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SB-12039 ADDENDUNM TO JUDGMENT

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Petitioner’s Initials _______
Respondent’s Initials ______
STIPULATION AND ORDER
ON REQUEST FOR ORDER (FAMILY LAW)
Form SB12039
rev 11/05/12
Page 1 of 9
STIPULATION AND ORDER ON REQUEST FOR ORDER (FAMILY LAW)
Petitioner (Husband/Wife/Mother/Father/Other) not present. Pendente Lite
Respondent (Husband/Wife/Mother/Father/Other) not present. Modification
THE PARTIES HEREBY STIPULATE AND AGREE TO THE ITEMS CHECKED BELOW AND
THAT THE COURT SHALL MAKE THE FOLLOWING:
Temporary order pending the trial of this action or further order of the Court.
Order of modification.
1. CHILD CUSTODY AND VISITATION
Custody and visitation have been agreed to by the parties. See attached Mediation Report
(Mediation Date: ______________________).
Custody of the minor child/ren shall be ordered as follows, and such arrangements are in the
best interests of the minor child/ren:
DATE OF THIS HEARING
TIME
DEPARTMENT
FOR COURT USE ONLY
NAME, ADDRESS AND TELEPHONE NUMBER OF PETITIONER’S ATTORNEY or PETITIONER
BAR NO:
NAME, ADDRESS AND TELEPHONE NUMBER OF RESPONDENT’S ATTORNEY or RESPONDENT
BAR NO:
TITLE OF CASE :
, PETITIONER
, RESPONDENT
CASE NUMBER:
Child’s Name:
Date of Birth:
Petitioner’s Initials _______
Form SB12039
Respondent’s Initials ______
STIPULATION AND ORDER
ON REQUEST FOR ORDER (FAMILY LAW)
rev 11/05/12
Page 2 of 9
LEGAL CUSTODY
JOINT LEGAL CUSTODY of the minor child/ren shall be awarded to both parties, with:
BOTH PARTIES TO SHARE the physical care, custody and control of the minor
child/ren reasonably between them in such a manner as to insure that the minor
child/ren maintain frequent and continuing contact with both parents.
SOLE LEGAL CUSTODY of the minor child/ren shall be awarded to ____________________.
Additional Joint Legal Custody Provisions as stated in the Attached Form FL-341(E)
PHYSICAL CUSTODY
SOLE PHYSICAL CUSTODY shall be awarded to ___________________________________.
JOINT PHYSICAL CUSTODY shall be shared between both parties.
Additional Physical Custody Provisions as stated in the Attached Form FL-341(D)
AND
VISITATION AS FOLLOWS:
PRIMARY PHYSICAL CUSTODY to __________________________, with the right of
REASONABLE visitation to ___________________________________ as follows:
___________________________________________________________________
___________________________________________________________________
OR
As contained in the attached Family Court Services report, consisting of _____ pages with
mediation date of ______/_______/_______.
OR
Child’s Name: (continued)
Date of Birth:
Petitioner’s Initials _______ Form SB12039
rev 11/05/12
Respondent’s Initials ______
STIPULATION AND ORDER
ON REQUEST FOR ORDER (FAMILY LAW)
Page 3 of 9
SPECIFIC VISITATION as follows:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Holiday Schedule as stated in the Attached Form FL-341(C)
OTHER ORDERS RE: MINOR CHILDREN
Neither party shall remove the child/ren from the following geographic areas ___________
____________________ without prior written consent of the other party or prior order of the
Court first having been obtained except for vacation periods.
Neither party shall use or make, nor allow any other persons to use or make, any
disparaging, or derogatory remarks about the absent parent in the presence of said
child/ren.
Each party shall keep the other party informed of his or her current address and telephone
number and those of the child/ren and shall notify the other within _____ days of any change
of address or telephone number.
___________________ shall not consume any alcoholic beverages, narcotic, or restricted
dangerous drug (except upon prescription) within _____ hours of visitation or during the
visitation with the minor children.
Neither party shall discuss the facts of this case with the minor child/ren.
