Fill and Sign the Ca Statement of File Form

FL-650 GOVERNMENTAL AGENCY (under Family Code, §§ 17400, 17406): ––––– ––––– ––––– ––––– TELEPHONE NO.: ––––– FAX NO.: ––––– FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF ––––– STREET ADDRESS: ––––– MAILING ADDRESS: ––––– CITY AND ZIP CODE: ––––– BRANCH NAME: ––––– PETITIONER/PLAINTIFF: ––––– ––––– RESPONDENT/DEFENDANT: ––––– ––––– OTHER PARENT: ––––– STATEMENT FOR REGISTRATION OF FOREIGN SUPPORT ORDER Support Order Order For Wage or Income Withholding (Governmental) CASE NUMBER: ––––– The district attorney's statement to register a California support order a California order for wage or income withholding is as follows: 1. The Obligor (the parent ordered to pay support) is Petitioner/Plaintiff Respondent/Defendant Other parent 2. An endorsed filed copy of the most recent support order or order for wage or income withholding (or a copy) is attached. 3. a. An interstate affidavit of Obligor's payment history is attached. b. A Declaration of Support Arrearage (form 1285.62) is attached. c. The arrearage balance is unknown. 4. The district attorney's post office address is (specify) : ––––– ––––– 5. Obligor's last known place of residence or post office address, or address in the records of the California Department of Motor Vehicle, is (specify) : ––––– ––––– ––––– ––––– 6. States and counties in which the original order for support or order for wage or income withholding, and any modifications, are registered (specify) : ––––– ––––– ––––– ––––– None, or unknown. NOTICE TO OBLIGOR 1. You have 20 days after the date of mailing of this Statement for Registration of California Support Order to petition the court to cancel (vacate) this registration or for other relief. (Family Code, § 5603.) ( See the accompanying document to determine the date of mailing .) 2. The district attorney may seek a Health Insurance Coverage Assignment enrolling the children in an appropriate health insurance plan pursuant to Family Code section 3761. STATEMENT FOR REGISTRATION OF FOREIGN SUPPORT ORDER (Governmental) Family Code, §§ 17400, 17406): Form Adopted by for Manditory Use Judicial Council of California FL- [Rev. January 1, 2003] page1 of 1 el ectr onic form ã 2002 WWW.LawCA.co m L a w P u b l i s h e r s Form Adopted by Rule 1298.30 Judicial Council of California 1298.30 [Rev. July 1, 1998] STATEMENT FOR REGISTRATION OF FOREIGN SUPPORT ORDER (Governmental) Family Code, §§ 5601 E lectronic form © 1997-98 www.lawca.com