Fill and Sign the Instructions This Form is to Be Filled Out If the Party to Whom Support is Owed Wishes to Give Up the Right to Past Due Support

          F L-6 26ATTO RNEY O R P AR TY W IT H O UT A TTO RNEY ( N am e, s ta te b ar n um ber, a nd a ddre ss):F O R C O URT U SE O NLYT E LE PH O NE N O .FA X N O . ( O ptio nal) :E -M AIL A D DR ESS ( O ptio nal) :A TTO RNEY F O R ( N am e):S U PER IO R C O UR T O F C ALIF O RN IA , C O UNTY O FSTR EET A D DR ESSM AIL IN G A D D RESSC IT Y A N D Z IP C O DEBR AN CH N AM EP ETIT IO NER /P LA IN TIF F:R ESPO NDEN T/D EFE N DAN T:O TH ER P AR EN T:S TIP U LA TIO N A ND O RDER W AIV IN G U NASSIG NED A RR EA RS (Govern m en ta l)C ASE N UM BERIn str u ctio ns: T his f o rm is t o b e f ille d o ut if t h e p arty t o w hom s u pport is o w ed w is h es t o g iv e u p t h e r ig ht t o p ast- d ue s u pport t h at is ow ed t o h im o r h er. I f e it h er p arty h as a ny q uestio ns a bout t h e p ossib le c o nse quence s o f t h is w aiv e r, h e o r s h e s h ould a sk a n a tto rn ey. If e it h er p arty h as a ny q uestio ns a bout t h e c a se o r t h e in fo rm atio n o n t h is f o rm , h e o r s h e s h ould a sk t h e F am ily L aw F acilit a to r o r t h e loca l c h il d s u pport a gency.P A RTIE S1. T he p arty w aiv in g p ast s u pport isp etit io ner/p la in tif fr e sp ondent/d efe ndantoth er p are ntoth er ( s p ecif y ):2. The party ordered to pay support ispetit io ner/p la in tif fr e sp ondent/d efe ndantoth er p are ntoth er ( s p ecif y ):3 . T he p arty o rd e re d t o p ay s u pport a nd t h e p arty w aiv in g p ast s u ppo rt a re t h e p artie s t o t h is a gre em ent.R IG HT T O A N A TTO RNEY4. T he p artie s u nders ta nd t h eir r ig h t t o b e r e pre se nte d b y a n a tto rn ey, a t t h eir e xp ense , in c o nnectio n w it h t h ese p ro ce edin gs.N O T IM E L IM IT F O R C O LLE C TIO N5. T he p artie s u nders ta nd t h at t h e a m ounts o w ed f o r N on-A id a rre ars ( p ast- d ue c h ild s u pport o rd ere d t o b e p aid p ers o nally t o t h e p arty wa iv in g s u pport) r e m ain o w ed u ntil p aid . T here is n o t im e lim it f o r t h e c o lle ctio n o f p ast- d ue s u pport.C O NTIN UIN G C O LLE C TIO N E FFO RTS6. A ll m eth ods t o c o lle ct o r e nfo rc e t h e a m ounts p ast d ue m ay b e u se d u ntil t h e p ast d ue s u pport is p aid in f u ll, in clu din g, b ut n ot lim it e dto , w age a ssig nm ents , le vy o n a sse ts , t a x r e fu nd in te rc e ptio n, lic e nse s u sp ensio n, p ro perty lie ns, a nd c o nte m pt. T he p artie s unders ta nd t h at a w aiv e r o f s u pport w ill s to p a ll c o lle ctio n e ffo rts o f t h e s u pport w aiv e d.R IG HT T O D ETE R M IN ATIO N O F D IS PU TE D P A ST S U PPO RT7. I f t h e a m ount o f p ast- d ue s u pport is u nkn ow n o r u nce rta in , t h e p artie s u nders ta nd t h at t h ey h ave t h e r ig ht t o h ave t h e lo ca l c h ild s u pporta gency r e vie w a nd a udit t h e a m ount d ue, in clu din g a ll a m ounts o rd ere d, a ll p aym ents , a nd a ll c re dit s . T he p artie s a ls o u nders ta nd t h at if th ey a re n ot s a tis fie d w it h t h e a gency's a udit , t h ey h ave t h e r ig ht t o h ave a c o urt h earin g t o d ete rm in e t h e a m ount d ue.P age 1 o f 4Form Approved for Optional Use Judic ia l C ouncil o f C alif o rn ia FL -6 26 [N ew J a nuary 1 , 2 004]S TIP U LA TIO N A ND O RDER W AIV IN G U NASSIG NED A RREA RS (Gove rn m enta l) F am ily C ode, § 4 503, 1 7526 ele ctr o nic f o rm  