Fill and Sign the Notice Complete and File This Form with the Court Clerk to Request a Hearing Only You Object to the Orderlnotice to

               FL-450ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address)TELEPHONE 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 TREQUEST FOR HEARING REGARDING EARNINGS ASSIGNMENTCASE N UM BERNOTICE: Complete and file this form with the court clerk to request a hearing only you object to the Orderl/Notice to Withhold Income for Child Support (form FL-195/OMB0970-0154) or Earnings Assignment Order for Spousal or PartnerSupport (form FL-435). This form may not be used to modify your current child support order(See page 2 of formFL-192, Information Sheet on Changing a Child Support Order.) Page 3 of this form instructional only and does not need to be delivered to the court.A h earin g o n t h is a pplic a tio n w ill b e h eld a s f o llo w s ( s e e I n str u ctio ns f o r g ettin g a h earin g d ate o n p age 3 ):a .D ate :T im e:D ept.:D iv .:R oom :b. T he a ddre ss o f t h e c o urt is :sa m e a s n ote d a b oveo th er ( s p ecif y ):2 .I r e quest t h at s e rv ic e o f t h e E arn in gs A ssig nm ent O rd er f o r S pousa l o r P artn er S upport ( fo rm F L-4 35) o r O rd er/N otic e t o Wit h hold I n co m e f o r C hild S upport ( fo rm F L-1 95/O M B0970-0 154) b e q uash ed ( s e t a sid e) b eca usea.I a m n ot t h e o blig or n am ed in t h e e a rn in gs a ssig nm ent.b .T here is g ood c a use t o r e ca ll t h e e a rn in gs a ssig nm ent b eca use a ll o f t h e f o llo w in g c o ndit io ns e xis t:( 1 ) R eca llin g t h e e arn in gs a ssig nm ent w ould b e in t h e b est in te re st o f t h e c h ild re n f o r w hom I a m o rd ere d t o pa y s u pport ( s ta te r e aso ns):(2 ) I h ave p aid c o u rt- o rd ere d s u pport f u lly a nd o n t im e f o r t h e la st 1 2 m onth s w it h out e it h er a n e arn in gsassig nm ent o r a noth er m andato ry c o lle ctio n p ro ce ss.(3 ) I d o n ot o w e a n y a rre ara ge ( b a ck s u pport) .(4 ) S erv ic e o f t h e e arn in gs a ssig nm ent w ould c a use e xtr a ord in ary h ard sh ip f o r m e, a s f o llo w s ( s ta te r e aso ns,- y o um ust p ro ve t h ese r e aso ns a t a ny h earin g o n t h is a pplic a tio n b y c le ar a nd c o nvin cin g e vid ence ):c.T he o th er p are nt a nd I h ave a w rit te n a gre em ent t h at a llo w s t h e s u pp ort o rd er t o b e p aid b y a n a lt e rn ativ e m eth od. A co py o f t h e a gre em ent is a tta ch ed ( N O TE : I f t h e s u pport o blig atio n i s p aid t o t h e l o cal c h ild s u pport a g en cy, th is a g re em en t m ust b e s ig ned b y a r e p re sen ta tiv e o f t h at a g en cy.)F 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 -4 50 [R ev. J a nuary 1 , 2 005]F am ily C ode, § 5 246REQUEST FOR HEARING REGARDING EARNINGS ASSIGNMENT (Family Law—Governmental —UIFSA)ele ctr o nic f o rm  2 005 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 T3.I r e quest t h at t h e e arn in gs a ssig nm ent b e m odif ie d b eca usea.th e t o ta l a m ount o f a rre ara ges c la im ed a s o w in g is in co rre ct. ( C heck o ne o r m ore o f t h e f o llo w in g r e aso ns.)( 1 )I d id n ot r e ce iv e c re dit f o r a ll o f t h e p aym ents I h ave m ade. ( C heck ( a ), ( b ), o r b oth .)( a )I h ave a tt a ch ed m y s ta te m ent o f t h e p aym ent h is to ry , w hic h in clu des a m onth ly b re akd ow n o fam ounts o rd ere d a nd a m ounts p aid .(b )I m ade t h e f o llo w in g p aym ents t h at w ere n ot c re dit e d ( fo r e ach p aym ent, s p ecif y t h e d ate , t h e am ount, a nd t h e n a m e o f t h e p ers o n o r a gency p aid ):(2 )C hild s u p port w as t e rm in ate d ( s p ecif y n am e o f c h ild , c h ild 's d ate o f b ir th , d ate o f t e rm in atio n, a nd r e aso n support w as t e rm in ate d):(3)O th er ( s p ecif y ):b .th e m onth ly p aym ent s p ecif ie d in t h e e arn in gs a ssig nm ent is m ore t h an h alf o f m y t o ta l n et in co m e e ach m onth f r o mall s o urc e s.C.th e m onth ly a rre a ra ge p aym ent s ta te d in t h e e arn in gs a ssig nm ent c re ate s a n u ndue h ard sh ip b eca use ( d