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HOW TO OBTAIN A UNIFORM PARENTAGE ACT JUDGMENT (California)

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Superior Court of California, County of Sacramento
Family Law Facilitator’s Office
Page 1 of 18
03/05/18
HOW TO OBTAIN A UNIFORM PARENTAGE ACT
JUDGMENT BY DEFAULT
Purpose of this Packet
This packet is designed to help you obtain a judgment from the Court by
Default.
If the
other parent 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 to Establish Parental Relationship,
you are eligible to proceed by Default. However, a default judgment is not automatic.
This packet will explain how to file a Request To Enter Default and proceed to judgment.
There are two methods to obtain a judgment:
by hearing or by declaration
. You may
wish to seek legal assistance from a private attorney or visit the Family Law Facilitator
before you proceed, to decide which method is right for you.
When you proceed by default, the Judge may only make orders about those items listed in
your Petition. For example, if you did not ask for orders to help pay the cost of
pregnancy and birth, you cannot address those items now. 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 passed since the date of service on the other party.
Ø
The Proof of Service of Summons was completed correctly by another adult, 18 years
or older and not a party to the action, who served the documents.
Ø
The original Proof of Service of Summons has been filed.
Ø
No Response has been filed by the other parent.
Ø
The Income and Expense Declaration has been served and filed.
Ø
The other parent is
not
active duty military. (If the other parent is active duty
military, seek legal assistance from a private attorney or the Family Law Facilitator.)
Is a Default Hearing Required?
When proceeding by Default, you may always request a Default Hearing. However, you
may be able to proceed without a Default Hearing if all of the following are true:
Ø
You and the other parent 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 order.
Superior Court of California, County of Sacramento
Family Law Facilitator’s Office
Page 2 of 18
3/5/2018
Documents Needed to File for a Default Judgment– With or Without a Hearing
If you plan to have a
hearing
, you will first need to file the following documents with the
Court:
Ø
Request to Enter Default, form FL-165
Ø
Income and Expense Declaration, form FL-150
If you plan to proceed to judgment by default
without a hearing
, you will need to
complete all of the above documents plus the following additional documents:
Ø
Judgment (Uniform Parentage), form FL-250
Ø
Child Custody and Visitation Order Attachment, form FL-341
Ø
Supervised Visitation Order, form FL-341(A) (if needed)
Ø
Child Abduction Prevention Order Attachment, form FL-341B
Ø
Children’s Holiday Schedule Attachment, form FL-341C
Ø
Additional Provisions-Physical Custody Attachment, form FL-341D
Ø
Joint Legal Custody Attachment, form FL-341E
Ø
Child Support Information and Order Attachment, form FL-342
Ø
Non-Guideline Child Support Findings Attachment, form FL-342A
Ø
Child Support Information and Order Attachment, form FL-342
Ø
Non-Guideline Child Support Findings Attachment, form FL-342(A) (if needed)
Ø
Notice of Entry of Judgment, form FL-190
Ø
Child Support Case Registry Form, form FL-191
Ø
Notice of Rights and Responsibilities, form FL-192
Ø
Declaration for Default or Uncontested Judgment, form FL-230
Ø
Advisement and Waiver of Rights Re: Establishment of Parental Relationship, form
FL-235
Completing the Request to Enter Default, FL-165
In the top left box
of the document print your full name, mailing address, email 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 the other parent’s full name.
Superior Court of California, County of Sacramento
Family Law Facilitator’s Office
Page 3 of 18
3/5/2018
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.
Unless you have a current (i.e., completed and filed within the past two months)
one on file, you must attach an
Income and Expense Declaration form FL-150
or
Financial Statement (Simplified) form FL-155
to this form.
Determine which financial form to complete for your case:
You may
only
file the
Financial Statement (Simplified)
if you are eligible. If you
answer YES to any of the following questions, you may
NOT
use the Financial Statement
(Simplified):
•
Are you asking for spousal support (alimony) or a change in spousal support?
•
Is the other party asking for spousal support or a change in spousal support?
•
Are you asking for the other party to pay your attorney fees?
•
Is the other party asking you to pay his or her attorney fees?
•
Do you receive money (income) from
any other source than the following
sources:
o
Welfare (e.g., TANF/AFDC, General Relief, General Assistance)
o
Salary or wages
o
Disability
o
Unemployment
o
Interest
o
Worker’s Compensation
o
Social Security
o
Retirement
•
Are you self-employed?
If you answered YES to any of the questions above, you
MAY NOT
complete the
Financial Statement (Simplified)
and
MUST
complete the
Income and Expense
Declaration
.
On the Request to Enter Default form, check the first box for “is attached,” unless you
have a current Income and Expense Declaration or Financial Statement (Simplified) on
file and are not attaching a new one to this Request, in which case check the first box for
“is not attached.”
Check the box “
is not
attached” following “A completed Property Declaration (form FL-
160).”
Check box 2(a)
if you have not attached an Income and Expense Declaration or a
Financial Statement (Simplified) because you filed one within the past six months in this
case and your financial situation has not changed.
Superior Court of California, County of Sacramento
Family Law Facilitator’s Office
Page 4 of 18
3/5/2018
Skip boxes 2(b) – 2(e).
Check box 2(f).
Below the 6 boxes
print the date and your name, then sign where indicated.
Item 3.
You must check either
box a
or
b
. If you served the Summons and Petition to
Establish Parental Relationship 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 the other
parent. If you do not know the other parent’s current address, print the last known
address of the other parent, even if you know they no longer live there.
Below item 3,
print today’s date and your name, then sign where indicated.
In the bar at the top of page two,
print the names of the parties in the box to the left and
the case number in the box to the right. This is known as the “caption.”
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 the
other parent 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 the other parent is active duty military, you may not be able to proceed with a default
judgment without additional steps.
Read
item 5.
Below item 5,
if the other parent is not active duty military, print the date and your name
where indicated and sign your name to the right.
Superior Court of California, County of Sacramento
Family Law Facilitator’s Office
Page 5 of 18
3/5/2018
If the other parent is active duty military, do not continue. Seek legal assistance.
Completing the Advisement and Waiver of Rights Re: Establishment of Parental
Relationship, form FL-235
YOU WILL NEED TO COMPLETE THIS FORM ONLY IF YOU DO NOT INTEND
TO HAVE A HEARING. IF YOU ARE REQUESTING A DEFAULT HEARING, DO
NOT COMPLETE THIS FORM.
Fill out the caption at the top of the page.
Print your name next to “Petitioner”, and the
other parent’s name next to “Respondent.” In the top box to the right, print the case
number.
Read items 1 – 8.
Check box 9(a)
if you understand what you have just read.
Below item 9
print the date and your name where indicated and sign your name to the
right.
Box 9(b) and the Interpreter’s Declaration only apply to instances where a language
interpreter assists you in filling out this form.
