Fill and Sign the 128573 Fl 461 Attachment to Qualified Domestic Relations Order for Support Form

FL-4 61P ETIT IO NER /P LA IN TIF F:CASE NUMBERRESPO NDEN T/D EFE N DAN T:O TH ER P AR EN T:ATTACHMENT TOQUALIF IE D D O M ESTIC R ELA TIO NS O RDER F O R S U PPO RT ( F orm F L-4 00)S TA TE M EN T O F C O NFID EN TIA L I N FO RM ATIO NDO N O T F IL E W IT H C O URTThis s e p ara te S ta te m ent o f C onfid entia l In fo rm atio n s e ts fo rth th e s o cia l s e cu rit y n um ber o f th e E m plo ye e a nd an y A lt e rn ate P artic ip ant fo r w hose b enefit s p ousal o r f a m ily s u pport is b ein g w it h held u nder th e Q ualif ie d Dom estic R ela tio ns O rd er fo r S upport ( fo rm F L-4 60). T he P la n w ill r e quir e th is in fo rm atio n fo r ta x r e portin g pu rp ose s. D o n ot in clu de s o cia l s e cu rit y n um bers fo r p e rs o ns r e ce iv in g c h ild s u pport o r fo r a c h ild A lt e rn ate Pa ye e. T his f o rm m ust b e c o m ple te d a n d s erv ed o n t h e P la n w it h a c o py o f t h e o rd er.1 . E M PLO YEE IN FO RM ATIO Na. E m plo ye e N am e: b . E m plo ye e S ocia l S ecu rit y N um ber:2 . S P O USAL O R F A M IL Y A LT E R NATE P AYEE IN FO RM ATIO N ( fo r S pousa l o r F am ily S upport o nly ):a . S pousa l o r F am ily A lt e rn ate P aye e's N am e:b. S pousa l o r F am ily A lt e rn ate P aye e's S ocia l S ecu rit y N um ber: A TTA C HM EN T T O Q UALIF IE D D O M ESTIC RE LA TIO NS O RDER F O R S U PPO RT (EA R NIN G S A SS IG NM EN T O RD ER F O R S U PPO RT) Fam ily C ode, § 5 208-42 U .S .C . § 4 0~Form Adopted by for Optional Use Judicial Council of California FL-461 [Rev. January 1, 2003]ele ctr o n ic f o rm  2 002 WWW.LawCA.com La w P ublis h erspage1 of 1