Party receiving physical custody shall be responsible for the child’s/ren’s transportation on
the custody exchanges.
Transportation for visitation shall be as follows:
Transport TO visit provided by _________________________. Transport FROM
visit provided by _______________________________________.
Drop Off & Pickup will be at ______________________________________________.
Petitioner’s Initials _______ Form SB12039
Respondent’s Initials ______
STIPULATION AND ORDER
ON REQUEST FOR ORDER (FAMILY LAW)
rev 11/05/12
Page 4 of 9
Other: _________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
2. CHILD SUPPORT
_____ Petitioner _____ Respondent shall pay to the other party as and for child support the
sum of $__________ per month. The allocation of support per child is as stated in the
attached Child Support Calculation.
Child Support shall be:
due one-half on the first and one-half on the fifteenth day of each month
due on the first of the month
due on the _______ day of each month
commencing ___________ 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.
GUIDELINE: A printout of a computer calculation and findings is attached and incorporated in this
order. The amount of support per the guideline formula is $___________.
The amount of child support is set forth as calculated under the guideline.
OR
WE AGREE TO NON-GUIDELINE CHILD SUPPORT. The child support agreed to by the
parties is below or above guideline. Pursuant to Family Code Section 4065(a), the parties
declare that they 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; the agreement is in the best interests of the
children involved. Application of the guideline amount would be unjust or inappropriate in this
case. If the order is below the guideline, no change of circumstances will be required to
Petitioner’s Initials _______ Form SB12039
rev 11/05/12
Respondent’s Initials ______
STIPULATION AND ORDER
ON REQUEST FOR ORDER (FAMILY LAW)
Page 5 of 9
modify this order. If the order is above the guideline, a change of circumstances will be
required to modify this order.
Health insurance coverage for the minor children of the parties shall be maintained by the
petitioner respondent if available at no or reasonable cost through 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. Any health expenses
not paid by insurance shall be shared: _____% Petitioner _____% Respondent
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 mental disabling injury, illness, or condition and is chiefly dependent
upon the parent providing health insurance for support and maintenance when health insurance
coverage is available at no cost or at a reasonable cost to the parent or parents, as applicable.
ARREARS. _____Petitioner _____ Respondent shall pay to the other party the child support
arrears in the principal sum of $________ for the period of ___/___/___ to ___/___/___.
These arrears shall be paid as follows:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
CHILD CARE COSTS
______ Petitioner ______ Respondent shall pay reasonable child care costs related to
employment or necessary job training in the amount of $__________, per month:
Each party shall pay one-half.
Petitioner’s Initials _______
Form SB12039
rev 11/05/12
Respondent’s Initials ______
STIPULATION AND ORDER
ON REQUEST FOR ORDER (FAMILY LAW)
Page 6 of 9
_____ % Petitioner _____% Respondent
$______ Petitioner $______ Respondent
RESERVED. The Court’s jurisdiction to award child support is reserved.
NOT APPLICABLE. Child Support is not a subject of this stipulation.
3. SPOUSAL SUPPORT
WAIVER. Petitioner Respondent freely, knowingly and intelligently waives spousal
support forever. The Court’s jurisdiction to award spousal support to that/those parties shall
be terminated. The Court shall have no jurisdiction to award spousal support, and therefore
no support can be ordered regardless of future hardship. The Parties agree and the Court
finds that the Party/Parties waiving spousal support have considered the factors listed in
Family Code Section 4320.
ZERO SUPPORT/RESERVED – LONG-TERM MARRIAGE. Neither party shall receive
spousal support from the other. The court reserves jurisdiction over this issue for the benefit
of either party as this was a long-term marriage.
SPOUSAL SUPPORT PAYMENTS. Petitioner Respondent shall pay spousal support
to the other Party the sum of $________ per month,
due one-half on the first and one-half on the fifteenth day of each month
due on the first of the month
due on the _______ day of each month
commencing _____________ and continuing until _________________. Spousal
support shall terminate upon the death of either party or the remarriage of the supported
party, or further order of the Court, whichever occurs first.