Completing the Declaration For Default Or Uncontested Judgment, form FL-230
YOU WILL NEED TO COMPLETE THIS FORM ONLY IF YOU DO NOT INTEND
TO HAVE A HEARING. IF YOU ARE REQUESTING A DEFAULT HEARING, DO
NOT COMPLETE THIS FORM.
In the top left box
of the document print your full name, mailing address, email 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 the other parent’s full name.
In the fourth box from the top and to the right
, print your case number.
Read
items 1
and
2
.
Superior Court of California, County of Sacramento
Family Law Facilitator’s Office
Page 6 of 18
3/5/2018
Item 3.
Check the box for Petition or Complaint to Establish Parental Relationship.
Item 4
. Check both boxes if you are claiming that you and the Respondent are the parents
of the child(ren) in this case. Check only “Respondent” if you are attempting to establish
non-paternity for yourself, or only “Petitioner” if you are attempting to establish non-
paternity of the other party.
Item 5.
If you and the other parent signed a Voluntary Declaration of Paternity form for
the child(ren) at the birthing hospital, prenatal clinic, or other place, check the “has” box.
Otherwise check the “has not” box. If you checked the “has” box, attach a copy of the
Voluntary Declaration of Paternity to this form if one was not attached to your Petition to
Establish Parental Relationship. If you do not have a copy of your Voluntary Declaration
of Paternity, you may obtain one by calling 1-866-249-0773.
Check box 6(a).
Do not check 6(b).
Check box 7,
unless you are seeking a judgment of non-paternity.
Item 7(a).
If either parent is presently receiving public assistance for the child(ren),
check the appropriate box(es) to show which party is receiving public assistance. If
either party is receiving public assistance, print the name of the local child support
agency in the space below. In Sacramento county the address is:
Sacramento County DCSS
P.O. Box 419058
Rancho Cordova, CA 95741-9058
Check box 8
if you requested attorney fees and costs on your Petition to Establish
Parental Relationship.
Check box 9,
unless you are seeking a Judgment of non-paternity.
Check box 10
if you requested child visitation orders on your Petition to Establish
Parental Relationship.
Check box 11
if you requested that the Court make orders concerning the costs of
pregnancy and birth on your Petition to Establish Parental Relationship.
Check box 12
if you requested the Court legally change the name(s) of your child(ren).
Read Items 13 and 14.
Item 15
. Briefly describe any other relief that you requested in your Petition to Establish
Parental Relationship that has not already been addressed.
Superior Court of California, County of Sacramento
Family Law Facilitator’s Office
Page 7 of 18
3/5/2018
At the bottom of the page,
print the date and your name where indicated and sign your
name to the right.
Be sure to attach your Advisement and Waiver of Rights Re: Establishment of Parental
Relationship, form FL-235 to this form.
Completing the Judgment, form FL-250
Whether or not you are going to have a default hearing, you will need to complete a
Judgment. It will be easier to complete the judgment after your hearing. The yellow
minute order you receive in Court is merely a record of the proceedings and must be
prepared into a final Judgment.
You will have several pages of attachments. 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.
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 the other parent’s full name.
In the fourth box from the top and to the right
print your case number.
Check box 1
if you have a restraining order against the other parent and check the
appropriate box to indicate whether the Court is confirming or modifying that order.
Complete the remainder of
Item 1
as it pertains to your restraining Order. You will need
to attach a copy of the Restraining Order to your Judgment.
Item 2(a)
Check the box that corresponds to how you brought your case before the Judge.
If your case was presented to the Court for finalization by way of default hearing, you
may check the box labeled “Default or Uncontested.” If you are proceeding without a
hearing, also check the box labeled “By declaration.”
Items 2(b-h)
apply only to hearings.
Item 2(b).
Print the hearing date and Department listed on your Request to Enter Default
or minute order.
Superior Court of California, County of Sacramento
Family Law Facilitator’s Office
Page 8 of 18
3/5/2018
Item 2(c)
Print the name of the Judge who presided at your hearing. If you do not
remember the Judge’s name or how it is spelled, you can copy it from the top of the
yellow minute order given to you in Court at the end of your hearing.
Box 2(d).
Check the box “Petitioner present” to indicate that you were present at your
default hearing.
Box 2(e).
If the other parent was present at the hearing, check the box “Respondent.
present” If the Respondent’s attorney appeared in Court also check the “Attorney
present(name)” box and print the attorney’s name where indicated.
Item 2(f) 1-5.
Check the boxes that correspond to any additional findings the judge made
at your hearing. Read the minute order thoroughly to determine whether any of these
additional findings were made.
Item 2(g)
. If the other parent was also present at the hearing, check any appropriate
boxes.
Item 2(h)
. Print the names and titles of any other persons who participated in your
hearing and are listed on the minute order, excluding the Courtroom clerk and bailiff.
Item 3.
Print the full name of the child(ren)’s mother and father in the spaces provided
and check the appropriate boxes. Print the child(ren)’s name(s) and date(s) of birth
below exactly as it appears on the child’s birth certificate.
Item 4
. If the Court made custody and visitation orders, check box 4(a).
The custody and visitation orders will need to be prepared on separate forms and attached
to this Judgment. Check the appropriate boxes to indicate which forms will be attached.
If child support was ordered “Reserved,” check box (3) “Other” and print “Reserved” in
the space after the word, “specify:”
Item 5.
Use this item, to specify any additional orders the judge made during your
hearing.
Item 5(a)
. If the Court made child support orders, check box 5(a)
The support orders will need to be prepared on separate forms and attached to this
Judgment. Check the appropriate boxes to indicate which forms will be attached.
Items 5(b) and 5(c)
. Read and complete or attach the described forms.
Check box 5(d)
if the judge ordered that your child(ren)’s last name changed. Print the
new last name exactly as you want it to appear on the child’s birth certificate.
Check box 5e
if the judge ordered the birth certificate to be amended. Check boxes
5(e)(1) and/or 5(e)(2) based upon the amendment ordered.
Superior Court of California, County of Sacramento
Family Law Facilitator’s Office
Page 9 of 18
3/5/2018
Check box 5(f)
if applicable and attach the relevant documents.
Check box 5(g)
if applicable and attach the relevant documents.
Check Box 5(h)
if other orders were made by the Judge and/or requested on your Petition.
If you do not have enough space, check the box and check the box for “Continued on
Attachment 3h,” attach a separate page with these orders and label it “Attachment 3h.”
Item 6.
Print the number of pages that will be attached. 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 3(c) on your Judgment.
Child Custody and Visitation Order Attachment, form FL-341
Use this attachment whenever the Judge has made orders regarding child custody or
visitation, this includes referrals to mediation for purposes of child custody or visitation.
Review the minute order (the yellow sheet you received in Court) carefully.
If any of the boxes on the yellow minute order next to the words, “Custody,” “Parenting
Time” or “Family Court Services” were checked, you will need to complete form FL-
341. Review the bottom of the page for any “Other” orders the Judge may have made in
regards to custody and visitation. If the Judge made any “Other” orders, you must also
include them on this form.
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 “Judgment (Form FL-250)”
Read items 1 and 2.
