Fillable TerminationOfWageAssignment FL-430 EX PARTE APPLICATION FOR EARNINGS ASSIGNMENT ORDER

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TerminationOfWageAssignment FL-430 EX PARTE APPLICATION FOR EARNINGS ASSIGNMENT ORDER

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1.
Total amount unpaid (arrears) is at least:
2.
Date of order:
Payable by
Payable to
Total amount unpaid (arrears) is at least:
Payment of
Written notice of my intent to seek an earnings assignment was
a.
(1)
(2)
(3)
(4)
(specify):
by first class mail.
by personal service.
contained in the support order described in item 1 or 2.
other
Payable by (party):
Date of birth Monthly amountChild’s name
Payable to (party):
The amount of arrears stated in items 1f and 2d
(If penalties are not included, they are not waived.)
3.
b.
FL-430
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
TELEPHONE NO.:
FAX NO. (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARTY/PARENT:
FOR COURT USE ONLY
CASE NUMBER:
TERMINATE AN EARNINGS ASSIGNMENT ORDER
EX PARTE APPLICATION TO
MODIFY, OR
ISSUE,
(date):
Spousal or domestic partner support
family support was ordered as follows:
$
as of (date):
$
as of (date):
petitioner
other parent
other
respondent
respondent
(specify):
Interest and penalties
does
does not include interest at the legal rate. (If interest
does does not include penalties at the legal rate.
4.
(Complete for support ordered before July 1, 1990, only)
petitioner
child support
given at least 15 days before the date of filing this application
5.
An earnings assignment order has not been issued for support ordered after July 1, 1990.
Page 1 of 3
Family Code, §§ 3901, 5230, 5240, 5252
www.courts.ca.gov
EX PARTE APPLICATION TO ISSUE, MODIFY, OR
TERMINATE AN EARNINGS ASSIGNMENT ORDER
Form Adopted for Mandatory Use
Judicial Council of California
FL-430 [Rev. January 1, 2014]
E-MAIL ADDRESS (Optional):
b. c.
f.
d.
a.
b.
c.
d.a.
e.
The amount of arrears stated in items 1f and 2d
is not included, it is not waived.)
a.
b.
APPLICANT DECLARES
is overdue in the sum of at least one month's payment.
spousal or partner support
Child support was ordered as follows on
waived (explain):
Self Represented Litigant
San Bernardino
✔
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seeing what you entered on
your form, please press the
Clear This Form button at the
end of the form when finished.
JUDICIAL SUBPOENA
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
Courtat thethe Honorable
located at
County of
o'clock in theday of noon, and at any recessedin room , on the , 20 , at
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
I
Calendar No.
THE PEOPLE OF THE STATE OF NEW YORK
TO
Index No.
,
American LegalNet, Inc.
www.USCourtForms.com
Court in
Witness, Honorable , one of the Justices of the
day of , 20County,
COURT
COUNTY OF
Plaintiff(s)
-against-
Defendant(s)
:
:
:
:
:
:
:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mobile Tel. No.:
✔
7.
The local child support agency is no longer enforcing the current support obligation in this case but is required to
collect and enforce any arrears owing.
MODIFICATION OF CHILD SUPPORT EARNINGS ASSIGNMENT ORDER
Past due support has been paid in full, including any interest due.
TERMINATION OF CHILD SUPPORT EARNINGS ASSIGNMENT ORDER
The modified earnings assignment order is requested because (check all that apply):
ISSUANCE OF EARNINGS ASSIGNMENT ORDER
per month current spousal or domestic partner support.
a.
b.
d.
e.
g.
Total deductions per month:
c.
per month current child support.
per month current family support.
per month child support arrears.
per month spousal or domestic partner support arrears.
per month family support arrears.
FL-430
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARTY/PARENT:
CASE NUMBER:

6.
f.
$
The support arrears in this case are paid in full, including interest.
The earnings assignment order must be conformed to the most recent support order as follows (specify):
b.
c.
d.
e.
8.
The earnings assignment order for child support should be terminated because (check all that apply):
a.
b.
d.
f.
g.
h.
i.
There is no current support order.
The child reached age 18 and completed the 12th grade on
The child reached 18 and is no longer a full-time high school student as of
The child died on
The child married on
The child went on active duty with the armed forces of the United States on
details):
The child received a declaration of emancipation under Family Code section 7122 (name each child and give
(date):
(date):
(date):
(date):
(date):
EX PARTE APPLICATION TO ISSUE, MODIFY, OR
TERMINATE AN EARNINGS ASSIGNMENT ORDER
FL-430 [Rev. January 1, 2014]
Page 2 of 3
One or more of the following children listed in the child support order are emancipated (support is no longer
required by law) as of the following dates (name each emancipated child and date of emancipation):
a.
e.
The child reached age 19.





