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P E TIT IO NER /P LA IN TI FF:CAS E NU MBER : R ESPO NDEN T/D EFE NDAN T: OTHER PARENT: FL-3 42CH IL D S U PPO RT I N FO RM ATI ON AND O RD ER A TTA CHM EN TA tt a ch me nt t o Fin di ng s a n d Or der A fte r H earing Jud gme ntO th erR es tr a in in g O rd er A fte r H earing ( C LE TS )TH E C O URT USED T H E F O LLO W IN G IN FO RM ATIO N IN D ETE R M IN IN G T H E A M OUNT O F CHI LD SU PPO RT: 1. A p rin to ut of a co m pute r c a lc u la tio n an d find in gs is a tta ch ed a n d inc orpo ra ted in th is o rd er fo r a ll r e quir e d it e m s not fil le d o u t be low .2.In co me a. E ach p are nt’s m onth ly in co m e is as fol lo w s:Gr oss mo nth ly Net m on thl y Rece iv in g in co m e in co me TANF /Ca IWO RKS petit io ner/pl ain tiff : $ respo nd en t/d efe nda nt : $ $ $oth er p ar en t: $ $b. Imput atio n o f in co m e. T he co urt f in ds th at t h epet it io n er/p la in tif fr e sp on de nt/d e fe n dantoth e r p a re nthas t h e ca pacit y to earn :$pe r: an d h as b as ed t h e su ppor t o rde r u p on th is im pute d in co m e.3. Child ren of Th is Re lat ions hip a. N um ber of c h ild re n w ho are th e s ub je cts o f th e s u pport or de r (s p ecif y ): b. A ppro xim ate p er ce nt ag e of tim e s p ent wi th: p etit io ner/p la in tif f%4 . Hard sh ip sre sp on de nt/de fe nd ant% oth e r p a re n t %Hard sh ip s f o r t h e fol lo w in g h ave be en a llo w ed in ca lc u la tin g ch ild s u pp ort:a . b. c.O th er m in or c h ild re n: Ex tr ao rd in ary m edi ca l e xp ense s: Ca ta str o phic lo ss e s:pe tit io ne r/ pl ain tif f $ $ $ r e sp ond ent/ d e fe n da nt $ $ $ oth er p a re nt $ $ $ A ppr ox imate e ndin g tim e for the hard ship T H E C O URT ORDER S 5.Low -Income Adjustmenta. b.T he lo w-in co m e a dju stm ent a p p lie s. The lo w-in co m e a dju stm ent d o e s n o t ap ply b eca use (s p ecif y r e aso ns):6 . Child Sup por t a. Base c hi ld s u pp ort Petitioner/ plaintiffR esp o nd ent/de fen dantO th er p a re ntm ust p ay c h ild su p po rt begin nin g(d ate ): and co nt inu in g u ntil fu rth er o rd er o f th e co urt, o r u ntil the ch ild m arrie s, di es, is e m an cip ate d , re ac he s age 19, o r r e ach es ag e 18 and is not a fu ll-tim e h ig h sch ool stu dent, w hic heve r o ccu rs f ir s t, as f o ll ow s:C hild ’s nam eDate of b ir th Mont hly a m ountP ay ab le to (n am e)P aya bleon th e 1 st o f th e m onth oth er (s p ecif y ):on e-h alf o n th e 1 st an d on e-h alf o n th e 15t h o f th e m on thb. Mand ato ry ad dition al ch ild su ppo rt (1 ) Child -c a re c o sts r e la te d to em ploy ment o r r e aso na bly nece ssa ry jo b t r a in in g.P etit ion er/p la in tiff m ust p ay: Re sp o nd ent/d efe ndant m ust p ay: Oth e r p a re nt m ust p ay:% of to ta l or % of to ta l or % of to ta l or$ $ $per m ont h per m ont h per m ont hch ild -ca re c o sts . ch ild -ca re c o sts . ch ild -ca re c o sts .C osts to b e p aid a s fo llo ws (s p ecif y ):T H IS IS A CO URT O RDER . Page 1 of 2Fo rm Ad opted for M and ator y Use Jud ic ia l C ou ncil of C alif o rni a FL-3 42 [R ev . Ju ly 1, 20 05]CH IL D S U PPO RT IN FO RM ATIO N A ND ORDE R ATTA CHM EN TFam ily C od e, § § 40 5 5– 406 9 www.c o ur tin fo .c a .g ov P ET ITIONER /PLA IN TIF F: CASE N UMB ER : R ESPO ND EN T/ DE FENDAN T: OTH ER P AR EN T: T H E C O URT FU RTH ER O RDER S 6. b . M an d ato ry a dd itio na l ch ild s up por t (c on tin ued ) (2) Reaso na ble un in sur ed he alt h -c a re c o sts f o r t h e ch ildr enc. Petit io ner /p la in tif f m ust p ay : Respo nden t/d efe nda n t m ust pay: Othe r p are nt m ust pay: Co sts to b e p aid a s fo llo w s (s p ec ify) : Addi tio na l c hi ld s u pp ort % of to ta l or % of to ta l or % of to ta l or$ $ $pe r m on th . per m on th . per m on th .