SPECIAL ORDERS re SPOUSAL SUPPORT:
__________________________________________________________________
__________________________________________________________________
Petitioner’s Initials _______
Form SB12039
rev 11/05/12
Respondent’s Initials ______
STIPULATION AND ORDER
ON REQUEST FOR ORDER (FAMILY LAW)
Page 7 of 9
NOTICE: It is the goal of this State that each party must make reasonable good faith efforts to
become self-supporting as provided for in Family Code section 4320. The failure to make
reasonable good faith efforts may be one of the factors considered by the Court as a basis for
modifying or terminating support.
RESERVED. The Court’s jurisdiction to award spousal support to Petitioner
Respondent is reserved for later determination upon Request for Order.
NOT APPLICABLE. Spousal Support is not a subject of this stipulation.
4. ATTORNEY’S FEES, LITIGATION EXPENSES AND COURT COSTS
The issue of attorney’s fees for either party is reserved until further order of the Court.
_____________________ shall pay directly to ____________________ counsel as
attorney’s fees, expenses of litigation and Court costs the sum of $ __________, payable in
installments of $ __________ per ____________ payable on the __________ and
___________ days of each month commencing ________________ and continuing until
paid in full. If any ______ installment payments are not paid when due, the entire unpaid
balance will become immediately due and payable and shall bear interest at the legal rate
from date of default.
Each of the parties shall pay his/her own attorney’s fees, expenses of litigation and Court
costs, excepting those previously ordered.
NOT APPLICABLE. Attorney Fees are not a subject of this stipulation.
5. OTHER ORDERS
Additional orders ___________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Petitioner’s Initials _______
Form SB12039
rev 11/05/12
Respondent’s Initials ______
STIPULATION AND ORDER
ON REQUEST FOR ORDER (FAMILY LAW)
Page 8 of 9
_______________________________________________________________________
_______________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Check here if additional pages attached for Other Additional Orders.
All other issues are reserved until time of trial next hearing date.
This matter is continued to ___________________ at for further hearing on
all issues the following issues only:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Counsel for Petitioner Respondent to prepare a formal order.
This stipulation covers all matters in dispute in the Request for Order. This Order when
signed is the formal Order. No further documents are necessary.
This stipulation shall be deemed incorporated in and made a part of the minute order by reference
thereto, and as though the same were fully set forth therein.
SIGNATURE OF PARTIES
We have read the entire stipulation and agreement. We understand it fully and request the Court to
make our stipulation and agreement the Court’s order. We understand that willful failure to comply
a.m.
p.m.
Petitioner’s Initials _______
Form SB12039
rev 11/05/12
Respondent’s Initials ______
STIPULATION AND ORDER
ON REQUEST FOR ORDER (FAMILY LAW)
Page 9 of 9
with the provisions of this order will be a contempt of Court and may be punished by fine and
imprisonment. We waive all further notice of this order.
The foregoing is agreed to by:
x______________________ ______ x________________________ _______
Petitioner Date Respondent Date
Approved as conforming to the agreement of the parties:
_______________________________ _________________________________
(Petitioner’s Attorney, if any) (Respondent’s Attorney, if any)
IT IS SO ORDERED THIS ___________ day of _________________, _____________.
PURSUANT TO FAMILY CODE SECTION 3048 (A)
This Court exercises jurisdiction under the Uniform Child Custody and Jurisdiction
Enforcement Act (part 3 of the California Family code, commencing with section 3400)
Notice and opportunity to be heard were given under Family Code Section 3425.
Violation of the order may subject the party in violation to civil or criminal penalties, or both.
The habitual residence of the children is the United States of America
__________________________________
JUDGE OF THE SUPERIOR COURT
NOTICE TO PARTIES WITHOUT ATTORNEYS
If this stipulation is reached as a temporary order pre-trial, this order shall remain in effect until further order
of the Court. If you wish notice of the trial date and to present information to the Court at time of trial, you
must have filed a Response to the Petition.
If other agencies require a copy, counsel will be directed to prepare and forward same or prepare and
file a formal order and serve all opposing parties.
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SB-12039 ADDENDUNM TO JUDGMENT

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Completed 3 July 2020

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