escrib e t h e hard sh 1p a nd s ta te t h e a m ount y o u a re a ble t o p ay o n y o ur a rre ara g e)(N O TE : I f y o u w an t t o c h an ge t h e a m ount o f m oney b ein g d ed ucte d f o r a rre ara g e b ecau se c re ate s a ha rd sh ip , p le ase a tta ch a c o m ple te d F in an cia l S ta te m en t ( S im pli f ie d ) ( fo rm F L-1 55) o r I n co m e a n d E xp en se Decla ra tio n ( fo rm F L-1 50).)I d ecla re u nder p e nalt 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 :(T Y PE O R P R IN T N AM E O F P ER SO N R EQ UESTIN G H EAR IN G )(S IG NATU RE O F P ER SO N R EQ UESTIN G H EAR IN G )C LE R K'S C ER TIF IC ATE O F M AIL IN GI c e rtif y t h a t I a m n ot a p arty t o t h is a ctio n a nd t h at a t r u e c o py o f t h e R equest f o r H earin g R egard in g E arn in gs A ssig nm ent ( fo rm FL -4 50) w as m ail e d, w it h p osta ge f u lly p re paid , in a s e ale d e nve lo pe a ddre sse d a s s h ow n b elo w , a nd t h at t h e r e quest w as m aile dat ( p la ce ):o n ( d ate ):D ate :C le rk , b y, D eputyF L-4 50 [R ev. J a nuary 1 , 2 0 05] REQUEST FOR HEARING REGARDING EARNINGS ASSIGNMENT (Family Law—Governmental —UIFSA) Page 2 o f 3e le ctr o nic f o rm  2 005 WWW.LawCA.com La w P ublis h ers IN FO RM ATIO N S H EET A ND IN STR UCTIO NSFO R R EQ UEST F O R H EA RIN G R EG ARDIN G E A RNIN G S A SSIG NM EN T(D o n ot d eliv er t h is i n fo rm atio n s h eet t o t h e c o urt c le rk .)Please follow these instructions to complete the Request for Hearing Regarding Earnings Assignment (form FL-450) if you do not have an attorney representing you. Your attorney, if you have one, should complete this form. You must file the completed Request for Hearing form and its attachments with the court clerk within 10 days after the date your employer gave you a copy of Earnings Assignment Order for Spousal or Partner Support (form FL-435) or an Order/Notice to Withhold Income for Child Support (form FL-195/OMB0970-0154). The address of the court clerk is the same as the one shown for the superior court on the earnings assignment order. You may have to pay a filing fee. If you cannot afford to pay the filing fee, the court may waive it, but you will have to fill out some forms first. For more information about the filing fee and waiver of the filing fee, contact the court clerk or the family law facilitator in your county. (TYPE OR PRINT IN INK) Front page, first box, top of form, left side: Print your name, address, and telephone number in this box if they are not already there. Item 1. a –b. You must contact the court clerk’s office and ask that a hearing date be set for this motion. The court clerk will give you the information you need to complete this section. It e m 2 .C heck t h is b ox if y o u w ant t h e c o urt t o s to p t h e lo ca l c h ild s u pport a gency o r t h e o th er p are nt f r o m c o lle ctin g a ny s u pport f r o m your e arn in gs. I f y o u c h eck t h is b ox, y o u m ust c h eck t h e b ox f o r e it h er a , b , o r c b eneath it .b . C heck t h is b ox if y o u b elie ve t h at t h ere is ''g ood c a use all o f t h e c o nd it io ns lis te d in it e m 2 b e xis t in o rd er f o r g ood c a use t o a pply .a . C heck t h is b ox if y o u a re n ot t h e p ers o n r e quir e d t o p ay s u pport in t h e e arn in gs a ssig nm ent. " t o r e ca ll t h e e arn in gs a ssig nm ent N ote : T he c o urt m ust f in d t h atc. C heck t h is b ox if y o u a nd t h e o th e r p are nt h ave a w rit te n a gre em ent t h at a llo w s y o u t o p ay t h e s u pport a noth er w ay. Y oum ust a tta ch a c o py o f t h e a g re em en t, w hic h m ust b e s ig ned b y b o th t h e o th er p are nt a nd a r e pre se nta tiv e o f t h e lo ca l child s u p port a gency if p aym ents a re m ade t o a c o unty o ffic e .Item3. Check this box if you want to change the c b enea th it .a ssig nm ent. I f y o u c h eck t h is b ox, y o u m ust c h eck t h e b ox f o r e it h er a , b , o ra. C heck t h is b ox if t h e t o ta l a rre ara ges lis te d in it e m 9 o n t h e e arn in gs a ssig nm ent o rd er a re w ro ng. I f y o u c h eck t h is b ox,yo u m ust c h eck o ne o r m ore o f ( 1 ), ( 2 ), a nd ( 3 ). Y ou m ust a tta ch t h e o rig in al o f y o ur s ta te m ent o f a rre ara ges. K eep o ne copy f o r y o urs e lf .