Check the box at item 3
that indicates the country where the child(ren) habitually reside.
Read item 4.
Check box 5
if the Court made custody orders. List the children’s names and dates of
birth. List only those children included in the Court’s orders. Under “Legal Custody”
and “Physical Custody” print the name of the person awarded each type of custody. If
the Judge awarded joint custody, print the names of both parties. If custody was awarded
in accordance with a mediation report, print “Per attached Mediation Report.”
Check item 6
if the Court made a child abduction order; you will need to complete and
attach form FL-341(B).
Item 7 Visitation:
If the Court made orders regarding visitation or mediation, check the
box next to the number 7.
Superior Court of California, County of Sacramento
Family Law Facilitator’s Office
Page 10 of 18
3/5/2018
7a.
Check this box if the Court made an order for “reasonable visitation.”
7b.
Check this box if you have a custody/visitation agreement and/or recommendation
from Family Court Services or a private mediator and it was adopted as an order by the
Court. Print the number of pages contained in the agreement, partial agreement, and/or
recommendation portion of the report only. You will need to attach copies of the
agreement, partial agreement, and/or recommendation portion of the report to the form.
7c.
Check this box if the Court has referred the parties to mediation. Print the address
and telephone number of the mediator in the space provided. If the referral is to Family
Court Services, the address is 3341 Power Inn Road, Room 104 and the telephone
number is (916) 875-3400.
7d
. Check this box if the Court ordered “no visitation.”
7e.
Check this box if the Court ordered a specific visitation schedule. Check the box that
identifies the parent that has been granted visitation rights. If you do not have sufficient
space to list all of the Court’s visitation orders, check the boxes for “Other” at item 7e (4)
on page 2 and write “See Attachment 7e (4)” in the space provided. You may print or
type the text of the orders on a separate page, title the page “Attachment 7e (4)” and
attach the page to this form.
Now that you have completed item 7, go back and
print the names of the parties and the
case number in the boxes at the top of page 2.
Item 8, Supervised Visitation:
Check this box if the Court ordered “supervised visitation.”
Check the box that corresponds with which parent has been granted supervised visitation.
Next, you must complete and attach form FL-341A.
Item9, Transportation for Visitation:
Check this box if the Court made orders regarding
transportation of the child(ren).
Read the legal requirements indicated at item 9a
.
Check boxes 9b and 9c
and also check the box that identifies the party or person
responsible for transporting the child(ren) to and from the visits. If you check the box for
“other” at either or both items 9a or 9b, print the other person’s name in the space
provided.
Check boxes 9d and 9e
if the judge made specific orders regarding the exchange point at
the beginning and/or end of the visitation. Provide the address or addresses in the space
provided.
Check box 9f
if the judge made this order.
Superior Court of California, County of Sacramento
Family Law Facilitator’s Office
Page 11 of 18
3/5/2018
Check box 9g
if the Judge issued other orders related to transportation. Write the specific
additional orders in the space provided.
Check box 10
if there is an order restraining a parent from removing the child(ren) from
the County or State without written consent or Court order. Check the appropriate box to
show whether this order pertains to the Petitioner, Respondent or another person. If you
check the box for “other,” print the person’s name in the space provided. Finally, check
boxes 10a to 10c to indicate where this order applies.
In the boxes at the top of the page 3,
print the names of the parties and the case number.
Items 11-14
. Complete these items if the Court made orders for one of these categories by
checking the appropriate box(s) and either list the order made in the space provided or
provide order made on the form that is specified at the item number..
Item 15
. Check this box if the Judge has made any other orders about custody or
visitation and print the terms of the orders in the space provided.
Completing the Supervised Visitation Order Attachment, form FL-341(A)
Use this form if the Judge has ordered that visitation be supervised.
In the bar at the top of the page
, complete the caption.
Item 1.
Check the box(es) to identify which party is to be supervised. Check the reasons
indicated by the Court on the Minute Order. If none of the boxes apply, check the box
for “other” and print the reason as stated on the Minute Order.
Item 2.
Check the same box(es) as you did in item 1 for which party will be supervised.
Item 3.
Print the name, birth date, age and sex of each child that this order covers.
Item 4.
Indicate which of the following boxes for the type of supervision ordered.
4(a).
Check this box if the order is for supervision during the visit.
4(b).
Check this box if the Court ordered drop-off and pick-up of the child(ren) be
supervised.
Item 5.
Indicate who will be the Supervised Visitation Provider.
5(a).
Check this box if the Court ordered the visitation supervised by a professional.
5(b).
Check this box if the Court ordered the supervision to be done by anyone else.
Superior Court of California, County of Sacramento
Family Law Facilitator’s Office
Page 12 of 18
3/5/2018
Item 6.
Print the name, address and telephone number of the authorized supervision
provider, and/or check the box for “any other mutually agreed upon third party as
arranged.”
Item 7.
Print the visitation schedule or attach Child Custody and Visitation Order
Attachment, FL-341.
Item 8.
If the supervision will be provided by a professional, print how much each parent
has been ordered to pay in percentages. For example, if the Respondent is ordered to pay
all of the cost of visitation, then the order would be “Petitioner: 0%, Respondent: 100%.”
Item 9.
Complete this item if the Judge has ordered either of the parties to contact a
professional provider for supervision. Print the date by which contact must be made in
the space provided.
Item 10.
Print any other orders directly related to supervised visitation that were not
already covered on this form.
Completing the Child Abduction Prevention Orders Attachment, form FL-341(B)
You must use this form if the Court has made orders to prevent any of the children
involved in your case from being taken without permission by a parent.
In the bar at the top of the page
, complete the caption.
Directly below the words
, “CHILD ABDUCTION AND PREVENTION ORDERS
ATTACHMENT” check the box for, “Child Custody and Visitation Order Attachment”.
Read
Items 1-11
carefully and check all boxes that contain orders made by the Judge on
your minute order. Complete all required information for each box you checked.
Item 12
. Check this box if the Judge authorized any law enforcement officer to enforce
this order. Print the address of the Child Abduction Unit of the District Attorney’ Office
in the space provided. The address for Sacramento County is:
Sacramento County District Attorney’s Office
Child Abduction Unit
906 G Street, Suite 620
Sacramento CA 95814
Item 13
. Check this box if the Judge made any other orders about child abduction and
print the terms of the orders in the space provided. If there is not enough space, you may
print the orders on a separate piece of paper, labeled “Attachment 13” and attach it to this
form.
Completing the Children’s Holiday Schedule Attachment, form FL-341(C)
Superior Court of California, County of Sacramento
Family Law Facilitator’s Office
Page 13 of 18
3/5/2018
In the boxes at the top of the page
, complete the caption.
Directly below the words
,
“CHILDREN’S HOLIDAY SCHEDULE ATTACHMENT”
check the box, “to Findings and Orders after Hearing or Judgment”.
If the Judge has made orders about arrangements for any of the holidays listed in the first
column to the left of the page, complete the table.