The existing earnings assignment order for child support should be modified as follows (specify):
Other (specify):
I request an earnings assignment order issue for the following monthly deductions:
c.
✔
9.
MODIFICATION OF SPOUSAL, DOMESTIC PARTNER, OR FAMILY SUPPORT EARNINGS ASSIGNMENT ORDER
TERMINATION OF SPOUSAL, DOMESTIC PARTNER, OR FAMILY SUPPORT EARNINGS ASSIGNMENT ORDER
The modified earnings assignment order is requested because (check all that apply):
8.
(continued)
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
j.
l.
k.
(specify):
The State Disbursement Unit has been unable to deliver payment for a period of six months due to the failure
of the support recipient to notify the State Disbursement Unit of a change in his or her address.
The previous stay of the earnings assignment was improperly terminated
The existing earnings assignment order for spousal, domestic partner, or family support should be changed as follows
a.
b.
The support arrears in this case are paid in full, including interest.
The earnings assignment order must be conformed to the most recent support order as follows (specify):
c.
Past due support has been paid in full, including any interest due.
10.
The earnings assignment order for spousal, domestic partner, or family support should be terminated because (specify):
a.
b.
c.
d.
e.
f.
There is no current support order.
The supported spouse or domestic partner remarried or registered a domestic partnership on
The supported spouse or partner died on
By terms of the current order, spousal, partner, or family support terminated on
A previous stay of wage assignment was improperly terminated (specify):
(date):
(date):
(date):
g.
h.
The has been unable to deliver payment for a period of six
months due to the failure of the support recipient to notify that employer or the State Disbursement Unit of a
change in his or her address.