2 004 WWW.LawCA.com La w P ublis h ers          $           $     P ETIT IO NER /P LA IN TIF F:CASE N UM BERR ESPO NDEN T/D EFE N DAN T:O TH ER P AR EN T:C O NSEQ UEN CES O F W AIV IN G P A ST S U PPO RT8. T he p artie s u nders ta nd t h at o nce t h e p arty w aiv in g p ast s u pport g iv e s u p h is o r h er r ig ht t o p ast- d ue s u pport, h e o r s h e c a n n eve rre quest p a ym ent o f t h e a m ount g iv e n u p o r a sk t h e lo ca l c h ild s u pport a gency o r c o urt t o r e in sta te t h e a m ount g iv e n u p, U NLE SS h e or s h e h as s p ecif ic a lly r e ta in ed t h e r ig ht t o d o s o a s p art o f it e m 1 6.9. T he p artie s u nders ta nd t h at t h e p arty w aiv in g p ast s u pport c a nnot g iv e u p t h e r ig ht t o c o lle ct A id a rre ars ( p ast- d ue c h ild s u pport t h atbelo ngs t o t h e c o unty in e xch ange f o r r e ce ip t o f p ublic a ssis ta nce b enefit s ), n or c a n h e o r s h e g iv e u p t h e r ig ht t o f u tu re c h ild s u pport. Th e p artie s u nders ta n d t h at t h is s tip ula tio n d oes n ot a ffe ct t h e c u rre n t c h ild s u pport o rd er. I f t h ere i s a c u rre n t c h ild s u pport ord er, t h at o rd er s till r e m ain s i n f u ll f o rc e a n d e ffe ct.1 0 . T he p artie s h a ve h ad s u ffic ie nt t im e t o r e ad a nd t h in k a bout t h is s tip ula tio n a nd t o d is cu ss it w it h a ny a nd a ll a dvis o rs , c o unse lo rs , an d/o r a tto rn eys o f t h eir c h oosin g.1 1 . T he p arty w aiv in g p ast s u pport h as n ot b een p ro m is e d a nyth in g b y t h e p arty o rd ere d t o p ay s u pport, t h e lo ca l c h ild s u pporta gency, t h e c o urt, o r a nyo ne e ls e , t o in duce h im o r h er t o g iv e u p a m ounts o w ed t o h im o r h er, e xce pt a s s p ecif ic a lly s e t f o rth in wr it in g in t h is s tip ula tio n.12. T he p a rty w aiv in g p ast s u pport h as n ot b een t h re ate ned in a ny w ay ( p hysic a lly , e m otio nally , o r o th erw is e ) b y t h e p arty o rd ere d t o pa y s u pport, t h e lo ca l c h ild s u p port a gency, t h e c o urt, o r a nyo ne e ls e , t o f o rc e h im o r h er t o g iv e u p s u pport a m ounts .1 3. T he p a rty w aiv in g p ast s u pport h as t h ought a bout a nd d ecid ed t h a t it is in h is o r h er b est in te re st a nd t h e b est in te re st o f h is o r h er child re n t o g iv e u p t h is s u pport a rre ara ge.A M OUNT O F P A ST-D UE S U PPO RT 14. A s o f ( d ate c a lc u la te d):a .N O N-A ID A RREA RS ( th ese a re t h e a m ounts o w ed p ers o nally t o t h e p atty w aiv in g p ast s u pport b efo re t h is w aiv e r b eco m es effe ctiv e ):T yp eP rin cip alIn te re stT im e P erio d(1 )C hild S upport:$$th ro ugh(2 )S pousa l/ F am ily S upport:$$th ro ugh(3 )O th er ( s p ecif y ):$$th ro ugh(4 )T O TA L:$S ee A tta ch m ent 1 4a.b.T yp eIn te re stT im e P erio dA ID A RREA RS ( th ese a re t h e a m ounts a ssig ned a nd o w ed t o a p ublic a gency a nd c a nnot b e w aiv e d b y t h e p attie s): Prin cip al(1 )C hild S upport:$$th ro ugh(2 )S pousa l/ F am ily S upport:$$th ro ugh(3 )O th er ( s p ecif y ):$$th ro ugh(4 )T O TA L:$S ee A tta ch m ent 1 4b.C.T he p artie s a gre e t h at t h e a m ounts in it e m s 1 4a a nd 1 4b w ill b e c o nsid ere d a f in al d ete rm in atio n b y t h e c o urt o f t h e a m ount of p a st- d ue s u pport.W ARNIN G : I f t h e b ox a t i t e m 1 4c i s c h ecked y o u m ay b e p ro hib it e d f r o m a n y f u tu re c h alle n ge r e g ard in g t h e a m ount