In the box
below the recognized holidays table
,
if the Judge ordered that any other three-
day weekends will be spent with the parent who would normally have the child that
weekend, check the box starting with the words, “Three-day weekends….”.
If the Judge made any other orders about the children’s holiday arrangements, check the
box marked “Other” and print the terms of the orders in the space provided. If there is
not enough space, you may print the orders on a separate piece of paper, labeled, “Other
Orders Attachment” and attach the page to this form.
Item 2:
If the Judge made orders about the children’s vacations, review the yellow
minute order and check the appropriate boxes. Complete all required information for
each box that you checked.
Additional Provisions-Physical Custody Attachment, form FL-341(D)
In the boxes at the top of the page
, complete the caption.
Directly below the words “ADDITIONAL PROVISIONS-PHYSICAL CUSTODY
ATTACHMENT,” check the box next to the words “Findings and Order after Hearing or
Judgment.”
Read items 1-16 carefully and check all boxes that contain orders made by the Judge on
your minute order. Complete all required information for each box you checked.
Item 17.
If the Judge made other orders for physical custody that were not already
covered on this form check this box and print those orders in the space provided.
Joint Legal Custody Attachment, form FL-341 (E)
In the boxes at the top of the page,
complete the caption.
Directly below the words “ JOINT LEGAL CUSTODY ATTACHMENT,” check the box
next to the words “Findings and Order after Hearing or Judgment.”
Read items 1-7 carefully and check all boxes that contain orders made by the Judge on
your minute order. Complete all required information for each box you checked.
Item 8.
If the Judge made other orders for legal custody that are not already covered on
this form check this box and print those orders in the space provided.
Superior Court of California, County of Sacramento
Family Law Facilitator’s Office
Page 14 of 18
3/5/2018
Completing the Child Support Information and Order Attachment, form FL-342
Use this form if the Judge made a child support order, even if it is “reserved.”
In the boxes at the top of the page
, complete the caption.
Directly below the words “Child Support Information and Order Attachment”
check the
box for “Other” and print “Judgment (Form FL-250).”
Check box 1,
if there is a computer printout of the calculation for child support attached
to the Minute Order, and skip items 2 through 5. This computer-generated printout
would have been provided by the Judge.
Check box 2
if the Judge included income information for one or both parents on the
Minute Order. In some cases, only the net income is written. In the space provided at
2a
,
include only the amounts printed on the minute order. Complete
item 2b
if the judge
based the child support amount on an income amount that one of the parents is allegedly
capable (not actual) of earning.
Check box 3 and complete item 3(a)
by writing in the number of minor children included
in this order.
Check box 3(b)
if the Judge included timeshare information on the Minute Order. You
will find this information in the child support area listed as “TS___ %.” (TS = Time
Share). Usually, only the parent with the smaller timeshare is noted. In that case, you can
determine the percentage difference for the other parent by subtracting the stated
percentage from 100
.
For example, if the mother has custody of the children and the
Judge printed “20%” for the timeshare, mother’s timeshare will be “80%” (100% - 20% =
80%).
Check box 4
if the Court granted a hardship for other minor children or extraordinary
medical expenses or catastrophic losses. Check the appropriate boxes and print the
amount where indicated.
Check box 5
if a low income adjustment was requested by either parent. If the request
was denied, check
box 5(b)
and state the reason for the denial. If the request was granted,
check
box 5(a)
and print the amount of the adjustment.
Check box 6
to indicate that child support has been ordered.
At
item 6(a)
check the box to indicate who will be paying support and print the date
support payments are to begin. Print the name and date of birth of each child who is
included in the child support order. Then, print the amount of child support and the
parent who will receive the child support. Specify when payment will be made by
checking the box indicating whether it will be the 1st, the 1st and
the 15th or some other
Superior Court of California, County of Sacramento
Family Law Facilitator’s Office
Page 15 of 18
3/5/2018
calendar day. If no calendar day and time is included on the minute order, leave the
boxes blank.
In the boxes at the top of the page 2
, complete the caption.
Check boxes 6(b) and 6(b)(1)
if orders were made regarding child-care costs related to
employment or job training and complete items 6b(1)(a) to 6b(1)(d) For example, if the
parents were ordered to each pay ½ of the child-care costs, check the boxes for both
“petitioner” and “respondent” and print 50% in the space provided for each. Otherwise,
check the box at 6b(1)(d) and print the amount ordered by the Judge.
Check box 6(c) and (6)(c)(2)
if the Court ordered one or both parents to pay uninsured
healthcare costs for the child(ren) and complete items 6b(2)(a) to 6b(2)(d).
Check box 6(d) and 6d(1)
if orders were made for payment of additional education or
other special needs expenses for the children.. Complete the requested information.
Check box 6(d) and 6d(2)
if orders were made regarding payment of travel expenses for
visitation. Complete the requested information.
Check box 6(e)
if the child support ordered is more or less than the State guidelines
require. You will also need to complete form FL-342(A).
Add all of the dollar amounts ordered in items 6(a) to 6(d) and write in the total amount
in the box next the words “Total child support per month.” Do not include percentages.
Item 7.
Check the appropriate box at item 7(a) to indicate which parent was ordered to
maintain health insurance for the children. Check boxes 7(b) and 7(c) only if similar
language is included on your minute order.
Read Item 8 and item 9.
Check box 10
if either parent has been ordered to look for a job and check the appropriate
box(es) to indicate which parent(s). Print any conditions in the space provided.
Item 11.
Print any additional child support orders not included above. For example, if
the Court made an order regarding repayment of child support arrears, include it here.
Read items 12 and 13.
Attach the Notice of Rights and Responsibilities (FL-192) and
complete and attach the Child Support Case Registry form (FL-191).
Completing the Non-Guideline Child Support Findings Attachment, form FL-
342(A)
Superior Court of California, County of Sacramento
Family Law Facilitator’s Office
Page 16 of 18
3/5/2018
Use this form if the amount of child support ordered is more or less than the amount
required by the State Child Support Guidelines.
In the bar at the top of the page,
complete the caption.
Directly below the words “NON-GUIDELINE CHILD SUPPORT FINDINGS
ATTACHMENT,” check the box for Attachment to “Child Support Information and
Order Attachment.”
Item 1.
This is used when both parties have agreed to, and the Court has approved, an
amount of support that is more or less than the guideline (the amount calculated by law).
Check the box for “over” or “under” and print the guideline child support amount.
Item 2.
Check this box if the Court gave reasons for ordering an amount different than
the guideline.
2a.
Print what the guideline amount would be and whether it would be payable to mother
or father.
2b.
Check the box if the Court is ordering an “increase” or a “decrease” in comparison to
the guideline calculation, and how much was ordered.
2c.
Check the box that corresponds to when the order ends. If no date is specified, check
the box next to the words, “until further order.”
2d(1).
Check this box only if the Court ordered sale of the home deferred and the amount
of child support paid is related to the rental value of the home.
2d(2).
Check this box if the parent paying support has extraordinarily high income and
the amount determined under the guideline would exceed the needs of the child(ren).
