Fill and Sign the Ca Child Support 497298959 Form

FL-401 ATTORNEY OR PARTY WITHOUT ATTORNEY TELEPHONE NO.: ––––– ––––– ––––– ––––– ––––– ATTORNEY FOR (Name) : ––––– FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF ––––– STREET ADDRESS: ––––– MAILING ADDRESS: ––––– CITY AND ZIP CODE: ––––– BRANCH NAME: ––––– PETITIONER/PLAINTIFF: ––––– ––––– RESPONDENT/DEFENDANT: ––––– APPLICATION FOR DISBURSEMENT AND ORDER FOR DISBURSEMENT FROM CHILD SUPPORT SECURITY DEPOSIT (Family Law–Uniform Parentage) CASE NUMBER: ––––– APPLICATION FOR DISBURSEMENT FROM CHILD SUPPORT SECURITY DEPOSIT 1. The undersigned is entitled to receive child support payments. A deposit has been established to secure payment of the child support. The support is more than 10 days late, as follows: Amount due as child support Date due Amount paid Amount due ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– Total amount due: ––––– 2. I request the court to order disbursement of the amount due from the child support security deposit. 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) A copy of this application must be served on the obligor and proof of its service attached to the original that is filed with the court. ORDER FOR DISBURSEMENT FROM CHILD SUPPORT SECURITY DEPOSIT AND ORDER TO REPLENISH FUNDS 3. The following financial institution (name) : ––––– shall pay the following amount: $ ––––– to the following person who is entitled to receive payment of child support (name) : ––––– 4. The obligor (name) : ––––– shall replenish the child support security deposit by depositing the following amount: $ ––––– not later than (date) : ––––– The original evidence of replenishment shall be filed with the court. A copy of the evidence of replenishment shall be served on the person entitled to receive payment of the child support. Date: ––––– JUDGE OF THE SUPERIOR COURT 5. I certify that the foregoing order is a copy of the original on file with the court. Date: Clerk, by , Deputy = page 1 of 1 Form Adopted by for Manditory Use Judicial Council of California APPLICATION FOR DISBURSEMENT AND ORDER FOR Family Code, §§ 4570–4573electronic form ã 2002 WWW.LawCA.com Law Publishers FL-401 [Rev. January 1, 2003] DISBURSEMENT FROM CHILD SUPPORT SECURITY DEPOSIT Form Adopted by Rule 1285.29 Judicial Council of California 1285.29 [New January 1, 1995] APPLICATION FOR DISBURSEMENT AND ORDER FOR DISBURSEMENT FROM CHILD SUPPORT SECURITY DEPOSIT (Family Law–Uniform Parentage) Family Code, §§ 4570-4573 Electronic form (c) 1998 Fresno LaserGraphics, Inc.