Enforcement Act (Fam. Code, §§ 3400–3465).
Notice and opportunity to be heard. The responding party was given notice and an opportunity to be heard, as provided by the
laws of the State of California.
3. Country of habitual residence. The country of habitual residence of the child or children in this case is
(specify):
Other
the United States
Child Custody. Custody of the minor children of the parties is awarded as follows:
Child abduction prevention. There is a risk that one of the parties will take the children out of California without the other
party's permission. (Child Abduction Prevention Orders Attachment (form FL-341(B)) must be attached and must be obeyed.)
Visitation (Parenting Time)
Child's Name
Legal custody to: (person who makes
decisions about health, education, etc.)
Birth Date
Physical custody to:
(person with whom child lives)
FL-341
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
fifth weekend in
10.
a.
c.
b.
(specify):
the state of California.
the following counties
other places
(specify):
9.
b.
c.
d.
a.
(address):
(specify):
Transportation to begin the visits will be provided by the
Transportation from the visits will be provided by the
The exchange point at the beginning of the visit will be at
The exchange point at the end of the visit will be at
During the exchanges, the party driving the children will wait in the car and the other party will wait in his or her
home (or exchange location) while the children go between the car and the home (or exchange location).
Other (specify):
other
respondent petitioner
(address):
(specify):
other
respondent petitioner
The children must be driven only by a licensed and insured driver. The car or truck must have legal child restraint
devices.
f.
g.
e.
8.
(specify):
FL-341 [Rev. July 1, 2016]
(You must attach Supervised Visitation Order (form FL-341(A).)
must have written permission from the other parent or a court order to take the children out of
The
(name):
will have supervised visitation (parenting time) with the minor children according to the schedule set forth on page 1.
(2)
Alternate weekends starting
(date):
at
(day of week) (time)
from
a.m.
p.m./ if applicable, specify:
at
(day of week)
to a.m.
p.m./ if applicable, specify:
after school
start of school
after school
start of school
after school
start of school
after school
start of school
(time)
(3)
(date):
Weekdays starting
at
(day of week) (time)
from
at
(day of week) (time)
to
(4)
Other visitation (parenting time) days and restrictions are:
listed in Attachment 7e(4) (form
as follows:
MC-025 may be used for this purpose)
p.m./ if applicable, specify:
a.m.
a.m.
p.m./ if applicable, specify:
e.
Visitation (Parenting Time) (continued)
Supervised visitation (parenting time). Until
Transportation for visitation (parenting time)
further order of the court other
other
respondent petitioner
Travel with children. The
petitioner respondent other parent/party
(name):
CHILD CUSTODY AND VISITATION (PARENTING TIME)
ORDER ATTACHMENT
Page 2 of 3
THIS IS A COURT ORDER.
FL-341
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
7.
12.
13.
15.
attached schedule. (Additional Provisions—Physical Custody Attachment (form FL-341(D)) may be used for this purpose.)
(Joint Legal Custody Attachment (form FL-341(E)) may be used for this purpose.)
11. The children will spend holiday time as listed
Holiday Schedule Attachment (form FL-341(C)) may be used for this purpose.)
Other (specify):
FL-341 [Rev. July 1, 2016]
CHILD CUSTODY AND VISITATION (PARENTING TIME)
ORDER ATTACHMENT
Page 3 of 3
THIS IS A COURT ORDER.
Holiday schedule.
below
in the attached schedule (Children's
The parties will follow the additional custody provisions listed
Additional custody provisions.
below in the
The parties will share joint legal custody as listed Joint legal custody.
in the attached schedule. below
14. Access to children's records. Both the custodial and noncustodial parent have the right to access records and information
about their minor children (including medical, dental, and school records) and consult with professionals who are providing services
to the children.
FL-341
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
FL-341(A)
CASE NUMBER:
PETITIONER/PLAINTIFF:
OTHER PARENT/PARTY:
RESPONDENT/DEFENDANT:
SUPERVISED VISITATION ORDER
Attachment to Child Custody and Visitation (Parenting Time) Order Attachment (form FL-341)
1.
abduction of child(ren)
sexual abuse
physical abuse
domestic violence
drug abuse
alcohol abuse
neglect
(specify):
other
2.
The court finds, under Family Code section 3100, that the best interest of the child(ren) requires that visitation by
THE COURT MAKES THE FOLLOWING ORDERS
3.
CHILD(REN) TO BE SUPERVISED
Child's Name
SexAgeBirth Date
4.
TYPE
a.
Supervised visitation
b.
Supervised exchange only
5.
SUPERVISED VISITATION PROVIDER
a.
Professional (individual provider or supervised visitation center)
b.
Nonprofessional
6.
AUTHORIZED PROVIDER
Name
TelephoneAddress
Any other mutually agreed-upon third party as arranged.
7.
DURATION AND FREQUENCY OF VISITS (see form FL-341 for specifics of visitation):
8.
PAYMENT RESPONSIBILITY % % %
Petitioner:
Respondent:
9.
Petitioner will contact professional provider or supervised visitation center no later than
(date):
Respondent will contact professional provider or supervised visitation center no later than
(date):
THE COURT FURTHER ORDERS
10.
Page 1 of 1
SUPERVISED VISITATION ORDER
Family Code, §§ 3100, 3031
www.courts.ca.gov
Date:
JUDICIAL OFFICER
Form Adopted for Mandatory Use
Judicial Council of California
FL-341(A) [Rev. January 1, 2015]
Evidence has been presented in support of a request that the contact of
with the child(ren) be supervised based upon allegations of
Petitioner Respondent
Other Parent/Party
disputes these allegations and the court reserves the findings on
these issues pending further investigation and hearing or trial.