SIGNATURE
(TYPE OR PRINT NAME)
Date:
Other (specify):
Other (specify):
Other (specify):
EX PARTE APPLICATION TO ISSUE, MODIFY, OR
TERMINATE AN EARNINGS ASSIGNMENT ORDER
FL-430 [Rev. January 1, 2014]
Page 3 of 3
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARTY/PARENT:
FL-430
CASE NUMBER:
(specify):
Attached is proof of age and/or high school status.
Print This Form
Clear This Form
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This Form button after you have printed the form.
FL-195
Document Tracking Identifier 1
INCOME WITHHOLDING FOR SUPPORT
ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO)
AMENDED IWO
ONE-TIME ORDER/NOTICE FOR LUMP SUM PAYMENT
TERMINATION of IWO Date:
Child Support Enforcement (CSE) Agency Court Attorney Private Individual/Entity (Check One)
NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the
sender (see IWO instructions http://www.acf.hhs.gov/programs/cse/newhire/employer/publication/publication.htm - forms).
If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying
order must be attached.
State/Tribe/Territory Remittance Identifier (include w/payment)
City/County/Dist./Tribe Order Identifier
Private Individual/Entity CSE Agency Case Identifier
RE:
Employer/Income Withholder’s Name Employee/Obligor’s Name (Last, First, Middle)
Employer/Income Withholder’s Address Employee/Obligor’s Social Security Number
Custodial Party/Obligee’s Name (Last, First, Middle)
Employer/Income Withholder’s FEIN
Child(ren)’s Name(s) (Last, First, Middle) Child(ren)’ s Birth Date(s)
ORDER INFORMATION: This document is based on the support or withholding order from (State/Tribe).
You are required by law to deduct these amounts from the employee/obligor’s income until further notice.
$ Per current child support
$ Per past-due child support - Arrears greater than 12 weeks? Yes No
$ Per current cash medical support
$ Per past-due cash medical support
$ Per current spousal support
$ Per past-due spousal support
$ Per other (must specify) .
for a Total Amount to Withhold of $ per .
AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information. If
your pay cycle does not match the ordered payment cycle, withhold one of the following amounts:
$
per weekly pay period
$
per semimonthly pay period (twice a month)
$
per biweekly pay period (every two weeks)
$
per monthly pay period
$ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order.
REMITTANCE INFORMATION: If the employee/obligor’s principal place of employment is (State/Tribe),
you must begin withholding no later than the first pay period that occurs days after the date of . Send
payment within
working days of the pay date. If you cannot withhold the full amount of support for any or all orders
for this employee/obligor, withhold up to
% of disposable income for all orders. If the employee/obligor’s principal
place of employment is not
(State/Tribe), obtain withholding limitations, time requirements, and any
allowable employer fees at
http://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contact_map.htm for the
employee/obligor’s principal place of employment.
✔
✔
California
To keep other people from seeing what you entered on your form, please press the Clear This Form button at the end of the form when
finished.
Zero
California
10
ASAP
7
50
California
FL-195
OMB Expiration Date – 05/31/2014. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version
of the form currently in use. 2
For electronic payment requirements and centralized payment collection and disbursement facility information (State
Disbursement Unit [SDU]), see
http://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contact_map.htm.
Include the Remittance Identifier with the payment and if necessary this FIPS code:
Remit payment to (SDU/Tribal Order Payee)
at (SDU/Tribal Payee Address)
Return to Sender [Completed by Employer/Income Withholder]. Payment must be directed to an SDU in accordance
with 42 USC §666(b)(5) and (b)(6) or Tribal payee (see Payments to SDU below). If payment is not directed to an
SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender.
If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that must issued this order, a
copy of this IWO must be provided to the employee/obligor.
If checked, the employer/income withholder must provide a copy of this form to the employer/obligor.
ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS
State-specific contact and withholding information can be found on the Federal Employer Services website located at:
http://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contact_map.htm
Priority: Withholding for support has priority over any other legal process under State law against the same income
(USC 42 §666(b)(7)). If a Federal tax levy is in effect, please notify the sender.
Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts
from more than one employee/obligor’s income in a single payment. You must, however, separately identify each
employee/obligor’s portion of the payment.
Payments to SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a
Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the
custodial party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this
IWO was sent by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or
the order was issued by a Tribal CSE agency, you must follow the “Remit payment to” instructions on this form.
Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the
amount was withheld from the employee/obligor’s wages. You must comply with the law of the State (or Tribal law if
applicable) of the employee/obligor’s principal place of employment regarding time periods within which you must implement
the withholding and forward the support payments.
Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs
due to Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority
to current support before payment of any past-due support. Follow the State or Tribal law/procedure of the
employee/obligor’s principal place of employment to determine the appropriate allocation method.
Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to
this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are
required to report and/or withhold lump sum payments.
Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the
employee/obligor’s income as the IWO directs, you are liable for both the accumulated amount you should have withheld
and any penalties set by State or Tribal law/procedure.
Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor
from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO.
Signature of Judge/Issuing Official (if required by State or Tribal law):
Print Name of Judge/Issuing Official:
Title of Judge/Issuing Official:
Date of Signature:
California State Disbursement Unit
P.O. Box 989067, West Sacramento, CA. 95798
FL-195
Employer’s name:
Employer FEIN: __
Employee/Obligor’s Name:
CSE Agency Case Identifier:
Order Identifier __
IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor. 3
Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer
Credit Protection Act (CCPA) (15 U.S.C. 1673(b)); or 2) the amounts allowed by the State or Tribe of the employee/obligor’s
principal place of employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making
mandatory deductions such as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and
Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the
disposable income if the obligor is not supporting another family. However, those limits increase 5% - to 55% and 65% - if
the arrears are greater than 12 weeks. If permitted by the State or Tribe, you may deduct a fee for administrative costs. The
combined support amount and the fee may not exceed the limit indicated in this section.
For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal
employers/income withholder who receive a State IWO, you may not withhold more than the lesser of the limit set by the law
of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section
303(d) of the CCPA (15 U.S.C. 1673 (b)).
Depending upon applicable State law or Tribal law, you may need to also consider the amounts paid for health care
premiums in determining disposable income and applying appropriate withholding limits.
Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks, then
the Employer should calculate the CCPA limit using the lower percentage.
Additional Information:
NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for
you or you are no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency
and/or the sender by returning this form to the address listed in the Contact information below:
This person has never worked for this employer nor received periodic income.
This person no longer works for this employer nor receives periodic income.
Please provide the following information for the employee/obligor:
Termination date: Last known phone number:
Last known address
Final payment date to SDU/Tribal Payee: Final payment amount:
New employer’s name:
New employer’s address:
CONTACT INFORMATION
To Employer/Income Withholder: If you have any questions, contact (Issuer name)
by phone at
, by fax at , by email or website at: .
Send termination notice and other correspondence to:
(Issuer address).
To Employer/Obligor: If the employee/obligor has questions, contact (Issuer name)
by phone at
, by fax at , by email or website at: .
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Copy
Make (2) copies of your corrected originals and then you will be ready to file your
paperwork.
File
After copying, take your original and the (2) sets of copies, and (1) self addressed
envelope with a postage stamp to the clerk’s office to file.
Finishing up
When you receive the (2) copies of the court order then you will keep (1) copy for
your records and send the other copy to the employer.
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TerminationOfWageAssignment FL-430 EX PARTE APPLICATION FOR EARNINGS ASSIGNMENT ORDER

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Completed 3 July 2020

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