Fill and Sign the Parental Obligations Form

–– –– –– ––––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– –– –– –– –– ––––– ––––– –– –– –– –– ––––– ––––– –– –– ––––– ––––– –– ––––– –– –– –– –– –– –– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– –– ––––– –– ––––– ––––– ––––– ––––– FL-630 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address) FOR COURT USE ONLY TELEPHONE NO. FAX NO. (Optional): E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name) : SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PETITIONER/PLAINTIFF : RESPONDENT/DEFENDANT : OTHER PARENT JUDGMENT REGARDING PARENTAL OBLIGATIONS CASE NUMBER AMENDE D SUPPLEMENTA L 1. a. NOTICE : THIS IS A PRO P OSED JUDGMENT . Thi s J u d g ment Rega r d i ng Pare nt al O b l i g a t i o ns w i l l b e e ntere d by t h e co u r t a n d will bec o me le g ally bin d i n g u n les s y o u fill o ut a n d fil e t he A n swer t o Com p lai n t or S u p p le me n tal Com p la i n t Reg a rd i n g Par e nta l O b l ig a t i o ns ( G ov e rnm e nta l) (f o rm F L - 6 10 ) wit h the c o urt cl e rk wit h i n 30 d ays of the date yo u were se r ved with th e Summons an d Complain t o r S u p p lem e nta l C o mp l ai n t Re g ar d i ng P a re n t al Ob li g ati on s (G o ver n mental) (fo r m F L-600). If y o u n e e d for m F L - 6 10, y ou ma y ge t o n e fr o m t h e lo c a l c h il d su p p o rt age n cy’s offic e , t h e co u r t cler k , or the family law f a cilit a t o r . T h e fam i ly la w faci l itat o r w il l he l p y o u fi l l ou t t h e f o rms . T o file t h e answer , follow the p r oce d u r e s listed i n t he a t ta c he d instr u cti o ns. b . NOTICE: THIS IS A JUDGMENT. It is now legally binding. 2. This matter proceeded as follows: a . b . Dep t.:Judgment entered under Family Code section 17430. By court hearing, appearances as follows: (1) Date: Judicial officer: ( 2 ) Petitioner/plaintiff present Respondent/defendant present Other parent present Attorney present (name): ( 3 ) Attorney present (name): ( 4 ) Attorney present (name): (5) Local child support agency attorney (Family Code, §§ 17400,17406) (name): ( 6 ) Other (specify): c. The obligor (the parent ordered to pay support) is the petitioner/plaintif f respondent/defenda nt other parent. 3 . This order is based on presumed income for the obligor under Family Code section 17400. 4 . Attached is a computer printout showing the parents' incomes and percentage of time each parent spends with the children. The printout, which shows the calculation of child support payable, will become the court's findings. 5 . This order is based on the attached documents (specify): THE COURT ORDERS 6. a. The mother and father listed in the complaint are the parents of the children named in item 6b. b. Obligor must pay current child support as follows: Na me Date of birth Monthly support amount ( 1 ) Other (specify): ( 2 ) For a total of: $ payable on the: day of each month beginning (date) NOTICE: Any party required to pay child support must pay interest on overdue amounts at the ''legal'' rate currently 10 percent per year. whi ch Page 1 of 2 Form Adopted for Mandatory Use Judicial Council of California FL-630 [Rev. July 1, 2005] JUDGMENT REGARDING PARENTAL OBLIGATIONS (Governmental) Family Code, §§ 17400 17402, 17404,174 36elec troni c form ã 2005 WWW.LawCA.co m L a w P u b l i s h e r s ––––– ––––– ––––– ––––– –– –– ––––– –– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– –– ––––– –– ––––– ––––– ––––– ––––– –– ––––– –– –– –– ––––– –– ––––– –– ––––– ––––– –––––7. Number of pages attached: ––––– –– ––––– CASE NUMBERPETITIONER/PLAINTIFF : RESPONDENT/DEFENDANT : OTHER PARENT 6. b. (3) The low-income adjustment applies. The low-income adjustment does not apply because (specify reasons) : (4) Any support ordered will continue until further order of court, unless terminated by operation of law. c . Obligor must pay child support for the past periods and in the amounts set forth below: Nam e Date of birth Period of support Amoun t ( 1 ) Other (specify): ( 2 ) For a total of: $ payable $: on the: day of each month. beginning (date): ( 3 ) Interest accrues on the entire principal balance owing and not on each installment as it becomes due. 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. No provision of this judgment can operate to limit any right to collect the principal (total amount of unpaid support) or to charge and collect interest and penalties as allowed by law. All payments ordered are subject to modification. f. All payments must be made to (name and address of agency) : g. An Order/Notice to Withhold Income for Child Support (form FL-195) will issue. h . Oblig or Obligee must (1) provide and maintain health insurance coverage for the children if it is available through employment or a group plan, or otherwise available at no or reasonable cost, and must keep the local child support agency office informed of the availability of the coverage; (2) if health insurance is not available, provide coverage when it becomes available; (3) within 20 days of the local child support agency's request, complete and return a health insurance form; (4) provide to the local child support agency all information and forms necessary to obtain health-care services for the children; (5) present any claim to secure payment or reimbursement to the other parent or caretaker who incurs costs for health-care services for the children; and (6) assign any rights to reimbursement to the other parent or caretaker who incurs costs for health-care services for the children. If the ''Obligor'' box is checked, a health insurance coverage assignment will issue. I. The parents must notify the local child support agency in writing within 10 days of any change in residence or employment. j. The form Notice of Rights and Responsibilities Health Care Costs and Reimbursement Procedures and Information Sheet on Changing a Child Support Order (form FL-192) is attached. k . The following person (the ''other parent'') is added as a party to this action under Family Code section 17404 (name): l . m . Obligor must pay costs $ The court further orders (specify): Dat e: JUDICIAL OFFICER SIGNATURE FOLLOWS LAST ATTACHMENT Approved as conforming to court order: Dat e: (SIGNATURE OF ATTORNEY FOR OBLIGOR) FL-630 [Rev. Julry 1, 2005] JUDGMENT REGARDING PARENTAL OBLIGATIONS (Governmental) Page 2 of 2el ectr onic form ã 2005 WWW.LawCA.co m L a w P u b l i s h e r s