(1 ) Costs r e lat ed to t h e ed uc ation al o r ot her sp ecia l n e eds of th e ch ild re n P etit ion er/pl ain tif f m ust p ay: Re sp ond ent/d ef end ant m ust p ay: Othe r pa ren t m ust p ay: Co sts to b e p aid a s fo llo w s (s p ecif y): (2 ) Tra ve l e xp ens es fo r vis it a tio n Pe tit ion er/pl ain tif f m ust p ay: Re sp o nd ent/d ef end ant m ust p ay : Oth e r pare nt m ust p ay : Costs to b e p aid a s fo llo w s (s p ecif y ): % o f t o ta l o r % o f t o ta l o r % o f t o ta l o r % o f to ta l o r % o f to ta l o r % o f to ta l o r$ $ $ $ $ $per m ont h. pe r m on th . per m ont h. per m on th . pe r m ont h. pe r m ont h.To tal c hi ld sup port per mo nth: $7. H ealt h -C are E xp ens esa.H ea lt h in su ra nce c o ve ra g e fo r th e m inor ch ild re n o f th e p artie s m ust b e m ain ta in ed by th ep etit io ner /p lai ntif f resp ond en t/d efe nd a nto th er p ar en tif a va ila bl e a t n o o r r ea so nab le co st th ro u ghthe ir re sp ec tiv e p la ce s o f e m plo ym en t o r se lf - e m plo ym ent. B oth par tie s a re o rd ere d to c o ope rat e in th e p re se nta tio n, c o lle ctio n, an d re im burs e m ent o f any he alt h -c a re c lai m s.b . H ealt h in su ra nce is n o t a va ila ble to th e at a r e aso n a ble c o st a t th is tim e. petit io ner/p la in tif fr e sp ond en t/d efe n d a ntoth er p ar en tc.Th e p arty p ro vid in g c ov erag e m ust as sign th e r ig ht o f r e im burs e m ent t o t h e oth e r party .8 . E arnin gs Ass ign me nt An Ord er /N otic e to W it h hol d In co m e for C hild S upp ort (fo rm FL -1 95) m us t is su e. N ote: T he pay or o f ch ild s u pport is r e sp onsib le for t h e paym ent of s u pport di re ctly to th e r ec ip ie nt u ntil s up port p a ym ents ar e d ed uct ed f r o m t h e payo r’s wages, a nd f o r an y su pp ort n o t pa id b y th e a ssig nm ent.9 .No n-Gu ideli ne Order Th is o rd er d oes n o t m eet th e c h ild su pp ort g uide lin e se t f o rth in Fa mily C od e s e ctio n 405 5. A N on-G uid eli ne C hi ld Support Find in gs A tta ch m ent (fo rm F L-3 42 (A )) is atta ch ed.1 0 . Em plo ym en t S ea rc h O rd er ( Fam ily C ode , § 4 505 ) Petit io ner /p la in tif f Resp on de nt/d ef enda nt fo ll ow in g ter ms an d c o ndit io ns:O th er p ar en tis o rd ere d to se e k em plo ym ent w it h the1 1 . O th er Or ders (s p ecif y ):1 2 . R eq u ir ed A tt a ch men ts A N ot ic e o f R ig hts a n d R esp on sib ili tie s— Heal th Care Costs a nd R ei m bu rs em ent P roc ed ure s an d In fo rm atio n Sheet o n C han gin g a Ch il d Sup p ort O rd er (fo rm FL-1 92) m us t b e a tta ch ed a n d is in co rp ora te d in to th is ord er . 13. Ch ild Su pport Case Reg istry Form Both pa rtie s m ust c o m plete an d file with th e cou rt a C hi ld Support C as e R eg is tr y Form (fo rm F L-1 91 ) w it h in 10 days o f th e d a te of this or der. T he rea fte r, th e p artie s m ust notif y th e c o urt o f any ch ange in th e in fo rm atio n su bm itte d w it h in 1 0 d ays of th e ch a ng e b y filin g an u p date d f o rm .NOT ICE: A ny p art y r eq uir ed to pa y c h ild su ppo rt m ust p ay i n te res t on overd ue a m oun ts at th e leg al r a te , w hic h is cu rr e n tly 1 0 pe rc en t pe r year.FL- 34 2 [R ev. Jul y 1, 20 05] TH IS IS A C O URT ORDER . CHIL D S U PPO RT IN FO RM ATIO N A ND ORDE R ATTA CHM EN T Pa ge 2 of 2