o f past-d ue s u pport i n dic ate d a t i t e m s 1 4a a n d 1 4b .d.T he p artie s a gre e t h at t h e a m ounts s ta te d a bove r e pre se nt t h e a m oun t o f p ast- d ue s u pport in dic a te d b y t h e lo ca l c h ild s u pport ag ency r e co rd s. H ow eve r, in a gre ein g t o t h is w aiv e r o f n on-a id a rre ars , t h e p artie s h ave n ot r e ach ed a n a gre em ent r e gard in g the a ccu ra cy o f t h e a m ount o f p ast- d ue s u pport a s s ta te d.FL-6 26 ( N ew J a nuary 1 , 2 004)S TIP U LA TIO N A ND O RDER W AIV IN G U NASSIG NED A RR EA RS (Govern m en ta l)P age 2 o f 4e le ctr o nic f o rm  2 004 WWW.LawCA.com La w P ublis h ers     (d ate ):       $        P ETIT IO NER /P LA IN TIF F:CASE N UM BER :R ESPO NDEN T/D EFE N DAN T:O TH ER P AR EN T:W AIV ER O F P A ST-D UE S U PPO RT15. I n c o n sid era tio n o f t h e p aym ent b y t h e p arty o rd ere d t o p ay s u pport o f t h e s u m s s e t f o rth b elo w , a nd t h e p erfo rm ance o f a ny o th er condit io n s ta te d b elo w , t h e p artie s a gre e a s f o llo w s ( c h eck a nd c o m ple te e it h er a o r b , b ut n ot b oth , a nd a dd o th er a pplic a ble pr o vis io ns):a .U pon p aym ent b y p arty o rd ere d t o p ay s u pport o f t h e s u m o f $t o t h e lo ca l c h ild s u pport a gency o n o r b efo re(d ate ):, t h e N on -A id a rre ars s e t f o rth in p a ra gra ph 1 4a a bove s h all b e d eem ed p aid in f u ll.b .U pon p aym ent b y p arty o rd ere d t o p ay s u pport o f t h e s u m o f $t o t h e lo ca l c h ild s u pport a gency o n o r b efo re, t h e p are nt o rd ere d t o p ay s u pport s h all o w e t h e f o llo w in g s u m s f o r n on-a id s u pport.T yp eP rin cip alIn te re stT im e P erio d(1 )C hild S upport:$$a s o f ( d a te ):(2 )S pousa l/ F am ily S upport:$$a s o f ( d a te ):(3 )O th er ( s p ecif y ):$$a s o f ( d a te ):(4 )T O TA L:$C.O th er ( s p ecif y ):S ee A tta ch m ent 1 5 f o r a ddit io nal p ro vis io ns.C O NDIT IO NS O F W AIV ER16.T his w aiv e r o f p ast- d ue s u pport is c o ndit io ned o n t h e p arty o rd ere d t o p ay s u pport a gre em ents s e t f o rth in t h is d ocu m ent. I f t h e party o rd ere d t o p ay s u pport f a ils t o p erfo rm a ny c o ndit io n, t h en t h is w aiv e r is N ULL a nd V O ID a nd o f n o f o rc e o r e ffe ct w hats o eve r. Ho w eve r, if b ox 1 4c is c h ecke d, t h e s e ttin g o f s u pport a rre ars in it e m s 1 4a a nd 1 4b w ill c o ntin ue t o b e v a lid a s t h e c o urt'sd ete rm in atio n o f t h e a m ount o f s u p port a rre ara ge. S pecif ic c o ndit io ns o f t h is w aiv e r a re a s f o llo w s:a . A ddit io nal c o nd it io ns o f t h is w aiv e r ( o ptio nal) ( i. e ., lu m p-s u m p aym ent, t im ely p aym ent o f c u rre nt s u pport, e tc .) :b .S ee A tta ch m ent 1 6 f o r a ddit io nal c o ndit io ns o f w aiv e r. E ach p arty m ust i n it ia l o r s ig n a ll a d dit io nal p ag es.17. T his s tip ula tio n a nd o rd er d oes n ot m odif y o r a ffe ct t h e d uty o f t h e p arty o rd ere d t o p ay c u rre nt s u pport t h at a ccru es, o r a ny s u pport arre ars t h at m ay a ccu m ula te , a fte r t h e d ate s e t f o rth in it e m 1 4.18. E ach p arty u n ders ta nds t h at t h e lo ca l c h ild s u pport a gency d oes n ot r e pre se nt h im o r h er in t h is m atte r. N eit h er p arty h as b een giv e n le gal a dvic e f r o m lo ca l c h ild s u pport a gency, o r a ny o f it s a tto rn eys, o r t h e f a m ily la w f a cilit a to r, in r e gard t o