Petitioner
Respondent Other Parent/Party
must, until further order of the court, be limited to contact
supervised by the person(s) set forth in item 6 below pending further investigation and hearing or trial.
Petitioner Respondent Other Parent/Party
Other Parent/Party:
Other Parent/party will contact professional provider or supervised visitation center no later than
(date):
FL-342
CHILD SUPPORT INFORMATION AND ORDER ATTACHMENT
TO
THE COURT USED THE FOLLOWING INFORMATION IN DETERMINING THE AMOUNT OF CHILD SUPPORT:
1.
2.
Gross monthly
income
Net monthly
income
Receiving
TANF/CaIWORKS
Each parent’s monthly income is as follows:
Imputation of income. The court finds that the
and has based the support order upon this imputed income.
3.
%
%
4.
Hardships for the following have been allowed in calculating child support:
Petitioner/
plaintiff
Respondent/
defendant
Approximate ending time
for the hardship
a.
b.
c.
THE COURT ORDERS
5.
6.
a.
Base child support
(date): and continuing until further order of the court, or until the child marries, dies, is emancipated, reaches
age 19, or reaches age 18 and is not a full-time high school student, whichever occurs first, as follows:
Payable to (name):
Date of birth Monthly amount
one-half on the 1st and one-half on the 15th of the monthPayable
THIS IS A COURT ORDER.
Page 1 of 3
CHILD SUPPORT INFORMATION AND ORDER ATTACHMENT
Form Adopted for Mandatory Use
Judicial Council of California
FL-342 [Rev. January 1, 2017]
Family Code, §§ 4055–4069
www.courts.ca.gov
Child’s name
%
must pay child support beginning
has the capacity to earn:
a.
b.
Other parent/
party
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
CASE NUMBER:
a.
b.
Petitioner/plaintiff: $
Respondent/defendant: $
Other parent/party: $
$
$
$
$
$
$
$
$
$
$
$
$
Number of children who are the subjects of the support order (specify):
Approximate percentage of time spent with petitioner/plaintiff:
Respondent/defendant:
Other parent/party:
The low-income adjustment applies.
Other minor children:
Extraordinary medical expenses:
Catastrophic losses:
Child support
Petitioner/plaintiff
Respondent/defendant Other parent/party
Petitioner/plaintiff
Respondent/defendant
Other parent/party
Hardships
Children of this relationship
Income
Low-income adjustment
Findings and Order After Hearing (form FL-340)
Restraining Order After Hearing (CLETS-OAH) (form DV-130)
Judgment (form FL-180)
$
per
(specify):
on the 1st of the month
Other
a.
b.
other (specify):
The low-income adjustment does not apply because (specify reasons):
A printout of a computer calculation and findings is attached and incorporated in this order for all required items not filled out
below.
This order does not meet the child support guideline set forth in Family Code section 4055. Non-Guideline Child Support
Findings Attachment (form FL-342(A)) is attached.
(1)
(2)
their respective places of employment or self-employment. Both parties are ordered to cooperate in the presentation, collection,
and reimbursement of any health-care claims. 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.
THIS IS A COURT ORDER.
Page 2 of 3
CHILD SUPPORT INFORMATION AND ORDER ATTACHMENT
FL-342 [Rev. January 1, 2017]
d.
7.
Health-care expenses
Health insurance coverage for the minor children of the parties must be maintained by the
a.
per month.
per month.
per month.
per month.
per month.
per month.
if available at no or reasonable cost through
FL-342
(2)
Reasonable uninsured health-care costs for the children
per month.
per month.
per month.
c.
Mandatory additional child support
THE COURT FURTHER ORDERS
per month child-care costs.
(d)
(c)
6. b.
(1)
Child-care costs related to employment or reasonably necessary job training
per month
per month
child-care costs.
child-care costs.
(a)
(b)
e.
Child Support Order Suspension
f.
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.
Total child support per month: $
$
$
$
$
$
$
$
$
$
$
$
$
Mandatory additional child support
Additional child support
Non-Guideline Order
Petitioner/plaintiff must pay:
Respondent/defendant must pay:
Other parent/party must pay:
Costs to be paid as follows
(specify):
(d)
(c)
(a)
(b)
Petitioner/plaintiff must pay:
Respondent/defendant must pay:
Other parent/party must pay:
Costs to be paid as follows
(specify):
(d)
(c)
(a)
(b)
Petitioner/plaintiff must pay:
Respondent/defendant must pay:
Other parent/party must pay:
Costs to be paid as follows
(specify):
(d)
(c)
(a)
(b)
Petitioner/plaintiff must pay:
Respondent/defendant must pay:
Other parent/party must pay:
Costs to be paid as follows
(specify):
Costs related to the educational or other special needs of the children
Travel expenses for visitation
petitioner/plaintiff
respondent/defendant other parent/party
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
CASE NUMBER:
% of total or
% of total or
% of total or
% of total or
% of total or
% of total or
% of total or
% of total or
% of total or
% of total or
% of total or
% of total or
Notices
a.
Notice of Rights and Responsibilities (Health-Care Costs and Reimbursement Procedures) and Information Sheet on Changing
a Child Support Order (form FL-192) must be attached and is incorporated into this order.
Child Support Case Registry Form
Both parties must complete and file with the court a Child Support Case Registry Form (form FL-191) within 10 days of the date of
this order. Thereafter, the parties must notify the court of any change in the information submitted within 10 days of the change by
filing an updated form.
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.
THIS IS A COURT ORDER.
Page 3 of 3
CHILD SUPPORT INFORMATION AND ORDER ATTACHMENT
FL-342 [Rev. January 1, 2017]
FL-342
11.