2d(3).
Check the boxes that apply, but only if the Judge noted on your Minute Order that
the other party is not contributing to the needs of the children at a level equal to the
party’s parenting time.
2d(4)(i-iv).
Check these boxes if the Judge made any of these findings and print any
other findings the Court made relating to non-guideline support next to the word “other.”
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
Family Law Facilitator’s Office
Page 17 of 18
3/5/2018
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 the other parent’s full name.
In the fourth box from the top and to the right
print your case number.
Check box 6.
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
the other parent’s name and mailing address inside the bracket on the right.
Completing the Child Support Case Registry Form, FL-191
You must complete and submit with your Judgment a
Child Support Case Registry
Form, FL-191,
if your Judgment contains a child support order, even if it is $0 or
“reserved.” This form is double-sided, and written directions are attached to it.
Filing Your Papers
Make 2 copies of all the documents you completed. Staple your Income and Expense
Declaration (or Financial Statement, Simplified) to the Request To Enter Default. You
will need to address a stamped envelope to the other parent (unless you checked
Box 3a
on the Request to Enter Default) and clip it to the Request to Enter Default. You will
need two additional stamped envelopes to clip to the Notice of Entry of Judgment.
Address one to yourself and address the other one to the other parent.
Follow the directions below based upon whether or not you will be requesting a
Default hearing.
1. Default Hearing
If you are requesting a default hearing, you will need the original plus 3 copies of the
Request to Enter Default and any attachments. Take the forms, copies and envelope to
the family law filing clerk in Room 100. Be sure to ask for a hearing date because the
clerk may not give you one otherwise. The clerk will stamp or print a hearing date on
your copy of the papers and hand it back to you. The clerk will mail one of the copies to
the other parent in the envelope you have provided. The other parent’s copy will not
have a hearing date on it and the other parent will not be notified of the hearing date by
the Court. If you would like the other parent to attend the default hearing, you may tell
him or her the hearing date and time, but he or she is not required to attend and may not
be allowed to speak to the Judge at the hearing.
Superior Court of California, County of Sacramento
Family Law Facilitator’s Office
Page 18 of 18
3/5/2018
Before your Hearing: Complete the Child Support Case Registry form and take it with
you to the hearing.
The Day of Your Hearing: Plan to arrive early to Court in case you run into any
problems, such as difficulty parking or a long line at the metal detector. Check in with
the bailiff as soon as you arrive in the Courtroom. If you have brought your completed
Child Support Case Registry form, ask the bailiff to give it to the courtroom clerk.
After Your Hearing: If your Judgment contains a child support order, even if it is $0 or
“reserved,” you must complete and return a
Child Support Case Registry Form, FL-
191
, within ten days of the date stamped on your filed Judgment. If you did this at your
hearing, you do not have to do it again. If the Department of Child Support Services is
collecting your child support for you, you do not need to complete this form. The
completed form can be mailed to the Court or submitted in the drop box.
2. Without a Hearing
Make 2 copies of all the documents you completed. Attach your Income and Expense
Declaration or Financial Statement (Simplified), if needed, to the Request To Enter
Default. Address a stamped envelope to the other parent (unless you checked
Box 3a
on
the Request to Enter Default) and clip it to the Request to Enter Default.
Attach your completed child custody, child support and any other attachments (if
applicable) to your completed Judgment. Since 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 (and affix a minimum of 3 first class stamps)
and a legal-sized #10 envelope to the other parent (and affix one first class postage
stamp) so that the Court can mail all of the forms and copies back to you, and the Notice
of Entry of Judgment form to the other parent. 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 the other parent.
Group the forms together so that the original of each document is on top of its own
copies. Deposit the forms in the drop box or mail them to the Court. Your signed, filed
endorsed copy of the judgment will be returned to you by mail in the envelope you
provide.
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
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):
ATTORNEY OR PARTY WITHOUT ATTORNEY
(Name, State Bar number, and address):
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
CASE NUMBER:
INCOME AND EXPENSE DECLARATION
Date:
(SIGNATURE OF DECLARANT)
Page 1 of 4
INCOME AND EXPENSE DECLARATION
Form Adopted for Mandatory Use
Judicial Council of California
FL-150 [Rev. January 1, 2007]
FL-150
Family Code, §§ 2030–2032,
2100–2113, 3552, 3620–3634,
4050–4076, 4300–4339
www.courtinfo.ca.gov
Employment
1.
Employer:
Employer's address:
Occupation:
Employer's phone number:
Number of years of college completed
(specify):
I have completed high school or the equivalent:
Date job started:
If unemployed, date job ended:
I get paid
$
gross (before taxes)
I work about hours per week.
(If you have more than one job, attach an 8½-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.)
Number of years of graduate school completed
(specify):
Degree(s) obtained
(specify):
3.
Tax information
I last filed taxes for tax year
(specify year):
single head of household
married, filing separately
married, filing jointly with
(specify name):
I file state tax returns in
I claim the following number of exemptions (including myself) on my taxes
(specify):
This estimate is based on
(explain):
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.
OTHER PARENT/CLAIMANT:
per month per week
California
4.
Other party's income.
I estimate the gross monthly income (before taxes) of the other party in this case at
(specify):
$
(Give information on your current job or, if you're unemployed, your most recent job.)
Age and education
2.
I have:
a.
c.
d.
My tax filing status is
other
(specify state):
(If you need more space to answer any questions on this form, attach an 8½-by-11-inch sheet of paper and write the
question number before your answer.)
b.
Yes
No
b.
c.
d.
e.
Degree(s) obtained
(specify):
My age is
(specify):
a.
professional/occupational license(s)
(specify):
vocational training
(specify):
If no, highest grade completed
(specify):
a.
b.
c.
d.
e.
f.
g.
h.
Attach copies
of your pay
stubs for last
two months
(black out
social
security
numbers).
per hour.
Number of pages attached:
(TYPE OR PRINT NAME)
TELEPHONE NO.:
ATTORNEY FOR
(Name):
E-MAIL ADDRESS
(Optional):
Sacramento
3341 Power Inn Road
3341 Power Inn Road
Sacramento, CA 95826
William R. Ridgeway Family Relations Courthouse
Disability: Social security (not SSI) State disability (SDI) Private insurance .
All other property,
CASE NUMBER:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/CLAIMANT:
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.)
Page 2 of 4
INCOME AND EXPENSE DECLARATION
FL-150 [Rev. January 1, 2007]
Salary or wages (gross, before taxes). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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.)
5.
a.
c.
Last month
$
$
Commissions or bonuses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
My financial situation has changed significantly over the last 12 months because
(specify):
9.
Assets
11.
a.
b.
Total
$
$
$
Cash and checking accounts, savings, credit union, money market, and other deposit accounts . . . . . . . . . . . . . . . .
c.
Stocks, bonds, and other assets I could easily sell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Average
monthly
Change in income.
Investment income
(Attach a schedule showing gross receipts less cash expenses for each piece of property.)