t h is s tip ula tio n.19. T his f o rm c o nta in s t h e e ntir e u nders ta ndin g a nd a gre em ent o f t h e p artie s, a nd t h ere h ave b een n o v e rb al o r o th er w rit te n p ro m is e s o r condit io ns b y a nyo ne, e xce pt a s s ta te d in t h is f o rm .Date :(T Y PE O R P R IN T N AM E)(S IG NATU RE O F P AR TY W AIV IN G P AST S U PPO RT)D ate :(T Y PE O R P R IN T N AM E)(S IG NATU RE O F P AR TY O RDER ED T O P AY S U PPO RT)F L-6 26 [N ew J a nuary 1 , 2 004]S TIP U LA TIO N A ND O RDER W AIV IN G U NASSIG NED A RREA RS (G overn m en ta l)P age 3 o f 4e le ctr o nic f o rm  2 004 WWW.LawCA.com La w P ublis h ers       A TTO RNEY'S S TA TE M EN TI a m t h e a tto rn ey o f r e co rd f o r t h e p arty id entif ie d in t h is w aiv e r. I h ave g one o ve r t h is f o rm a nd a ny a tta ch m ents w it h m y c lie nt. I h ave exp la in ed e ach p ro vis io n o f t h is f o rm t o m y c lie nt a nd a nsw ere d t h e c lie nt's q uestio ns w it h r e gard t o t h is f o rm . I h ave d is cu sse d t h e f a cts o f th e c a se w it h m y c lie nt a nd p ossib le a lt e rn ativ e s t o a nd c o ndit io ns f o r w aiv e r. I h ave e xp la in ed t h e c o nse quence s o f t h e w aiv e r a nd benefit s a nd d etr im ents o f a ny a gre em ent.D ate :(T Y PE O R P R IN T N AM E)(S IG NATU RE O F A TTO RNEY F O R P AR TY O RDER ED T O P AY S U PPO RT)D ate :(T Y PE O R P R IN T N AM E) (S IG NATU RE O F A TTO RNEY F O R P AR TY W AIV IN G P AST S U PPO RT) LO CAL C HIL D S U PPO RT A G EN CY Date :(T Y PE O R P R IN T N AM E, T IT LE , A N D C O UNTY )(S IG NATU RE O F R EPR ESEN TA TIV E O F L O CAL C H IL D S U PPO RT A G EN CY) INTERPRETER'S STATEMENT (if applicable) Th e p arty n am ed b elo w is u nable t o r e ad o r u nders ta nd t h is S tip ula tio n a nd O rd er W aiv in g U nassig ned A rre ars b eca use P arty w aiv in g p ast s u pport's p rim ary la nguage is ( s p ecif y ): Pa rty o rd ere d t o p ay s u pport's p rim ary la nguage is ( s p ecif y ): Oth er ( s p ecif y ):I c e rtif y u n der p en alt y o f p erju ry u nd er t h e la w s o f t h e S ta te o f C alif o rn ia t h at I h ave , t o t h e b est o f m y a bilit y , r e ad o r t r a nsla te d f o r t h e above -n am ed p a rty /p artie s t h e S tip ula tio n a nd O rd er W aiv in g U nassig ned A rre ars . T he a bove -n am ed p arty /p artie s s ta te d h e o r s h e unders to od t h e t e rm s o f t h e S tip ula tio n a nd O rd er W aiv in g U nassig ned A rre ars b efo re s ig nin g it .D ate :(T Y PE O R P R IN T N AM E O F IN TE R PR ETE R )(S IG NATU RE O F IN TE R PR ETE R F O R ( in se rt n am e)D ate :(T Y PE O R P R IN T N AM E O F IN TE R PR ETE R )(S IG NATU RE O F IN TE R PR ETE R F O R ( in se rt n am e)C O URT'S F IN DIN G S A ND O RDERThe c o urt, h avin g r e vie w ed a nd c o n sid ere d t h is S tip ula tio n, a nd a ny a tta ch m ents , f in ds t h at t h e p arty o w ed s u pport e xp re ssly , k n ow in gly , vo lu nta rily a nd in te llig ently h as w aiv e d p ast- d ue s u pport a s m ore s p ecif ic a lly s e t f o rth in t h is d ocu m ent. T he c o urt a cce pts t h is S tip ula tio n, appro ve s it , a nd o rd ers t h at a ll f u rth er e nfo rc e m ent is t e rm in ate d a s t o t h e w aiv e d s u pport.IT I S S O O RDER ED .Date :(J U DIC IA L O FFIC ER O F T H E S U PER IO R C O URT)F L-6 2 6 [N ew J a nuary 1 , 2 004]S TIP U LA TIO N A ND O RDER W AIV IN G U NASSIG NED A RREA RS (Govern m en ta l)P age 4 o f 4e le ctr o nic f o rm  2 004 WWW.LawCA.com La w P ublis h ers