12.
13.
If this form is attached to Restraining Order After Hearing (form DV-130), the support orders issued on this form (form FL-342)
remain in effect after the restraining orders issued on form DV-130 end.
b.
9.
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.
is ordered to seek employment with the
10.
8.
Earnings assignment
An earnings assignment order is issued. Note: The payor of child support is responsible for the payment of support directly to the
recipient until support payments are deducted from the payor’s wages and for payment of any support not paid by the assignment.
b.
c.
at a reasonable cost at this time.
7.
following terms and conditions:
petitioner/plaintiff
respondent/defendant other parent/party
The party providing coverage must assign the right of reimbursement to the other party.
Health insurance is not available to the
Petitioner/plaintiff
Respondent/defendant Other parent/party
Employment search order (Family Code § 4505)
Other orders (specify):
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
CASE NUMBER:
FL-342(A)
PETITIONER/PLAINTIFF:
CASE NUMBER:
RESPONDENT/DEFENDANT:
NON-GUIDELINE CHILD SUPPORT FINDINGS ATTACHMENT
Child Support Information and Order Attachment (form FL-342)
Attachment to
Judgment (Family Law) (form FL-180) Other
(specify):
The court makes the following findings required by Family Code sections 4056, 4057, and 4065:
1. STIPULATION TO NON-GUIDELINE ORDER
below orThe child support agreed to by the parties is above
The 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. If the order is below the guideline, no change of
circumstances will be required to modify this order. If the order is above the guideline, a change of circumstances will be
required to modify this order.
OTHER REBUTTAL FACTORS
2.
Support calculation
per month
payable
by petitioner/plaintiff respondent/defendant
per month.increase
c. The court finds the child support amount revised by these factors to be in the best interest of the child and that application
These changes remain in effect until
(date):
until further order
d.
The factors are:
(1)
The sale of the family residence is deferred under Family Code section 3800, and the rental value of the
family residence in which the children reside exceeds the mortgage payments, homeowners insurance, and
property taxes by: $
(2)
The parent paying support has extraordinarily high income, and the amount determined under the guideline
would exceed the needs of the child. (Fam. Code, § 4057(b)(3).)
is not contributing to the needs of the The petitioner/plaintiff
(3)
children at a level commensurate with that party’s custodial time. (Fam. Code, § 4057(b)(4).)
(4)
Special circumstances exist in this case. The special circumstances are:
(i) The parents have different timesharing arrangements for different children.
(Fam. Code, § 4057(b)(5) (A).)
The parents have substantially equal custody of the children and one parent has a much lower or (ii)
(iii)
Other (Fam. Code, § 4057(b)(5))
(specify):
(iv)
Page 1 of 1
NON-GUIDELINE CHILD SUPPORT FINDINGS ATTACHMENT
Family Code, § 4056
Form Adopted for Mandatory Use
Judicial Council of California
FL-342(A) [Rev. January 1, 2008]
www.courtinfo.ca.gov
higher percentage of income used for housing than the other parent.
(Fam. Code, § 4057(b)(5)(B).)
The child has special medical or other needs that require support greater than the formula amount.
These needs are (Fam. Code, § 4057(b)(5)(C))
(specify):
per month. The amount of support that would have been ordered under the guideline formula is: $
a. The guideline amount of child support calculated is: $
b. The court finds by a preponderance of the evidence that rebuttal factors exist. The rebuttal factors result in an
decrease in child support. The revised amount of support is: $
of the formula would be unjust or inappropriate in this case.
per month. (Fam. Code, § 4057(b)(2).)
respondent/defendant
the statewide child support guidelines.
FL-191
ATTORNEY OR PARTY WITHOUT ATTORNEY
(Name, State Bar number, and address):
COURT PERSONNEL:
STAMP DATE RECEIVED HERE
DO NOT FILE
CHILD SUPPORT CASE REGISTRY FORM
CASE NUMBER:
Mother First form completed
Father
THIS FORM WILL NOT BE PLACED IN THE COURT FILE. IT WILL BE
MAINTAINED IN A CONFIDENTIAL FILE WITH THE STATE OF CALIFORNIA.
Notice: Pages 1 and 2 of this form must be completed and delivered to the court along with the court order for support.
Pages 3 and 4 are instructional only and do not need to be delivered to the court. If you did not file the court order, you must
complete this form and deliver it to the court within 10 days of the date on which you received a copy of the support order.
Any later change to the information on this form must be delivered to the court on another form within 10 days of the
change. It is important that you keep the court informed in writing of any changes of your address and telephone number.
ModificationInitial child support or family support orderb.
Total monthly base current child or family support amount ordered for children listed below, plus any monthly amount ordered
payable on past-due support
:
(1) Current
base child
support:
(2) Additional
monthly
support:
Person required to pay child or family support
(name):
Relationship to child
(if applicable):
Person or agency to receive child or family support payments
(name):
TYPE OR PRINT IN INK
Page 1 of 4
Family Code, § 4014
Form Adopted for Mandatory Use
Judicial Council of California
FL-191 [Rev. July 1, 2005]
CHILD SUPPORT CASE REGISTRY FORM
www.courtinfo.ca.gov
Change to previous information
Relationship to child
(specify):
TELEPHONE NO.: FAX NO. (
Optional):
E-MAIL ADDRESS
(Optional):
ATTORNEY FOR
(Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT:
(5) Wage withholding was
(date):
ordered but stayed until
Support order information
(this information is on the court order you are filing or have received).
ordered
(3) Total
past-due
support:
$
$
$
Date order filed:
1.
3.
2.
a.
c.
