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FL- 6 15 僅供法庭使用 電話號碼: 傳真號碼 電子郵件地址 律師 加 州 高 等 法 院 郡 街道地址: 郵寄地址: 城市與郵遞區號: 分部名稱: 請願人/原告: 答辯人/被告: 其他父母: 父 母 義 務 與 判 斷 力 之 案號: 判 決 或 追 加 判 決 契 約 (姓名): (選擇性): (選擇性): 政府機關 (根據家庭法 ): 其他委任使用之採用表格 替 代 FL- 6 9 2 加州司法委員會 FL-615 [ 200 9 年 1 月 1 日修正] 第 1 頁, 共 4 頁 家庭法 , § § 17400, 17402,17406 父母義務與判斷力之判決或追加判決契約 (政府) § § 1 7 4 0 0 , 1 7 40 6 1. 此事件處理方式如下: a. 透過書面契約,無需出庭。 b. 透過法院聽證會,出席者如下: (1) 日期: 部門: 司法人員: (2) 請願人/原告出席 律師出席 (3) 答辯人/被告出席 律師出席 (4) 其他父母出席 律師出席 (5) 當地子女撫養機 構 (家庭法, § § 17400 , 17406 ),出席者 (6) 其他 c. 義務 人 (受命令需支付撫養費的父(母))為 請願人/原告 答辯人/被告 其他父母 2. 此命令是依據附件 3. 當事人同意 a. 義務人已閱讀並瞭解本表 第 4 頁所載之 。義務人放棄這些權利,且自願同意判決可能將依照此契約。 b. 根據準則計算,義務人應支付的撫養金額為:每 月 $ 我們同意準則撫養金額。 如發生下列事項,準則金額應予以駁回: (1) 我們已獲悉準則的撫養金額,我們自願同意子女撫養金額為:每 月 $ ;協議是以子女的最佳利益 著想;此同意的金額將可滿足子女的需求;子女並未獲得公共補助金;無正在等待審核的公共補助金申請;準則 適用金額在此案件中不公平且不適當。我們瞭解若命令金額低於準則金額,則無需提出情況變更說明以變更此命 令至準則金額。若命令金額高於準則金額,則需提出情況變更說明以修正此命令。 (2) 其他駁回因素 c. 附檔為電腦的列印資料,其顯示父母的收入和與兒女共處的時間百分比。列印資料顯示子女撫養費應付金額的計算,並將作 為法庭調查結果。 請注意: 任何需支付子女撫養費的當事人,必須按法定利率支付逾期款項的利息;目前法定利率為每 年 10% 。 (姓名): (姓名): (姓名): (姓名): (請指出): (請指定): 契約權利建議與棄權 (請指出): 僅 供 資 訊 用 途 請 勿 上 呈 法 庭 FL-615 請願人/原告: 案號: 答辯人/被告: 其他父母: 第2頁, 共4頁 FL-615 [200 9年1月1日修正] 父母義務與判斷力之判決或追加判決契約 (政府) 3. d. 請願人/原告 答辯人/被告 其他父母 為以 下 3e中所列兒童的父母。 e. 義務人必須支付目前子女的撫養費如下: 姓名 生日 每月撫養費 (1) 其他 (2) 總計: $ ,於每月 日支付 開始 (3) 適用低收入調整。 不適用低收入調整因為 (4) 任何撫養費命令在法院作出進一步命令前皆有效,因基於法律而終止的情況除外。 f. 義務人必須支付過去的補助金以及下列的金額。 姓名 生日 補助期 金額 (1) 其他 (2) 總計: $ 應支付: $ 於每月 日 開始 (3) 利息將依照積欠的整筆本金計算,而非依照積欠的每筆分期金額計算。 g. 若這是 的判決,其不會修正或取代任何先前所作出關於撫養或欠款的判決或命 令,除非特別提出。 h. 此判決中無任何限制收取本 金 (未支付撫養金的總金額),或依法律許可索取和收取利息及罰金之權利的條款。所有判定之款項均 可能有所變動。 i. 所有款項需支付給 j. (表 單 FL-195/OM B編號 0970-0154 )。 k. 義務人 權利人 必 須 (1) 透過雇用或團體計劃,或在無費用或合理費用內,提供並維持子女的健康保險項目, 並通知當地子女撫養機構受保的範圍; (2)若無法取得健康保險,則必須在可取得時提供; (3)在當地子女撫養機構要求後 的 20天 內,填妥並交回健康保險表單; (4)提供當地子女撫養機構所有替子女取得健康保險服務的必要資訊和表單; (5)提交索賠申請, 以取得其他父母或保母針對子女健康保險服務所產生的款項或賠償; (6)針對子女健康保險服務,交付任何獲得賠償的權利給其他 父母或保母。若勾選「義務人」方塊,則將發出健康保險範圍指派文件。 (日期): (日期): (請指出): (請指出): (機構名稱和地址): 追加控訴 核發撫養費之收入扣繳 (指定原因): FL-615 請願人/原告: 案號: 答辯人/被告: 其他父母: 日期: (書寫或正楷姓名) (當地子女撫養機構律師簽名) 日期: (書寫或正楷姓名) (請願人簽名) 日期: (書寫或正楷姓名) (請願人律師簽名) 日期: (書寫或正楷姓名) (答辯人簽名) 日期: (書寫或正楷姓名) (答辯人律師簽名) 日期: (書寫或正楷姓名) (其他父母簽名) 日期: (書寫或正楷姓名) (其他父母律師簽名) 第3頁, 共4頁 FL-615 [200 9年1月1日修正] 父母義務與判斷力之判決或追加判決契約 (政府) 3. I. 