I received one-time money (lottery winnings, inheritance, etc.) in the last 12 months
(specify source and
6.
7.
Rental property income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other
(specify): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dividends/interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
$
8.
$
Trust income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Additional income.
Pension/retirement fund payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Social security retirement (not SSI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Workers' compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other (military BAQ, royalty payments, etc.)
(specify): . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . .
.
g.
h.
i.
j.
k.
l.
d.
e.
$
$
Public assistance (for example: TANF, SSI, GA/GR) currently receiving . . . . . . . . . . . . . . . . .
Spousal support from this marriage from a different marriage . . . . . . . . . . . . . . . . . .
$
$
$
$
$
$
$
b. Overtime (gross, before taxes) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
a
.
c.
d.
b.
I am the
owner/sole proprietor business partner other
(specify):
Number of years in this 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.
Name of business
(specify):
Type of business
(specify):
Income from self-employment, after business expenses for all businesses
. . . . . . . . . . . . . . . . . . . . . $
Deductions
10.
a.
Last month
$
$
$
$
$
Required union dues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Required retirement payments (not social security, FICA, 401(k), or IRA). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Medical, hospital, dental, and other health insurance premiums
(total monthly amount). . . . . . . . . . . . . . . . . . . . . . . .
d. Child support that I pay for children from other relationships. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
e. Spousal support that I pay by court order from a different marriage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
g.
$
Necessary job-related expenses not reimbursed by my employer
(attach explanation labeled "Question 10g") . . . . .
Partner support from this domestic partnership from a different domestic partnership
f.
$
$
f.
Partner support that I pay by court order from a different domestic partnership . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
amount):
c.
real and personal
(estimate fair market value minus the debts you owe) . . . .
FL-150
CASE NUMBER:
Name
Age
How the person is
related to me?
(ex: son)
That person's gross
monthly income
Pays some of the
household expenses?
The following people live with me:
Average monthly expenses
Groceries and household supplies. . . . . . .
Rent or mortgage. . .
$
(1)
Eating out. . . . . . . . . . . . . . . . . . . . . . . . . .
If mortgage:
average principal:
Utilities (gas, electric, water, trash) . . . . . .
$
Telephone, cell phone, and e-mail . . . . . . .
average interest:
$
$
Laundry and cleaning . . . . . . . . . . . . . . . . .
$
Clothes . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
Education
. . . . . . . . . . . . . . . . . . . . . . . . . .
Real property taxes . . . . . . . . . . . . . . $
Entertainment, gifts, and vacation. . . . . . . .
$
Homeowner's or renter's insurance
(if not included above) . . . . . . . . . . . .
Auto expenses and transportation
$
$
Monthly payments listed in item 14
(itemize below in 14 and insert total here). .
Maintenance and repair . . . . . . . . . . .
$
$
Savings and investments. . . . . . . . . . . . . . . $
$
Other
(specify): . . . . . . . . . . . . . . . . . . . . . .
$
Child care . . . . . . . .. . . . . . . . . . . . . . . . . .
$
TOTAL EXPENSES
(a–q)
(do not add in
$
the amounts in a(1)(a) and (b))
Page 3 of 4
INCOME AND EXPENSE DECLARATION
FL-150 [Rev. January 1, 2007]
$
$
$
$
Yes No
Yes No
Yes No
Yes No
a.
b.
c.
d.
Estimated expenses Actual expenses
Proposed needs
Installment payments and debts not listed above
(insurance, gas, repairs, bus, etc.) . . . . . . .
Charitable contributions. . . . . . . . . . . . . . . . $
Date of last payment
Amount
For
Paid to
$
$
$
$
Home:
Balance
The source of this money was
(specify):
I still owe the following fees and costs to my attorney
(specify total owed):
$
I confirm this fee arrangement.
(SIGNATURE OF ATTORNEY)
(TYPE OR PRINT NAME OF ATTORNEY)
Attorney fees
(This is required if either party is requesting attorney fees.):
To date, I have paid my attorney this amount for fees and costs
(specify):
$
Insurance (life, accident, etc.; do not
include auto, home, or health insurance). . . $
My attorney's hourly rate is
(specify):
$
12.
13.
14.
15.
a.
b.
c.
(2)
(3)
(4)
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
q.
r.
e.
Yes No
$
$
$
$
Amount of expenses paid by others
$
s.
a.
b.
c.
d.
Date:
Health-care costs not paid by insurance. . .
(a)
(b)
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/CLAIMANT:
FL-150
$
$
$
$
CASE NUMBER:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/CLAIMANT:
CHILD SUPPORT INFORMATION
I do not have health insurance available to me for the children through my job.
Children's health-care expenses
I do
a.
The monthly cost for the
children's
health insurance is or would be
(specify):
$
Additional expenses for the children in this case
Children's health care not covered by insurance . . . . . . . . . . . . . . . . . . . .
Travel expenses for visitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Children's educational or other special needs
(specify below): . . . . . . . .
Page 4 of 4
INCOME AND EXPENSE DECLARATION
FL-150 [Rev. January 1, 2007]
Child care so I can work or get job training. . . . . . . . . . . . . . . . . . . . . . . . .
Name of insurance company:
Address of insurance company:
I have
(specify number):
children under the age of 18 with the other parent in this case.
The children spend percent of their time with me and percent of their time with the other parent.
(Do not include the amount your employer pays.)
Amount per month
$
Special hardships.
I ask the court to consider the following special financial circumstances
Major losses not covered by insurance (examples: fire, theft, other
insured loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Expenses for my minor children who are from other relationships and
are living with me . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Extraordinary health expenses not included in 18b. . . . . . . . . . . . . . . . . .
(attach documentation of any item listed here, including court orders):
$
$
$
$
$
$
Amount per month
For how many months?
(NOTE: Fill out this page only if your case involves child support.)
(If you're not sure about percentage or it has not been agreed on, please describe your parenting schedule here.)
b.
a.
c.
d.
16.
17.
18.
19.
a.
b.
b.
c.
d.
a.
b.
c.
Names and ages of those children
(specify):
The expenses listed in a, b, and c create an extreme financial hardship because
(explain):
Other information I want the court to know concerning support in my case
(specify):
20.
Number of children
Child support I receive for those children. . . . . . . . . . . . . . . . . . . . . . .
$
(1)
(3)
(2)
FL-150
Child custody and visitation are as specified in one or more of the attached forms:
JUDGMENT
(Uniform Parentage
—
Custody and Support)
c.
d.
e.
a.
b.
Family Code, §§ 3120, 3900,
7600 et seq.
Form Adopted for Mandatory Use
Judicial Council of California
FL-250 [Rev. January 1, 2004]
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER:
FL-250
TELEPHONE NO.:
ATTORNEY OR PARTY WITHOUT ATTORNEY
(Name, State Bar number, and address):
ATTORNEY FOR
(Name):
FAX NO.:
CASE NUMBER:
RESPONDENT:
This matter proceeded as follows: By declarationDefault or uncontested Contested
Room:Dept.:Date:
Judicial officer
(name):
Petitioner present
Respondent present
Attorney present
(name):
Petitioner
3.