Child Support:
Family Support:
Spousal Support:
$0 (zero) order
Reserved order
(4) Payment
on past-
due support:
$
Current
base family
support:
Additional
monthly
support:
Total
past-due
support:
$
$
$
$0 (zero) order
Reserved order
Payment
on past-
due support:
$
Current
spousal
support:
Total
past-due
support:
$
$
$0 (zero) order
Reserved order
Payment
on past-
due support:
$
Sacramento
3341 Power Inn Road
Sacramento, CA 95826
William R. Ridgeway Family Relations Courthouse
You are required to complete the following information about yourself. You are not required to provide information about the other
person, but you are encouraged to provide as much as you can. This form is confidential and will not be filed in the court file. It will be
maintained in a confidential file with the State of California.
Father’s name:
Date of birth:
Social security number:
Street address:
City, state, zip code:
Mailing address:
Driver’s license number:
State:
Telephone number:
Self-employedEmployed Not employed
g.
Employer’s name:
Street address:
City, state, zip code:
Telephone number:
7.
A restraining order, protective order, or nondisclosure order due to domestic violence is in effect.
Father
Mother
Children
The order protects:
Father
Mother
From:
The restraining order expires on
(date):
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME) (SIGNATURE OF PERSON COMPLETING THIS FORM)
Page 2 of 4
CHILD SUPPORT CASE REGISTRY FORM
FL-191 [Rev. July 1, 2005]
a.
b.
c.
5.
a.
b.
c.
d.
e.
f.
Mother’s name:
Date of birth:
Social security number:
Street address:
City, state, zip code:
Mailing address:
City, state, zip code:
Driver’s license number:
State:
Telephone number:
Self-employedEmployed Not employed
g.
Employer’s name:
Street address:
City, state, zip code:
Telephone number:
a.
b.
c.
6.
d.
e.
f.
City, state, zip code:
PETITIONER/PLAINTIFF:
CASE NUMBER:
RESPONDENT/DEFENDANT:
OTHER PARENT:
The child support order is for the following children:
Date of birth
Social security number
a.
b.
Additional children are listed on a page attached to this document.
Child’s name
4.
c.
INFORMATION SHEET FOR CHILD SUPPORT CASE REGISTRY FORM
(Do NOT deliver this Information Sheet to the court clerk.)
Please follow these instructions to complete the
Child Support Case Registry Form
(form FL-191) if you do not have an attorney to
represent you. Your attorney, if you have one, should complete this form.
Both parents must complete a
Child Support Case Registry Form.
The information on this form will be included in a national database
that, among other things, is used to locate absent parents. When you file a court order, you must deliver a completed form to the court
clerk along with your court order. If you did not file a court order, you must deliver a completed form to the court clerk
WITHIN 10 DAYS
of the date you received a copy of your court order. If any of the information you provide on this form changes, you must complete a
new form and deliver it to the court clerk within 10 days of the change. The address of the court clerk is the same as the one shown for
the superior court on your order. This form is confidential and will not be filed in the court file. It will be maintained in a confidential file
with the State of California.
INSTRUCTIONS FOR COMPLETING THE
CHILD SUPPORT CASE REGISTRY FORM
(TYPE OR PRINT IN INK):
If the top section of the form has already been filled out, skip down to number 1 below. If the top section of the form is blank, you
must provide this information.
Page 1, first box, top of form, left side: Print your name, address, telephone number, fax number, and e-mail address, if any, in this box.
Attorneys must include their State Bar identification numbers.
Page 1, second box, top of form, left side: Print the name of the county and the court’s address in this box. Use the same address for
the court that is on the court order you are filing or have received.
Page 1, third box, top of form, left side: Print the names of the petitioner/plaintiff, respondent/defendant, and other parent in this box.
Use the same names listed on the court order you are filing or have received.
Page 1, fourth box, top of form, left side
: Check the box indicating whether you are the mother or the father. If you are the attorney for
the mother, check the box for mother. If you are the attorney for the father, check the box for father. Also, if this is the first time you
have filled out this form, check the box by "First form completed.” If you have filled out form FL-191 before, and you are changing any
of the information, check the box by “Change to previous information.”
Page 1, first box, right side
: Leave this box blank for the court’s use in stamping the date of receipt.
Page 1, second box, right side
: Print the court case number in this box. This number is also shown on the court papers.
Instructions for numbered paragraphs:
Enter the date the court order was filed. This date is shown in the “COURT PERSONNEL: STAMP DATE RECEIVED HERE" box
on page 1 at the top of the order on the right side. If the order has not been filed, leave this item blank for the court clerk to fill in.
If the court order you filed or received is the first child or family support order for this case, check the box by “Initial child support
or family support order." If this is a change to your order, check the box by “Modification.”
Information regarding the amount and type of support ordered and wage withholding is on the court order you are filing or have
received.
If your order provides for any type of current support, check all boxes that describe that support. For example, if your order
provides for both child and spousal support, check both of those boxes. If there is an amount, put it in the blank provided. If
the order says the amount is reserved, check the “Reserved order” box. If the order says the amount is zero, check the “$0
(zero) order" box. Do not include child care, special needs, uninsured medical expenses, or travel for visitation here These
amounts will go in (2). Do NOT complete the Child Support Case Registry form if you receive spousal support only.
If your order provides for a set monthly amount to be paid as additional support for such needs as child care, special needs,
uninsured medical expenses or travel for visitation check the box in Item 2 and enter the monthly amount. For example, if
your order provides for base child support and in addition the paying parent is required to pay $300 per month, check the box
in item 2 underneath the "Child Support" column and enter $300. Do NOT check this box if your order provides only for a
payment of a percentage, such as 50% of the childcare.
