Fill and Sign the Fl 630 490110264 Form

                          FL-630 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address)FOR COURT USE ONLYTELEPHONE NO.F A X N O . ( O ptio nal) :E-MAIL ADDRESS (Optional):ATTORNEY FOR (Name):SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS:MAILING ADDRESS:CITY AND ZIP CODE:BRANCH NAME: PETIT IO NER /P LA IN TIF F:R ESPO NDEN T/D EFE N DAN T:O TH ER P AR EN TJUDGMENT REGARDING PARENTAL OBLIGATIONSC ASE N UM BERA M EN DEDSU PPLE M EN TA L1. a .N O TIC E: T H IS IS A PR O PO SED J U DG M EN T. T his J ud gm en t R eg ard ing P are nta l O bl ig at ions w ill b e en te re d by the c o u rt and w ill b ecom e le ga lly b in di ng u nl ess you f ill o ut and f ile the Answer to Comp laint or Sup pleme ntal C om pla in t Reg ar din g Paren ta l Ob lig at ions (Go ver nm en ta l) (for m F L -61 0) w it h th e c ou rt c ler k w it h in 30 da ys o f t h e d ate y o u were serv ed w it h t h e Sum mons a n d Com pla in t or S up plem en ta l C om pla in t R eg ard ing Pare nt al O blig ati ons (G ov ern m en ta l) (f o rm FL -6 00). I f yo u need fo rm FL- 61 0, y ou m ay g et on e f r om t h e l o ca l chi ld s u p por t a g en cy’s o ffic e, t h e c o u rt c le rk , o r th e f a m ily la w f ac ilit at or . Th e fami ly la w facil itato r w ill h elp yo u fi ll o ut th e fo rm s. To f ile t he a n sw er, fo llo w t h e pro ced ure s lis te d in the atta ch ed in str uc tion s.b .NOTICE: THIS IS A JUDGMENT. It is now legally binding.2. T h is m atte r p ro ceed ed a s f o llo w s:a.b .D ept.:J u dgm ent e nte re d u nder F am ily C ode s e ctio n 1 7430. By c o urt h earin g, a ppeara nce s a s f o llo w s: (1 ) D ate :Ju dic ia l o ffic e r:(2 )P etit io ner/p la in tif f p re se nt Resp ondent/d efe ndant p re se nt Oth er p a re nt p re se ntA tto rn ey p re se nt ( n am e):(3 )A tto rn ey p re se nt ( n am e):(4 )A tto rn ey p re se nt ( n am e):(5 ) L oca l c h ild s u pport a gency a tto rn ey ( F am ily C ode, § § 1 7400,1 740 6) ( n am e):(6 )O th er ( s p ecif y ):c . T he o blig or ( th e p are nt o rd ere d t o p ay s u pport) is t h epetit io ner/p la in tif fr e sp ondent/d efe ndantoth er p are nt.3 .T his o rd er is b ase d o n p re su m ed in co m e f o r t h e o blig or u nder F am ily C ode s e ctio n 1 7400.4.A tta ch ed is a c o m pute r p rin to ut s h ow in g t h e p are nts ' in co m es a nd p erc e nta ge o f t im e e ach p are nt s p ends w it h t h e c h ild re n. The p rin to ut, w hic h s h ow s t h e c a lc u la tio n o f c h ild s u pport p aya ble , w ill b eco m e t h e c o urt's f in din gs.5.T his o rd er is b ase d o n t h e a tta ch ed d ocu m ents ( s p ecif y ):T H E C O URT O RDER S6. a . T he m oth er a nd f a th er lis te d in t h e c o m pla in t a re t h e p are nts o f t h e c h ild re n n am ed in it e m 6 b.b. O blig or m ust p ay c u rre nt c h ild s u pport a s f o llo w s:N am eDate of birthMonthly support amount(1 )O th er ( s p ecif y ):(2 )F or a t o ta l o f: $p aya ble o n t h e:day o f e ach m onthb egin nin g ( d ate )NOTICE: Any party required to pay child support must pay interest on overdue amounts at the ''legal'' rate currently 10 percent per year.whic hPage 1 o f 2F orm A dopte d fo r M andato ry U se Ju dic ia l C ouncil o f C alif o rn ia FL -6 30 [R ev. J u ly 1 , 2 005]JUDGMENT REGARDING PARENTAL OBLIGATIONS (Governmental)F am ily C od e, § § 1 7400 1 7402,17404,1 7436ele ctr o nic f o rm  2 005 WWW.LawCA.com La w P ublis h ers                    7. N um ber o f p ages a tta ch ed:    CASE N UM BERP ETIT IO NER /P LA IN TIF F:R ESPO NDEN T/D EFE N