Fill and Sign the California Declaration Order Form

FL-616 GOVERNMENTAL AGENCY (pursuant to Welf. & Inst. Code, §§ 11475.1 , 11478. 2): TELEPHONE AND FAX NOS.: ––––– ––––– ––––– ––––– ––––– ––––– 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 FOR AMENDED PROPOSED JUDGMENT (Governmental) CASE NUMBER: ––––– 1. The local child support agency is providing enforcement services in this case. 2. On (date): ––––– a Summons and Complaint was filed requesting the Obligor pay child support based on the California support guideline. The amount of the support requested was based on the Obligor's gross monthly income as follows (check one) : a, Presumed income as provided by law. b. Known income of: $ ––––– per month. 3. Since the filing of the Summons and Complaint a. the district attorney has received additional income information which would result in different support order. According to this information, Obligor's gross monthly income is: $ ––––– Obligee's gross monthly income is: $ ––––– b. Obligor's income has become unknown. c. Other (specify) : ––––– ––––– 4. An amended proposed judgment is attached. 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 DEFENDANT) DECLARATION FOR AMENDED PROPOSED JUDGMENT (Governmental) Family Code §§ 17400, 17406 Form Adopted by for Manditory Use Judicial Council of California FL-616 [Rev. January 1, 2003] page1 of 2 el ectr onic form ã 2002 WWW.LawCA.co m L a w P u b l i s h e r s PETITIONER/PLAINTIFF: ––––– ––––– RESPONDENT/DEFENDANT: ––––– ––––– OTHER PARENT: ––––– CASE NUMBER ––––– PROOF OF SERVICE 5. I served this declaration and the attached amended proposed judgment on the Obligor. a. Personal delivery. I personally delivered this declaration and judgment to the Obligor as follows: (1) Name of employee: ––––– (2) Address where delivered: ––––– ––––– (3) Date of delivery: ––––– (4) Time of delivery: ––––– b. M ail . I deposited this declaration and judgment in the United States mail, in a sealed envelope with postage fully prepaid. I used first class mail. The envelope was addressed and mailed as follows: (1) Name: ––––– (2) Address: ––––– ––––– (3) Date of delivery: ––––– (4) Place of Mailing (city and state) : ––––– 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 WHO SERVED ANSWER) 6. I served this declaration and the attached amended proposed judgment on the other parent. a. Personal delivery . I personally delivered this declaration and judgment to the other parent as follows: (1) Name: ––––– (2) Address where delivered: ––––– ––––– (3) Date of delivery: ––––– (4) Time of delivery. ––––– b. Mail . I deposited this declaration and judgment in the United States mail, in a sealed envelope with postage fully prepaid. I used first class mail. The envelope was addressed and mailed as follows: (1) Name: ––––– (2) Address where delivered: ––––– ––––– (3) Date of mailing: ––––– (4) Place of mailing (city and state) : ––––– 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 WHO SERVED OTHER PARENT) DECLARATION FOR AMENDED PROPOSED JUDGMENT Page 2 of 2FL-616 [Rev. January 1, 2003] el ectr onic form ã 2002 WWW.LawCA.co m L a w P u b l i s h e r s (Governmental)