Page 3 of 4
CHILD SUPPORT CASE REGISTRY FORM
FL-191 [Rev. July 1, 2005]
1. a.
b.
c.
(1)
(2)
Write the name of the person who is supposed to pay child or family support.
Write the name of the person or agency supposed to receive child or family support payments.
List the full name, date of birth, and social security number for each child included in the support order. If there are more than five
children included in the support order, check the box below item 4e and list the remaining children with dates of birth and social
security numbers on another sheet of paper. Attach the other sheet to this form.
The local child support agency is required, under section 466(a)(13) of the Social Security Act, to place in the records pertaining to
child support the social security number of any individual who is subject to a divorce decree, support order, or paternity determination
or acknowledgment. This information is mandatory and will be kept on file at the local child support agency.
Top of page 2, box on left side
: Print the names of the petitioner/plaintiff, respondent/defendant, and other parent in this box. Use the
same names listed on page 1.
Top of page 2, box on right side
: Print your court case number in this box. Use the same case number as on page 1, second box,
right side.
You are required to complete information about yourself. If you know information about the other person, you may also fill in what you
know about him or her.
If you are the father in this case, list your full name in this space. See instructions for a–g under item 6 below.
If you are the mother in this case, list your full name in this space.
List the street address, city, state, and zip code where you want your mail sent, if different from the address where you live.
Indicate whether you are employed, not employed, self-employed, or by checking the appropriate box. If you are employed, write
the name, street address, city, state, zip code, and telephone number where you work.
If there is a restraining order, protective order, or nondisclosure order, check this box.
Check the box beside the parent who is restrained.
Write the date the restraining order expires. See the restraining order, protective order, or nondisclosure order for this date.
If you are in fear of domestic violence, you may want to ask the court for a restraining order, protective order, or nondisclosure order.
You must type or print your name, fill in the date, and sign the
Child Support Case Registry Form
under penalty of perjury. When you
sign under penalty of perjury, you are stating that the information you have provided is true and correct.
CHILD SUPPORT CASE REGISTRY FORM
FL-191 [Rev. July 1, 2005]
Page 4 of 4
If your order provides for a specific dollar amount to be paid towards any past due support, check the box in Item 4 that states
the type of past due support and enter the amount. For example, the court ordered $350 per month to be paid on the past due
child support, you would check the box in Item 4 in the "Child Support" column and enter $350.
If your order determined the amount of past due support, check the box in Item 3 that states the type of past due support and
enter the amount. For example, if the court determined that there was $5000 in past due child support and $1000 in past due
spousal support, you would check the box in item 3 in the "Child Support" column and enter $5000 and you would also check
the box in item 3 in the "Spousal Support" column and enter $1000.
(3)
(4)
2. a.
b.
3. a.
b.
4.
Write the relationship of that person to the child.
Write the relationship of that person to the child.
6.
5.
Check the box beside each person who is protected by the restraining order.
List your date of birth.
Write your social security number.
List the street address, city, state, and zip code where you live.
Write your driver's license number and the state where it was issued.
List the telephone number where you live.
7.
a.
b.
c.
d.
e.
f.
g.
a.
b.
c.
Check the "ordered" box if wage withholding was ordered with no conditions. Check the box "ordered but stayed until" if wage
withholding was ordered but is not to be deducted until a later date. If the court delayed the effective date of the wage
withholding, enter the specific date. Check only one box in this item.
(5)
FL-343
SPOUSAL, PARTNER, OR FAMILY SUPPORT ORDER ATTACHMENT
TO
Findings and Order After Hearing
(form FL-340)
Judgment
(form FL-180)
above
(for temporary support only).
1.
Net income.
The parties’ monthly income and deductions are as follows
(complete a, b, or both ):
Total Total Total Net monthly
gross monthly monthly hardship
disposable
income income
deductions deductions
receiving TANF/CaIWORKS
a. Petitioner:
b. Respondent:
3.
Judgment for spousal or partner support
months.
The parties were married for
(specify numbers):
years
b.
See Attachment 3d.
THE COURT ORDERS
petitioner petitioner 6. respondent must pay to the respondent
spousal support family support
a
s
$ per month, beginning
(date):
, payable through
(specify end date):
day of each month.payable on the
(specify):
Support must be paid by check, money order, or cash. The support payor’s obligation to pay support will terminate on
the death of either party, remarriage, or registration of a new domestic partnership of the support payee.
An earnings assignment for the foregoing support will issue. (
Note:
The payor of spousal, family, or partner support is
responsible for the payment of support directly to the recipient until support payments are deducted from the payor’s
earnings, and for any support not paid by the assignment.)
Service of the earnings assignment is stayed provided the payor is not more than
(specify number):
days late
in the payment of spousal, family, or partner support.
d.
Page 1 of 2
Form Approved for Optional Use
Judicial Council of California
FL-343 [Rev. July 1, 2012]
Family Code, §§ 150, 299, 3651,
SPOUSAL, PARTNER, OR FAMILY SUPPORT ORDER ATTACHMENT
(Family Law)
3653, 3654, 4320, 4330, 4337
www.courts.ca.gov
The marital standard of living was
(describe):
receiving TANF/CaIWORKS
Other
(specify):
The parties were registered as domestic partners or the equivalent for
(specify numbers):
c.
partner support
c.
b.
The
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT:
CASE NUMBER:
temporary
THE COURT FINDS
2.
A printout of a computer calculation of the parties’ financial circumstances is attached for all required items not filled out
Modifies a judgment or order entered on
(date):
The parties are both self-supporting, as shown on the
Declaration for Default or Uncontested Dissolution or Legal
d.