( 1 ) C heck t h is b ox if y o u b elie ve t h e a m ount o f a rre ara ges lis te d o n t h e e arn in gs a ssig nm ent o rd er d oes n ot g iv e y o ucre dit f o r a ll t h e p aym ents y o u h ave m ade. I f y o u c h eck t h is b ox, y o u m ust c h eck o ne o r b oth o f t h e b oxe s b eneath it .( a ) C heck t h is b ox if y o u a re a tta ch in g y o ur o w n s ta te m ent o f a rre ara ges. T his s ta te m ent m ust in clu de a m onth lylis tin g o f w hat y o u w ere o rd ere d t o p ay a nd w hat y o u a ctu ally p aid .(b ) C heck t h is b ox if y o u w is h t o lis t a ny p aym ents t h at y o u b elie ve w ere n ot in clu ded in t h e a rre ara ges a m ount. F oreach p aym ent y o u m ust lis t t h e d ate y o u p aid it , t h e a m ount p aid , a nd t h e p ers o n o r a gency ( s u ch a s t h e lo ca l c h ilds u pport a g ency) t o w hom y o u m ade t h e p aym ent. B rin g t o t h e h earin g p ro of o f a ny p aym ent t h at is in d is p ute .(2 ) C heck t h is b ox if t h e c h ild s u pport f o r a ny o f t h e c h ild re n in t h e c a se h as b een t e rm in ate d ( e nded). I f y o u c h eck t h isb ox, y o u m ust lis t t h e f o llo w in g in fo rm atio n f o r e ach c h ild :• The name and birthdate of each child.• The date the child support order was terminated. • The reason child support was terminated.(3 ) C heck t h is b ox if t h ere is a noth e r r e aso n y o u b elie ve t h e a m ount o f a rre ara ges is in co rre ct. Y ou m ust e xp la in t h ere aso ns in d eta il.b . C heck t h is b ox if t h e t o ta l m onth ly p aym ent s h ow n in it e m 1 o f t h e e arn in gs a ssig nm ent o rd er is m ore t h an h alf o f y o urm onth ly n et in co m e.c. C heck t h is b ox if t h e t o ta l m onth ly p aym ent s h ow n in it e m 1 o f t h e e arn in gs a ssig nm ent o rd er c a use s y o u a s e rio us hard sh ip . Y ou m ust w rit e t h e r e a so ns f o r t h e h ard sh ip in t h is s p ace .Y ou m ust d ate t h is R equest f o r H earin g f o rm , p rin t y o ur n am e, a nd s ig n t h e f o rm u nder p enalt y o f p erju ry . Y ou m ust a ls o c o m ple te t h e certif ic a te o f m aili n g a t t h e b otto m o f p age 2 o f t h e f o rm b y p rin tin g t h e n am e a nd a ddre ss o f t h e o th er p artie s in b ra cke ts a nd p ro vid in ga s ta m ped e nve lo pe a ddre sse d t o e ach o f t h e p artie s. W hen y o u s ig n t h is R equest f o r H earin g f o rm , y o u a re s ta tin g t h at t h ein fo rm atio n y o u h a ve p ro vid ed is t r u e a nd c o rre ct. A fte r y o u f ile t h e r e quest, t h e c o urt c le rk w ill n otif y y o u b y m ail o f t h e d ate , t im e, a nd loca tio n o f t h e h ea rin gYou must file your request within 10 days of receiving the Earnings Assignment Order for Spousal or Partner Support or the Order/Notice to Withhold Income for Child Support from your employer. You may file your request in person at the clerk’s office or mail it to the clerk. In either event, it must be received by the clerk within the 10-day period. If you need additional assistance with this form, contact an attorney or the family law facilitator in your county. Your family law facilitator can help you, for free, with any questions you have about the above information. For more information on finding a lawyer or family law facilitator, see the California Courts Online Self-Help Center at www.lawca.com( S ee p ag e 2 o f f o rm F L-1 92, I n fo rm atio n S heet o n C hangin g a C hild S upport O rd er.)F L-4 50 [R ev. J a nuary 1 , 2 0 05] REQUEST FOR HEARING REGARDING EARNINGS ASSIGNMENT (Family Law—Governmental—UIFSA) Page 3 o f 3e le ctr o nic f o rm  2 005 WWW.LawCA.com La w P ublis h ersN O TIC E: U se f o rm F L-4 50 t o r e q uest a h earin g o nly i f y o u o bje ct t o t h e O rd erlN otic e t o W it h hold I n co m e f o r C hild S upport (fo rm F L -1 95/O M B0970-0 154) o r E arn in gs A ssig nm en t O rd er f o r S pousal o r P artn er S upport ( fo rm F L-4 35). T his f o rm w ill n ot modif y y o ur c u rre n t s u pport a m ount