Fill and Sign the California Service Order Form

FL-455 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address) : TELEPHONE NO.: ––––– ––––– ––––– ––––– ––––– ATTORNEY FOR (Name) : ––––– Name and Address)FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF ––––– STREET ADDRESS: ––––– MAILING ADDRESS: ––––– CITY AND ZIP CODE: ––––– BRANCH NAME: ––––– PETITIONER/PLAINTIFF: ––––– ––––– RESPONDENT/DEFENDANT: ––––– ––––– Stay Termination of Stay OF SERVICE OF WAGE ASSIGNMENT ORDER AND ORDER CASE NUMBER: ––––– APPLICATION FOR STAY (NOTICE: If this application is made separately from a hearing on support, you must get a hearing date from the clerk and give notice. See below.) I request the court to stay the service of the wage assignment in this case because (check one or more applicable reasons): 1. I have paid fully and on time the previously ordered support for the last 12 months, and I do not owe any back support arrearages). 2. I have not been subject to a support order for the last 12 months, but I have posted cash cash bond with the clerk of the court in the amount of $ ––––– , which is equal to three months' support, and I do not owe any back support (arrearages). 3. Service of the wage assignment would cause extraordinary hardship on me as follows (state reasons) : (Note: You must prove these reasons at any hearing on this application by clear and convincing evidence.) ––––– ––––– ––––– 4. I have a written agreement with the party receiving support that provides a stay of service of the wage assignment. A copy of the agreement is attached. (Note: This agreement must be signed by the district attorney if support is payable to a county officer designated for that purpose.) 5. My employer or the district attorney has been unable to deliver the support payments to the recipient for at least six months because the recipient has not notified my employer or the district attorney of a change of address. (Attach statement under oath by employer or district attorney.) 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 APPLICANT) NOTICE OF HEARING A hearing on this application will be held as follows: a. Date: ––––– Time: ––––– Dept.: ––––– Room: ––––– b. The address of the court is shown above is: ––––– ––––– ––––– ––––– STAY OF SERVICE OF WAGE ASSIGNMENT ORDER AND ORDER Civil Code, §§ 4390.3, 4390.4 page1 of 2 Form Adopted by for Manditory Use Judicial Council of California FL-455 [Rev. January 1, 2003] elec troni c form ã 2002 WWW.LawCA.co m L a w P u b l i s h e r s PETITIONER/PLAINTIFF: ––––– ––––– RESPONDENT/DEFENDANT: ––––– CASE NUMBER: ––––– APPLICATION FOR TERMINATION OF STAY I request the court to terminate the stay of service of the wage assignment previously issued in this case on (date) : ––––– because (check one or more applicable reasons) : 1. The person required to make payments has missed at least one payment of support, which continues unpaid. (Note: A false statement about missed payments is punishable as a contempt.) 2. I am the person required to make the payments, the district attorney, and I wish the stay terminated. 3. The reasons for granting the stay no longer exist. (Hearing required. See reverse for notice of hearing.) (State facts showing the previous reasons for granting the stay no longer exist) : ––––– ––––– ––––– 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 APPLICANT) PROOF OF SERVICE BY MAIL 1. I am over the age of 18 and not a party to this cause. I am a resident of or employed in the county where the mailing took place, and my residence or business address is (specify) : ––––– ––––– 2. I served a copy of this Application re stay of service of wage assignment order by enclosing it in a sealed envelope with first class postage fully prepaid and depositing it in the United States Postal Service as follows: a. Date of deposit: ––––– b. Place of deposit (city, 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 DECLARANT) ORDER GOOD CAUSE APPEARING: 1. Service of the wage assignment issued in this action is stayed. 2. The stay of service granted above shall terminate without further order on (date) : ––––– 3. The previously ordered stay of service of the wage assignment made on (date) : ––––– is terminated, and the wage assignment previously issued in this case may be served. Date: ––––– (JUDGE OF THE SUPERIOR COURT) STAY OF SERVICE OF WAGE ASSIGNMENT ORDER AND ORDER (Family Law) page2 of 2el ectr onic form ã 2002 WWW.LawCA.co m L a w P u b l i s h e r sFL-455 [Rev. January 1, 2003]