Separation
(form FL-170).
e.
The issue of spousal or partner support for the petitioner respondent is reserved for a later determination.
4.
The court terminates jurisdiction over the issue of spousal or partner support for the petitioner respondent.
5.
Restraining Order After Hearing (CLETS-OAH)
(form DV-130) Other
(specify):
a.
a.
$
$
$
$
$
$
$
$
THIS IS A COURT ORDER.
Stipulation of Parties
months.
years
PETITIONER/PLAINTIFF:
CASE NUMBER:
RESPONDENT/DEFENDANT:
OTHER PARENT:
The parties must promptly inform each other of any change of employment, including the employer’s name, address, and
telephone number.
8.
This order is for family support. Both parties must complete and file with the court a
Child Support Case Registry Form
(form
FL-191) within 10 days of the date of this order. The parents must notify the court of any change of information submitted
within 10 days of the change by filing an updated form. A
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.
9.
NOTICE: Any party required to pay support must pay interest on overdue amounts at the “legal” rate, which is currently
10 percent.
THIS IS A COURT ORDER.
Page 2 of 2
SPOUSAL, PARTNER, OR FAMILY SUPPORT ORDER ATTACHMENT
(Family Law)
FL-343 [Rev. July 1, 2012]
Other orders (
specify):
11.
Notice: If this form is attached to
Restraining Order After Hearing (CLETS-OAH) (Order of Protection)
(form DV-130), the
orders issued on this form (FL-343) do not expire upon termination of the restraining orders issued on form DV-130.
10.
The petitioner
7.
respondent should make reasonable efforts to assist in providing for his or her support needs.
NOTICE OF RIGHTS AND RESPONSIBILITIES
Health-Care Costs and Reimbursement Procedures
IF YOU HAVE A CHILD SUPPORT ORDER THAT INCLUDES A PROVISION FOR THE
REIMBURSEMENT OF A PORTION OF THE CHILD'S OR CHILDREN'S HEALTH-CARE COSTS
AND THOSE COSTS ARE NOT PAID BY INSURANCE, THE LAW SAYS:
Notice.
You must give the other parent an itemized
statement of the charges that have been billed for any health-
care costs not paid by insurance. You must give this
statement to the other parent within a reasonable time, but no
more than 30 days after those costs were given to you.
Proof of full payment.
If you have already paid all of the
uninsured costs, you must (1) give the other parent proof that
you paid them and (2) ask for reimbursement for the other
parent's court-ordered share of those costs.
Court-ordered insurance coverage.
If a parent provides
health-care insurance as ordered by the court, that insurance
must be used at all times to the extent that it is available for
health-care costs.
Proof of partial payment.
If you have paid only your share
of the uninsured costs, you must (1) give the other parent
proof that you paid your share, (2) ask that the other parent
pay his or her share of the costs directly to the health-care
provider, and (3) give the other parent the information
necessary for that parent to be able to pay the bill.
a. Burden to prove.
The party claiming that the coverage is
inadequate to meet the child's needs has the burden of
proving that to the court.
Cost of additional coverage.
If a parent purchases health-
care insurance in addition to that ordered by the court, that
parent must pay all the costs of the additional coverage. In
addition, if a parent uses alternative coverage that costs
more than the coverage provided by court order, that parent
must pay the difference.
Payment by notified parent.
If you receive notice from a
parent that an uninsured health-care cost has been incurred,
you must pay your share of that cost within the time the court
orders; or if the court has not specified a period of time, you
must make payment (1) within 30 days from the time you were
given notice of the amount due, (2) according to any payment
schedule set by the health-care provider, (3) according to a
schedule agreed to in writing by you and the other parent, or
(4) according to a schedule adopted by the court.
Preferred health providers.
If the court-ordered coverage
designates a preferred health-care provider, that provider
must be used at all times consistent with the terms of the
health insurance policy. When any party uses a health-care
provider other than the preferred provider, any health-care
costs that would have been paid by the preferred health
provider if that provider had been used must be the sole
responsibility of the party incurring those costs.
Disputed charges.
If you dispute a charge, you may file a
motion in court to resolve the dispute, but only if you pay that
charge before filing your motion. If you claim that the other
party has failed to reimburse you for a payment, or the other
party has failed to make a payment to the provider after proper
notice has been given, you may file a motion in court to resolve
the dispute. The court will presume that if uninsured costs have
been paid, those costs were reasonable. The court may award
attorney fees and costs against a party who has been
unreasonable.
FL-192
Form Approved for Optional Use
Judicial Council of California
FL-192 [Rev. January 1, 2015]
Family Code, §§ 4062, 4063
www.courts.ca.gov
NOTICE OF RIGHTS AND RESPONSIBILITIES
Health-Care Costs and Reimbursement Procedures
Page 1 of 2
1.
2.
3.
4.
5.
6.
7.
b.
FL-192 [Rev. January 1, 2015]
NOTICE OF RIGHTS AND RESPONSIBILITES
Health-Care Costs and Reimbursement Procedures
INFORMATION SHEET ON CHANGING A CHILD SUPPORT ORDER
General Information
The court has just made a child support order in your case. This order will remain the same unless a party to the action requests that
the support be changed (modified). An order for child support can be modified only by filing a motion to change child support and
serving each party involved in your case. If both parents and the local child support agency (if it is involved) agree on a new child
support amount, you can complete, have all parties sign, and file with the court a
Stipulation to Establish or Modify Child Support and
Order
(form FL-350) or
Stipulation and Order (Governmental)
(form FL-625).
When a Child Support Order May Be Modified
The court takes several things into account when ordering the payment of child support. First, the number of children is considered.