DAN T:O TH ER P AR EN T6. b . ( 3 )The lo w -in co m e a dju stm ent a pplie s. Th e lo w -in co m e a dju stm ent d oes n ot a pply b eca use ( s p ecif y r e aso ns):(4 ) A ny s u pport o rd ere d w ill c o ntin u e u ntil f u rth er o rd er o f c o urt, u nle ss t e rm in ate d b y o pera tio n o f la w .c.O blig or m ust p ay c h ild s u pport f o r t h e p ast p erio ds a nd in t h e a m ounts s e t f o rth b elo w :Nam eDate o f b ir thP erio d o f s u pportA m ount(1 )O th er ( s p ecif y ):(2 )F or a t o ta l o f: $p aya ble $ :on t h e:d ay o f e ach m onth .begin nin g ( d ate ):(3 )In te re st a ccru es o n t h e e ntir e p rin cip al b ala nce o w in g a nd n ot o n e ach in sta llm ent a s it b eco m es d ue.d. If this is a judgment on a Supplemental Complaint, it does not modify or supersede any prior judgment or order for support or arrearage, unless specifically provided.e. N o p ro vis io n o f t h is ju dgm ent c a n o pera te t o lim it a ny r ig ht t o c o lle ct t h e p rin cip al ( to ta l a m ount o f u npaid s u pport) o r t o c h arg eand c o lle ct in te re st a nd p enalt ie s a s a llo w ed b y la w . A ll p aym ents o rd ere d a re s u bje ct t o m odif ic a tio n.f. A ll p aym ents m ust b e m ade t o ( n a m e a nd a ddre ss o f a gency):g. An Order/Notice to Withhold Income for Child Support (form FL-195) will issue.h.O blig orObligee must (1) provide and maintain health insurance coverage for the children if it is availableth ro ugh e m plo ym ent o r a g ro up p la n, o r o th erw is e a va ila ble a t n o o r r e aso nable c o st, a nd m ust k e ep t h e lo ca l c h ild s u pport ag ency o ffic e in fo rm ed o f t h e a va ila bilit y o f t h e c o ve ra ge; ( 2 ) if h ealt h in su ra nce is n ot a va ila ble , p ro vid e c o ve ra ge w hen it be co m es a va ila ble ; ( 3 ) w it h in 2 0 d a ys o f t h e lo ca l c h ild s u pport a gency's r e quest, c o m ple te a nd r e tu rn a h ealt h in su ra nce f o rm ; (4) p ro vid e t o t h e lo ca l c h ild s u pport a gency a ll in fo rm atio n a nd f o rm s n ece ssa ry t o o bta in h ealt h -c a re s e rv ic e s f o r t h e c h ild re n; (5) p re se nt a ny c la im t o s e cu re p aym ent o r r e im burs e m ent t o t h e o th er p are nt o r c a re ta ke r w ho in cu rs c o sts f o r h ealt h -c a re se rv ic e s f o r t h e c h ild re n; a nd ( 6 ) a ss ig n a ny r ig hts t o r e im burs e m ent t o t h e o th er p are nt o r c a re ta ke r w ho in cu rs c o sts f o r healt h -c a re s e rv ic e s f o r t h e c h ild re n. I f t h e ''O blig or'' b ox is c h ecke d, a h ealt h in su ra nce c o ve ra ge a ssig nm ent w ill is su e.I. T he p a re nts m ust n otif y t h e lo ca l c h ild s u pport a gency in w rit in g w it h in 1 0 d ays o f a ny c h ange in r e sid ence o r e m plo ym ent.j. T he f o rm N otic e o f R ig hts a nd R esp onsib ilit ie s H ealt h C are C osts a nd R eim burs e m ent P ro ce dure s a nd I n fo rm atio n S heet on C hangin g a C hild S upport O rd er ( fo rm F L-1 92) is a tta ch ed.k.T he f o llo w in g p ers o n ( th e ''o th er p a re nt'') is a dded a s a p arty t o t h is a ctio n u nder F am ily C ode s e ctio n 1 7404 ( n am e):l.m .Obligor must pay costs $ Th e c o urt f u rth er o rd ers ( s p ecif y ):D ate :JU DIC IA L O FFIC ERSIG NATU RE F O LLO W S L A ST A TTA C HM EN TA ppro ve d a s c o nfo rm in g t o c o urt o rd er:D ate :(S IG NATU RE O F A TTO RNEY F O R O BLIG OR)FL-6 30 [R ev. J u lr y 1 , 2 005] JUDGMENT REGARDING PARENTAL OBLIGATIONS (Governmental) Page 2 o f 2e le ctr o nic f o rm  2 005 WWW.LawCA.com La w P ublis h ers