Fill and Sign the Ca Governmental Online Form

FL-685 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address) : 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: ––––– RESPONSE TO GOVERNMENTAL NOTICE OF MOTION OR ORDER TO SHOW CAUSE HEARING DATE: ––––– TIME: ––––– DEPT., ROOM, OR DIVISION: ––––– CASE NUMBER: ––––– 1. PARENTAGE I do do not admit that I am the parent of all of the children. I admit that I am the parent of all of the children except (specify) : ––––– 2. CHILD SUPPORT a. I consent to the order requested. b. I request the following child support order: ––––– ––––– 3. HEALTH INSURANCE COVERAGE and HEALTH INSURANCE COVERAGE ASSIGNMENT a. I consent to the order requested. b. I request the following health insurance coverage order: ––––– ––––– 4. FEES AND COSTS I do do not consent to the order requested. 5. OTHER REQUESTS I do do not consent to the orders requested in item 5 of the request. 6. FACTS IN SUPPORT of this request are: contained in an attached Declaration. ––––– ––––– ––––– ––––– ––––– 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) RESPONSE TO GOVERNMENTAL NOTICE OF MOTION OR ORDER TO SHOW CAUSE (Governmental) page1 of 2el ectr onic form ã 2002 WWW.LawCA.co m L a w P u b l i s h e r sForm Adopted by for Manditory Use Judicial Council of California FL-685 [Rev. January 1, 2003] PETITIONER/PLAINTIFF: ––––– RESPONDENT/DEFENDANT: ––––– CASE NUMBER: ––––– PROOF OF SERVICE BY MAIL 1. I am over the age of 18, not a party to this cause , and a resident of or employed in the county where the mailing took place. 2. My business or residence address is (specify) : ––––– ––––– ––––– 3. I served the District Attorney with a copy of this answer by enclosing it in a sealed envelope with postage fully prepaid, depositing it in the United States mail as follows: a. Date of deposit: ––––– b. Place of deposit (city and state) : ––––– c. Addressed as follows: ––––– ––––– ––––– 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 MAILING FORM) RESPONSE TO GOVERNMENTAL NOTICE OF MOTION OR ORDER TO SHOW CAUSE (Governmental)FL-685 [Rev. January 1, 2003] page2 of 2el ectr onic form ã 2002 WWW.LawCA.co m L a w P u b l i s h e r s