Next, the net incomes of both parents are determined, along with the percentage of time each parent has physical custody of the
children. The court considers both parties
’
tax filing status and may consider hardships, such as a child of another relationship. An
existing order for child support may be modified when the net income of one of the parents changes significantly, the parenting
schedule changes significantly, or a new child is born.
Examples
You have been ordered to pay $500 per month in child support. You lose your job. You will continue to owe $500 per month, plus
10 percent interest on any unpaid support, unless you file a motion to modify your child support to a lower amount and the court
orders a reduction.
You are currently receiving $300 per month in child support from the other parent, whose net income has just increased
substantially. You will continue to receive $300 per month unless you file a motion to modify your child support to a higher amount
and the court orders an increase.
You are paying child support based upon having physical custody of your children 30 percent of the time. After several months it turns
out that you actually have physical custody of the children 50 percent of the time. You may file a motion to modify child support to a
lower amount.
How to Change a Child Support Order
To change a child support order, you must file papers with the court.
Remember:
You must follow the order you have now.
What forms do I need?
If you are asking to change a child support order open with the local child support agency, you must fill out one of these forms:
FL-680,
Notice of Motion (Governmental)
or
FL-683
Order to Show Cause (Governmental)
and
FL-684,
Request for Order and Supporting Declaration (Governmental)
If you are asking to change a child support order that is
not
open with the local child support agency, you must fill out one of these
forms:
FL-300,
Request for Order
or
FL-390,
Notice of Motion and Motion for Simplified Modification of Order for Child, Spousal, or Family Support
You must also fill out one of these forms:
FL-150,
Income and Expense Declaration
or
FL-155,
Financial Statement (Simplified)
What if I am not sure which forms to fill out?
Talk to the family law facilitator at your court.
After you fill out the forms,
file them with the court clerk and ask for a hearing date. Write the hearing date on the form.
The clerk will ask you to pay a filing fee. If you cannot afford the fee, fill out these forms, too:
Form FW-001,
Request to Waive Court Fees
Form FW-003,
Order on Court Fee Waiver (Superior Court)
You must serve the other parent.
If the local child support agency is involved, serve it too.
This means someone 18 or over—
not you—
must serve the other parent copies of your filed court forms at least
16 court days
before
the hearing. Add
5 calendar days
if you serve by mail within California (see Code of Civil Procedure section 1005 for other situations).
Court days
are weekdays when the court is open for business (Monday through Friday except court holidays).
Calendar days
include
all days of the month, including weekends and holidays. To find court holidays, go to
www.courts.ca.gov/holidays.htm.
Go to your hearing and ask the judge to change the support.
Bring your tax returns from the last two years and your last two
months' pay stubs. The judge will look at your information, listen to both parents, and make an order. After the hearing, fill out:
FL-340,
Findings and Order After Hearing
and
FL-342,
Child Support Information and Order Attachment
Need help?
Contact the family law facilitator in your county or call your county's bar association and ask for an experienced family lawyer.
The server must also serve blank copies of these forms:
FL-320,
Responsive Declaration to Request for Order
and
FL-150,
Income and Expense Declaration,
or
FL-155,
Financial Statement (Simplified)
Then the server fills out and signs a
Proof of Service
(form FL-330 or FL-335). Take this form to the clerk and file it.
Page 2 of 2
FL-192
•
•
•
•
•
•
•
•
•
•
•
•
•
•
FL-170
FOR COURT USE ONLY
PETITIONER:
RESPONDENT:
CASE NUMBER:
DECLARATION FOR DEFAULT OR UNCONTESTED
DISSOLUTION LEGAL SEPARATION
(NOTE: Items 1 through 12 apply to both dissolution and legal separation proceedings.)
I declare that if I appeared in court and were sworn, I would testify to the truth of the facts in this declaration.
I agree that my case will be proven by this declaration and that I will not appear before the court unless I am ordered by the court to
do so.
Petition Response
is true and correct.
All the information in the
Default without agreement
No response has been filed and there is no written agreement or stipulated judgment between the parties;
a.
No response has been filed and the parties have agreed that the matter may proceed as a default matter without
notice; and
(2)
Default with agreement
The parties have entered into a written agreement regarding their property and their marriage or domestic partnership
rights, including support, the original of which is being or has been submitted to the court. I request that the court
approve the agreement.
The following statement is true
(check one):
Page 1 of 3
DECLARATION FOR DEFAULT OR UNCONTESTED
DISSOLUTION OR LEGAL SEPARATION
(Family Law)
Form Adopted for Mandatory Use
Judicial Council of California
FL-170 [Rev. July 1, 2012]
Family Code, § 2336
www.courts.ca.gov
1.
2.
3.
b.
ATTORNEY OR PARTY WITHOUT ATTORNEY
(Name, State Bar number, and address):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
TELEPHONE NO.:
ATTORNEY FOR
(Name):
FAX NO.
(Optional):
E-MAIL ADDRESS
(Optional):
The default of the respondent was entered or is being requested, and I am not seeking any relief not requested in the
petition; and
Type of case
(check a, b, or c):
4.
(1)
The community and quasi-community assets and debts are listed on the
completed
current
Property
Declaration
(form FL-160), which includes an estimate of the value of the assets and debts that I propose
to be distributed to each party. The division in the proposed
Judgment
(form FL-180) is a fair and equal
(B)
division of the property and debts, or if there is a negative estate, the debts are assigned fairly and equitably.
There are no assets or debts to be disposed of by the court.
(3)
(A)
(2)
(1)
Both parties have appeared in the case; and
Uncontested
c.