THE COURT FINDS
Name:
Attorney present
(name):
a.
2.
Father
are the parents of the following children:
Child's name
Date of birth
JUDGMENT
f.
Temporary judge
This judgment
contains personal conduct restraining orders
1.
g.
Other parties or attorneys present
(specify):
The petitioner signed Advisement and Waiver of Rights Re: Establishment of Parental Relationship
(form FL-235).
The petitioner appeared without counsel and was advised of relevant rights.
h.
Respondent
The respondent appeared without counsel and was advised of relevant rights.
The respondent signed Advisement and Waiver of Rights Re: Establishment of Parental Relationship
(form FL-235).
The restraining orders are contained in item(s): of the attachment.
They expire on
(date):
A CLETS form must be attached.
modifies existing restraining orders.
Page 1 of 2
www.courtinfo.ca.gov
Mother
Name:
Father
Mother
(1)
Child Custody and Visitation Order Attachment
(form FL-341)
(2)
Stipulation for Order for Child Custody and/or Visitation of Children
(form FL-355)
(3)
Other (specify):
4.
THE COURT ORDERS
The petitioner signed a Voluntary Declaration of Paternity.
The petitioner is married to the Respondent, and no other action is pending.
There is a prior judgment of parentage in a family support, juvenile, or adoption court case.
The respondent signed a Voluntary Declaration of Paternity.
The respondent is married to the Petitioner, and no other action is pending.
There is a prior judgment of parentage in a family support, juvenile or adoption court case.
(3)
(4)
(5)
(1)
(2)
(3)
(4)
(5)
(1)
(2)
Sacramento
3341 Power Inn Road
3341 Power Inn Road
Sacramento, CA 95826
William R. Ridgeway Family Relations Courthouse
JUDGMENT
(Uniform Parentage—Custody and Support)
FL-250 [Rev. January 1, 2004]
CASE NUMBER:
PETITIONER:
RESPONDENT:
Page 2 of 2
JUDICIAL OFFICER
Date:
Number of pages attached: _____
SIGNATURE FOLLOWS LAST ATTACHMENT
g.
The birth certificates must be amended to conform to this court order by
Continued on Attachment 3h.
6.
f.
Attorney fees and costs are as stated in the attachment.
e.
NOTICE: Any party required to pay child support must pay interest on overdue amounts at the "legal" rate,
which is currently 10 percent.
Reasonable expenses of pregnancy and birth are as stated in the attachment.
Other
(specify):
h.
a.
Child support is as stated in one or more of the attached:
(1)
(2)
(3)
d.
Child Support Information and Order Attachment
(form FL-342)
Stipulation to Establish or Modify Child Support and Order
(form FL-350)
Other
(specify):
The last names of the children are changed to
(specify):
b. 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 judgment. Thereafter, the parents must notify the court of any change in the information submitted, within 10 days of the
change.
c.
The form Notice of Rights and Responsibilities—Health Care Costs and Reimbursement Procedures and Information Sheet on
Changing a Child Support Order
(form FL-192) is attached.
5.
THE COURT FURTHER ORDERS
adding the father's name.
(1)
changing the last name of the children.
(2)
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:
For your protection and privacy, please press the Clear
This Form button after you have printed the form.
Print this form
Save this form
Clear this form
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:
Print this form
Save this form
Clear this form
For your protection and privacy, please press the Clear
This Form button after you have printed the form.
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:
ordered but stayed until
(date):
Wage withholding was
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:
$
(5)
Sacramento
3341 Power Inn Road
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-192
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:
1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
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.
b. 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.
7. 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.
Page 1 of 2
Form Approved for Optional Use
Judicial Council of California
FL-192 [Rev. January 1, 2021]
Family Code, §§ 4062, 4063
NOTICE OF RIGHTS AND RESPONSIBILITIES
Health-Care Costs and Reimbursement Procedures
www.courts.ca.gov
FL-192
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 ( ) or Stipulation and Order (Governmental) ( ).
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, you must fill out one of these forms:
•
, Request for Order or
•
, 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:
•
, Income and Expense Declaration or
•
, 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 may ask you to pay a filing fee. If you cannot afford the fee, fill out these forms, too:
•
, Request to Waive Court Fees
•
, 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 .
The server must also serve blank copies of these forms:
•
, Responsive Declaration to Request for Order and , Income and Expense Declaration,or
•
, Financial Statement (Simplified)
Then the server fills out and signs a Proof of Service ( or ). Take this form to the clerk and file it.
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:
•
, Findings and Order After Hearing and
•
, Child Support Information and Order Attachment
Need help?
Contact the in your county or call your county's bar association and ask for an experienced family lawyer.
FL-192 [Rev. January 1, 2021]
NOTICE OF RIGHTS AND RESPONSIBILITIES
Health-Care Costs and Reimbursement Procedures
Page 2 of 2
form FL-350
form FL-625
Form FL-300
Form FL-390
Form FL-150
Form FL-155
Form FW-001
Form FW-003
www.courts.ca.gov/holidays.htm
Form FL-320
form FL-150
Form FL-155
form FL-330
form FL-335
Form FL-340
Form FL-342
family law facilitator
FL-190
FOR COURT USE ONLY
PETITIONER:
RESPONDENT:
CASE NUMBER:
NOTICE OF ENTRY OF JUDGMENT
You are notified that the following judgment was entered on
(date):
1. Dissolution
2. Dissolution—status only
Dissolution—reserving jurisdiction over termination of marital status or domestic partnership
3.
4. Legal separation
Nullity
5.
Parent-child relationship6.
7.
Judgment on reserved issues
Other
(specify):
8.
Date:
Clerk, by
, Deputy
—NOTICE TO ATTORNEY OF RECORD OR PARTY WITHOUT ATTORNEY—
Under the provisions of Code of Civil Procedure section 1952, if no appeal is filed the court may order the exhibits destroyed or
otherwise disposed of after 60 days from the expiration of the appeal time.
I certify that I am not a party to this cause and that a true copy of the
Notice of Entry of Judgment
was mailed first class, postage
fully prepaid, in a sealed envelope addressed as shown below, and that the notice was mailed
Effective date of termination of marital or domestic partnership status
(specify):
WARNING: Neither party may remarry or enter into a new domestic partnership until the effective date of the termination
of marital or domestic partnership status, as shown in this box.
CLERK’S CERTIFICATE OF MAILING
Date:
Clerk, by
, Deputy
Page 1 of 1
NOTICE OF ENTRY OF JUDGMENT
(Family Law—Uniform Parentage—Custody and Support)
Family Code, §§ 2338, 7636,7637
Form Adopted for Mandatory Use
Judicial Council of California
FL-190 [Rev. January 1, 2005]
at
(place):
on
(date):
, California,
www.courtinfo.ca.gov
STATEMENT IN THIS BOX APPLIES ONLY TO JUDGMENT OF DISSOLUTION
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:
Name and address of petitioner or petitioner's attorney Name and address of respondent or respondent's attorney
TELEPHONE NO.:
ATTORNEY FOR
(Name):
FAX NO.
