Fill and Sign the Declaration for Amended Proposed Judgment 129917 Fl 616 Family Law Governmental 129917 Fl 616 Form

FL-616 GOVER NM EN TA L A G EN CY ( p urs u ant to W elf . & In st. C ode, § § 1 1475.1 , 1 1478.2 ): TE LE PH O NE A N D F A X N O S.: FO R C O URT U SE O NLY S U PER IO R C O URT O F C ALIF O RNIA , C O UNTY O F  STR EET A D DRESS: /// //MAIL IN G A D DRESS: /// //CIT Y A N D Z IP C O DE: /// // BR AN CH N AM E: /// //PE TIT IO NER /P LA IN TIF F: RESP O NDEN T/D EFE N DAN T: OTH ER P AR EN T: D EC LA RATIO N F O R A M EN DED P R O PO SED J U DG M EN T (Govern m en ta l) C ASE N UM BER : 1. The lo ca l c h ild s u pport a gency is p ro vid in g e nfo rc e m ent s e rv ic e s in t h is c a se . 2. On ( d ate ): a S um mons a nd C om pla in t w as f ile d r e questin g t h e O blig or p ay c h ild s u pport b ase d on th e C alif o rn ia s u pport g uid elin e. T he a m ount o f th e s u pp ort r e queste d w as b ase d o n th e O blig or's g ro ss m onth ly in co m e a s fo llo w s ( c h eck o ne):a , P re su m ed in co m e a s p ro vid ed b y la w . b. K now n in co m e o f: $ p er m onth . 3 . Sin ce t h e f ilin g o f t h e S um mons a nd C om pla in ta . th e d is tr ic t a tto rn ey h as r e ce iv e d a ddit io nal in co m e in fo rm atio n w hic h w ould r e su lt in d if fe re nt s u pport o rd er. A cco rd in g t o t h is in fo rm atio n, Oblig or's g ro ss m onth ly in co m e is : $ Oblig ee's g ro ss m onth ly in co m e is : $ b. O blig or's in co m e h as b eco m e u nkn ow n. c. Oth er ( s p ecif y ): 4. An a m ended p ro pose d ju dgm ent is a tta ch ed.I d ecla re u nder p enalt y o f p erju ry u nder t h e la w s o f t h e S ta te o f C alif o rn ia t h at t h e f o re goin g is t r u e a nd c o rre ct.D ate : (TYPE OR PRINT NAME) (S IG NATU RE O F D EFE N DAN T) D EC LA RATIO N F O R A M EN DED P R O PO SED J U DG M EN T (Gove rn m en ta l) F am ily C ode § § 1 7400, 17406 Form Adopted by for Manditory Use Judicial Council of California FL-616 [Rev. January 1, 2003]page1 of 2ele ctr o nic f o rm  2 002 WWW.LawCA.com La w P ublis h ers PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT: CASE NUMBER PROOF OF SERVICE 5. I s e rv e d t h is d ecla ra tio n a nd t h e a tta ch ed am ended p ro pose d ju dgm ent o n t h e O blig or.a . P ers o nal d eliv ery . I p ers o nally d eliv e re d t h is d ecla ra tio n a nd ju dgm ent t o t h e O blig or a s f o llo w s: (1 ) Nam e o f e m plo ye e: (2 ) Addre ss w here d eliv e re d: (3 ) Date o f d eliv e ry : (4 ) Tim e o f d eli v e ry : b. M ail. I d eposit e d th is d ecla ra tio n a nd ju dgm ent in th e U nit e d S ta te s m ail, in a s e ale d e nve lo pe w it h p osta ge fu lly pre paid . I u se d f ir s t c la ss m ail. T he e nve lo pe w as a ddre sse d a nd m aile d a s f o llo w s: (1 ) Nam e: (2 ) Addre ss: (3 ) Date o f d eliv e ry : (4 ) Pla ce o f M ailin g ( c it y a nd s ta te ): I d ecla re u nder p enalt y o f p erju ry u nder t h e la w s o f t h e S ta te o f C alif o rn ia t h at t h e f o re goin g is t r u e a nd c o rre ct.D ate :   (TYPE OR PRINT NAME) (S IG NATU RE O F P ER SO N W HO S ER VED A N SW ER ) 6 . I s e rv e d t h is d ecla ra tio n a nd t h e a tta ch ed am ende d p ro po se d ju dgm ent o n t h e o th er p are nt.a . P ers o nal d eliv ery . I p ers o nally d eliv e re d t h is d ecla ra tio n a nd ju dgm ent t o t h e o th er p are nt a s f o llo w s: (1 ) Nam e: (2 ) Addre ss w here d eliv e re d: (3 ) Date o f d eliv e ry : (4 ) Tim e o f d eli v e ry . b. M ail. I d eposit e d t h is d ecla ra tio n a nd ju dgm ent in t h e U nit e d S ta te s m ail, in a s e ale d e nve lo pe w it h p osta ge fully p re paid . I u se d f ir s t c la ss m ail. T he e nve lo pe w as a ddre sse d a nd m aile d a s f o llo w s: (1 ) Nam e: (2 ) Addre ss w here d eliv e re d: (3 ) Date o f m ailin g: (4 ) Pla ce o f m ailin g ( c it y a nd s ta te ): I d e cla re u nder p enalt y o f p erju ry u nder t h e la w s o f t h e S ta te o f C alif o rn ia t h at t h e f o re goin g is t r u e a nd c o rre ct.D ate :  (TYPE OR PRINT NAME) (S IG NATU RE O F P ER SO N W HO S ER VED O TH ER P AR EN T) DEC LA RATIO N F O R A M EN DED P R O PO SED J U DG M EN T (Govern m en ta l) P age 2 o f 2 FL-616 [Rev. January 1, 2003]ele ctr o nic f o rm  2 002 WWW.LawCA.com La w P ublis h ers