(2)
(1)
Declaration of disclosure
(check a, b, or c):
Both the petitioner and respondent have filed, or are filing concurrently, a
Declaration Regarding Service of Declaration
a.
of Disclosure
(form FL-141) and an
Income and Expense Declaration
(form FL-150).
This matter is proceeding by default. I am the petitioner in this action and have filed a proof of service of the preliminary
Declaration of Disclosure
(form FL-140) with the court. I hereby waive receipt of the final
Declaration of Disclosure
(form
b.
FL-140) from the respondent.
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
another, separate stipulation.
c.
5.
The parties have entered into a written agreement regarding their property and their marriage or domestic partnership
rights, including support, the original of which is being or has been submitted to the court. I request that the court
approve the agreement.
amended
Sacramento
3341 Power Inn Road
Sacramento, CA 95826
William R. Ridgeway Family Relations Courthouse
PETITIONER:
CASE NUMBER:
RESPONDENT:
Child support
should be ordered as set forth in the proposed
Judgment
(form FL-180).
7.
b.
am receiving am not receiving intend to apply for public assistance for the child or children
To the best of my knowledge, the other party is is not receiving public assistance.
The petitioner respondent is presently receiving public assistance, and all support should be made
payable 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.
If there are minor children, check and complete item (1) if applicable and item (2) or (3):
a.
petitioner’s respondent’s earning ability. The facts in support I request that this order be based on the
(3)
of my estimate of earning ability are
(specify):
Continued on Attachment 7a(3).
FL-170 [Rev. July 1, 2012]
DECLARATION FOR DEFAULT OR UNCONTESTED
DISSOLUTION OR LEGAL SEPARATION
(Family Law)
I
listed in the proposed order.
Page 2 of 3
FL-170
6.
Child custody and visitation (parenting time)
should be ordered as set forth in the proposed
Judgment
(form FL-180).
d.
Facts in support of requested judgment (
In a default case, state your reasons below):
Contained on Attachment 6d.
The information in the child support calculation attached to the proposed judgment is correct based on my
personal knowledge.
(2)
a.
The information in
Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act
(UCCJEA) (form FL-105)
has not changed since it was last filed with the court.
(If changed, attach updated form.)
has
Complete items (1) and (2) regarding public assistance.
(2)
(1)
c.
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.)
a.
I knowingly give up forever any right to receive spousal or partner support.
b.
I ask the court to reserve jurisdiction to award spousal or partner support in the future to
(name):
I ask the court to terminate forever spousal or partner support for:
c.
d.
8.
Family support should be ordered as set forth in the proposed
Judgment
(form FL-180).
e.
b.
There is an existing court order for custody/parenting time in another case in
(county)
:
The case number is
(specify):
Child support is being enforced in another case in
(county):
The case number is
(specify):
(1)
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:
petitioner respondent.
Other
(specify):
f.
c.
The current custody and visitation (parenting time) previously ordered in this case, or current schedule is
(specify):
Spousal or Partner Support Declaration Attachment
(form FL-157)
written agreement
attached declaration
(Attachment 8d.)
Contained on Attachment 6c.
THIS STATEMENT APPLIES ONLY TO LEGAL SEPARATIONS
I ask that the court grant the request for a judgment for legal separation based on irreconcilable differences and that the
court make the orders set forth in the proposed
Judgment
(form FL-180) submitted with this declaration.
I understand that a judgment of legal separation does not terminate a marriage or domestic partnership and that I am
still married or a partner in a domestic partnership.
Other
(specify):
19.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)
18.
PETITIONER:
CASE NUMBER:
RESPONDENT:
FL-170
FL-170 [Rev. July 1, 2012]
DECLARATION FOR DEFAULT OR UNCONTESTED
DISSOLUTION OR LEGAL SEPARATION
(Family Law)
Page 3 of 3
STATEMENTS IN THIS BOX APPLY ONLY TO DISSOLUTIONS
If this is a dissolution of marriage or of a domestic partnership created in another state, the petitioner and/or the respondent
have been residents of this county for at least three months and of the state of California for at least six months continuously
and immediately preceding the date of the filing of the petition for dissolution of marriage or domestic partnership.
I ask that the court grant the request for a judgment for dissolution of marriage or domestic partnership based on irreconcilable
differences and that the court make the orders set forth in the proposed
Judgment
(form FL-180) submitted with this declaration.
17.
This declaration is for the termination of
marital or domestic partner status only.
I ask the court to reserve jurisdiction
over all issues whose determination is not requested in this declaration.
15.
16.
There are irreconcilable differences that have led to the irremediable breakdown of the marriage or domestic partnership, and
there is no possibility of saving the marriage or domestic partnership through counseling or other means.
This declaration may be reviewed by a commissioner sitting as a temporary judge, who may determine whether to grant this
request or require my appearance under Family Code section 2336.
13.
14.
12. respondent requests restoration of his or her former name as set forth in the proposed
Judgment
(form FL-180).
The petitioner
9.
Parentage
of the children of the petitioner and respondent born prior to their marriage or domestic partnership should be
ordered as set forth in the proposed
Judgment
(form FL-180).
10.
Attorney fees
should be ordered as set forth in the proposed
Judgment
(form FL-180)
a.
A Voluntary Declaration of Paternity is attached.
11. The judgment should be entered nunc pro tunc for the following reasons
(specify)
:
b. Parentage was previously established by the court in
(county):
The case number is
(specify):
facts in support in form FL-319
other
(specify facts below)
:
Written agreement of the parties attached here or to the
Judgment
(form FL-180).
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HOW TO OBTAIN A JUDGMENT OF DISSOLUTION, LEGAL (California)

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Completed 14 November 2020

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