(Optional):
E-MAIL ADDRESS
(Optional):
Sacramento
3341 Power Inn Road
3341 Power Inn Road
Sacramento, CA 95826
William R. Ridgeway Family Relations Courthouse
DECLARATION FOR DEFAULT OR UNCONTESTED JUDGMENT
FOR COURT USE ONLY
ATTORNEY FOR
(Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
PETITIONER:
RESPONDENT:
CASE NUMBER:
I declare that if I appeared in court and were sworn, I would testify to the truth of the facts in this declaration.
I request that proof will be by this declaration and that I will not appear before the court unless I am ordered by the court to appear.
Petition or Complaint to Establish Parental Relationship Response or AnswerAll the information in the
DEFAULT OR UNCONTESTED
(Check a or b)
a. The default of the respondent was entered or is being requested, and I am not seeking any relief not requested in the
petition.
OR
b. The parties have stipulated that the matter may proceed as an uncontested matter without notice, and the stipulation is
attached.
NOTE: If a support order is requested, submit a completed
Income and Expense Declaration
(form FL-150), or
Financial Statement (Simplified) (form FL-155), unless a current form is on file. Include your best estimate of the
other party's gross monthly income.
CHILD SUPPORT should be ordered as set forth in the proposed Judgment
(form FL-250)
.
a.
ATTORNEY FEES should be ordered as set forth in the proposed Judgment
(form FL-250).
8.
DECLARATION FOR DEFAULT OR UNCONTESTED JUDGMENT
(
Uniform Parentage, Custody and Support)
Family Code, §§ 7600, 3120,
3900 et seq
Form Adopted for Mandatory Use
Judicial Council of California
FL-230 [Rev. January 1, 2003]
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
FL–230
Petitioner is/are the parent(s) of the minor child(ren).
Respondent and/or
4.
has not been signed regarding this child
(attach a copy if available).
hasA Voluntary Declaration of Paternity form
TELEPHONE NO.:
ATTORNEY OR PARTY WITHOUT ATTORNEY
(Name, state bar number, and address):
FAX NO.:
1.
2.
3.
5.
6.
7.
RespondentPetitioner
b.
payable to the local child support agency at (specify address):
CHILD CUSTODY should be ordered as set forth in the proposed Judgment
(form FL-250).
9.
CHILD VISITATION should be ordered as set forth in the proposed Judgment
(form FL-250).
10.
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.
11.
NAMES OF THE CHILDREN should be changed as set forth in the proposed Judgment
(form FL-250).
13.
I have read and understand the Advisement and Waiver of Rights Re: Establishment of Parental Relationship
(form FL-235),
which is signed and attached to this declaration.
14.
Other
(specify):
15.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(SIGNATURE OF DECLARANT)(TYPE OR PRINT NAME)
12.
REASONABLE EXPENSES OF PREGNANCY AND BIRTH should be ordered as set forth in the proposed Judgment
(form
FL-250).
Petition to Establish Custody and Support Response
Page 1 of 1
is presently receiving public assistance (TANF); thus all support should be made
is true and correct.
www.courtinfo.ca.gov.
Sacramento
3341 Power Inn Road
3341 Power Inn Road
Sacramento, CA 95826
William R. Ridgeway Family Relations Courthouse
(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)
INTERPRETER'S DECLARATION
ADVISEMENT AND WAIVER OF RIGHTS RE:
ESTABLISHMENT OF PARENTAL RELATIONSHIP
(Uniform Parentage)
CASE NUMBER:
PETITIONER:
RESPONDENT:
ADVISEMENT AND WAIVER OF RIGHTS RE: ESTABLISHMENT OF PARENTAL RELATIONSHIP
RIGHT TO BE REPRESENTED BY A LAWYER.
I understand that I have the right to be represented by a lawyer of my
own choice at my own expense. If I cannot afford a lawyer, I can contact the Lawyer Referral Association of the local
bar association or the Family Law Facilitator for assistance.
RIGHT TO A TRIAL.
I understand that I have a right to have a judge determine whether I am the parent of the children
named in this action.
RIGHT TO CONFRONT AND CROSS-EXAMINE WITNESSES.
I understand that in a trial I have the right to confront
and cross-examine the witnesses against me and to present evidence and witnesses in my own defense.
RIGHT TO HAVE PARENTAGE TESTS.
I understand that, where the law permits, I have the right to have the court
order parentage tests. The court will decide who pays for the tests. The court could order that I pay none, some, or all
of the costs of the tests.
WAIVER.
I understand that I am admitting that I am the parent of the children named in the stipulation and am giving
up the rights stated above (except the right to an attorney if I have an attorney).
his/her primary language is
(specify):
other
(specify):
I certify under penalty of perjury under the laws of the State of California that I have, to the best of my ability, read or translated for
(SIGNATURE OF INTERPRETER)
1.
2.
3.
4.
6.
CHILD SUPPORT.
I understand that I will have the duty to contribute to the support of the children named in this
action and that this duty of support will continue for each child until the obligation is terminated by law.
CRIMINAL NON-SUPPORT.
I understand that if I willfully fail to support the children, criminal proceedings may be
initiated against me.
9.
I have read and understand the
Judgment (Uniform Parentage
—
Custody and Support) (form FL-250) and this
Advisement and
Waiver of Rights.
Date:
I understand the translation.
UNDERSTANDING.
Form Approved for Optional Use
Judicial Council of California
FL-235 [Rev. January 1, 2003]
Family Code, § 7600 et seq.
The 1.
2.
Date:
FL-235
a.
b.
a.
b.
(TYPE OR PRINT NAME)
5.
OBLIGATIONS.
I understand that if I admit that I am the parent of the children in this action that those children will be
my children for legal purposes.
the Judgment
(Uniform Parentage—Custody and Support) (form FL-250) and this
Respondent
Petitioner Respondent is unable to read or understand the
Judgment (Uniform Parentage—Custody and
8.
7.
IF I AM REPRESENTED BY AN
ATTORNEY, I ACKNOWLEDGE THAT MY
ATTORNEY HAS READ AND EXPLAINED
TO ME THE CONTENTS OF THE
STIPULATION, RECITALS, AND WAIVERS,
AND I ACKNOWLEDGE THAT I
UNDERSTAND THEM.
Petitioner
Parentage—Custody and Support) (form FL-250) and this
Advisement and Waiver of Rights before signing them.
Support) (form FL-250) and this
Advisement and Waiver of Rights because:
Page 1 of 1
www.courtinfo.ca.gov.
said he or she understood the
Judgment (Uniform
Respondent Petitioner
Advisement and Waiver of Rights.
the
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HOW TO OBTAIN A UNIFORM PARENTAGE ACT JUDGMENT (California)

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Completed 7 April 2021

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