父母必須在變更住宅或工作的十天內,以書面方式通知當地子女撫養機構。 m. 已附上 (表 單 FL-192 )。 n. 義務人必需支付之費用: $ 給 ,根據下列條款 o. 根據家庭法 第 1740 4款,已新增下列人士(其他父母)為此訴訟之當事人 p. 其他 權利與義務之公 告 — 變更子女撫養命令之健康保險費用與賠償程序和資訊表 (請指出): (請指出): (請指出): (姓名): 判決 4. 法院如此命令。 日期: 司法人員 5. 附加頁數: 最後附件簽名 FL-615 請願人/原告: 案號: 答辯人/被告: 其他父母: 第4頁, 共4頁 FL-615 [200 9年1月1日修正] 父母義務與判斷力之判決或追加判決契約 (政府) 契約權利建議與棄權 1. 由 律 師 代 表 之 權 利 。 我 瞭 解 本 人 擁 有 自 費 選 擇 律 師 代 表 本 人 的 權 利 。 若 我 無 法 負 擔 代 表 本 人 之 律 師 的 費 用 , 本 人 可 要 求 法 庭 免 費 指 派 代 表 律 師 , 但 必 須 在 本 人 對 在 此 訴 訟 中 所 列 名 兒 童 提 出 爭 取 監 護 , 且 僅 限 在 父 母 議 題 上 時 才 可 作 出 此 等 要 求 。 我 瞭 解 當 地 子 女撫養機構的律師並不代表本人。 2. 審 判 的 權 利 。 我 瞭 解 我 有 權 利 請 求 司 法人員: (1)判定我是否為契約所列兒 童的 父 (母), (2)決定我必需支付多少 子女撫養費, 和 (3)決定我欠多少款 項 (未支付之撫養費 )的權利。 3. 與證人對質和交叉訊問的權利。 我瞭解 在審判中針對本人的任何指控都需受到 證明。審判過程中,證人作證時我可由 律師代表,並對他們詢問問題。 我也可 以提出證據和證人。 4. 在 法 律 允 許 下 進 行 親 子 測 試 的 權 利 。 我 瞭 解 在 法 律 允 許 的 情 況 下 , 我 有 權 利 取 得 法 庭 命 令 進 行 親 子 測 試 。 法 庭 將 決 定 測 試 方 式 。 法 庭 可 命 令 我 無 需 支付測試費用,或部分或全額支付。 5. 權利使用與棄權。我瞭解透過同意此契 約條款,即代表本人承認是契約中所 列 兒童之 父 (母),且放棄上述之權利。 6. 當契約包括子女撫養費時。 a. 我瞭解我有責任遵守契約中所列兒 童之撫養命令,直到由法院變更命 令,或由法律終止命令為止。 b. 我也瞭解若法庭指定由當地子女撫 養機構收取撫養費,法庭將命令撫 養費款項直接從工資或其他收入中 扣除,並交付予該機構。 c. 我 已 得 知 準 則 中 的 子 女 撫 養 費 金 額 , 以 及 該 建 議 子 女 撫 養 金 額 的 決定方式。 7. 當契約包括提供健康保險時。 我瞭解 我必須在擁有保險或可擁有保險時, 以免費或合理費用,提供年幼子女健 康保險。法院可能發出健康保險指派/ 國家醫療支援通知的命令給本人,以 替子女取得健康保險。 8. 本人在自由且自願的情況下同意此契 約之條款。 9. 我瞭解當地子女撫養機構是依法律執 行撫養責任的機構。 10. 我 瞭 解 如 果 我 蓄 意 不 提 供 子 女 撫 養 費, 則可能遭到刑事訴訟。 11. 撫 養 費 收 取 。 我 瞭 解 我 所 積 欠 的 任 何撫養費,可能從我的任何財產中收 取。收款方式可能是從州立或聯邦 政 府積欠本人的款 項 (如退稅、失業和 殘障津貼,以及樂透獎金 )中扣除、 沒收本人財產、對財產執行留置權, 或任何其他的合法方式。 12. 如果是由律師代表本人,本人的律師 已閱讀並向我解釋契約條款和此權利 建議與棄權,且本人瞭解這些條款。 我已閱讀並瞭解 或 附檔為此 之翻譯,語言為 契約權利建議與棄權; 契約權利建議與棄權 (指出語言): 我瞭解翻譯譯文。 我瞭解翻譯譯文。 日期: 日期: (書寫或正楷姓名) (書寫或正楷姓名) (當事人簽名) (當事人簽名) 日期: 日期: (書寫或正楷姓名) (書寫或正楷姓名) (簽名) (簽名) 我於此保證,並受加州法律之偽證刑罰約束,本人有能力針對上述之母語提供口譯和翻譯的服務,且將盡所能替上述當事人閱讀、口譯或 翻譯 至當事人的母語。上述當事人表示其在簽署 前, 已瞭解該條款。 提供口譯/翻譯者之聲明: 下列當事人無法閱讀或瞭解此 因為 父母義務與判斷力之判決或追加判決契約, (插入姓名) (請指定): 的母語是 ____ _____ _____ _____ _____ _ 且其 他/她有 並無 閱讀翻譯至此語言的契約。 (插入姓名) (請指定): 的母語是 ____ _____ _____ _____ _____ _ 且其 他/她有 並無 閱讀翻譯至此語言的契約。 父母義務與判斷力之判決或追加判決契約 父母義務與判斷力之判決或追加判決契約

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