Fill and Sign the Ca Support Family Form

FL-420 ATTORNEY OR PARTY WITHOUT ATTORNEY Name and Address) or TELEPHONE NO.: GOVERNMENTAL AGENCY (under Family Code, §§ 17400, 17406): ––––– ––––– ––––– ––––– ––––– ––––– ––––– 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: ––––– DECLARATION OF SUPPORT ARREARAGE CASE NUMBER: ––––– 1. The Obligor/Payor (person who pays support) is the Petitioner/Plaintiff Respondent/Defendant Other parent 2. The amount of support arrearages, interest, and penalties, if any, owed in this proceeding is calculated as follows: a. Total Amount of Support $ ––––– as of (date): ––––– b. Amount paid $ ––––– as of (date): ––––– c. Amount applied to principal: $ ––––– d. Amount applied to interest: $ ––––– e. Balance of principal owed: $ ––––– as of (date): ––––– f. Balance of interest owed:* $ ––––– as of (date): ––––– g. Penalties ordered:* $ ––––– as of (date): ––––– h. Balance owed: $ ––––– as of (date): ––––– * If interest or penalties are not claimed, they are not waived. 3. Details of the arrearage statement, consisting of (specify number): ––––– pages, are attached. 4. An interest calculation statement is attached. 5. Other (specify): ––––– ––––– I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Declared on information and belief, Date: ––––– ––––– (TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT) Form Adopted by for Manditory Use Judicial Council of California f:-420 [Rev. January 1, 2003] DECLARATION OF SUPPORT ARREARAGE (Family Law) Family Code, §§ 5230.5, 7524(a), 17526(c)electronic form ã 2002 WWW.LawCA.com Law Publishers