Fill and Sign the Petition to Obtain Information from Superior Court Adoption

ATTO RNEY F O R (N am e): SU PER IO R C O UR T OF C A LI FO RNIA , C O UNTY O F3. 4. 5.               GO VER NM EN TA L AG EN CY ( u nde r Fam ily Co de, §§ 1 7 400 ,17406 ): FO R C O URT U SE O NLYF L-5 30TE LE P H O NE NO .: FAX N O.:E-MA IL A D D RE SS (O ptio n al) :S TR EE T A D D RE SS:M AI LING A D D RESS :CIT Y A N D Z IP C O DE:BR AN CH N AM E: PETITIONER:R ES PO NDEN T: O TH ER : JUD GM EN T R EG AR DIN G P A RE NTAL O BLIG ATIO NS (U IF S A ) CAS E NUM BE R :AM EN D EDSU PPLE M EN TA L1.a.N O TI CE : T H IS IS A PR OP OS ED JU DGM EN T. T hi s Jud gm en t R eg ard in g P are nta l O bl igat ions ( U lF SA ) w ill b e ent er ed by th e cou rt an d will be co m e l e g al ly bi nd in g un le s s yo u fill o ut an d file th e Resp ons e t o U nifor m S upp ort Pe tit io n ( U lF S A ) (fo rm FL -5 20 ) w it h the co urt cle rk wit h in 30 days of th e date y ou were se rv e d w it h th e Sum m ons (U lF S A ) (fo rm F L -5 10) a n d Un if o rm Support Pe tition (fo rm FL -5 00/O M B 0 970- 0085). I f y o u ne ed a Resp onse f o rm , you m ay g et o ne fr om th e lo cal c h ild s u p port a g en cy, t h e c o urt clerk , o r t h e f a m ily la w f a cilit a to r. T he f a m ily law facili t a to r w ill h elp y o u fil l o ut th e f o rm s. T o f ile t he R esp on se, f o ll o w t he p roc ed ur es lis te d in t h e in fo rm atio n she et a tt a c h ed to th at f o rm .2.b. NOTICE : TH IS IS A JUDG MENT . It is now le gall y bin ding. TH IS M ATTE R P RO CEED ED A S F OLLO W S:a. b.Ju d gm en t e nte re d u nder F am ily C ode s e ctio n 5 002. By c o urt he arin g, appea ran ce s a s fo llo w s:(1 ) (2) (3)D ate :P etit io ne r p re se n t Resp o nd ent p re se ntD ep t.: J u dic ia l o ffic e r: Att o rn ey p re se n t (nam e): Att o rn ey p re se n t (nam e): (4 ) (5)C hild su pport a gency ( Fa mily C od e, §§ 1 7 40 0, 1 74 06) by (n am e): Oth e r (s p ec ify):c.Th e o blig or ( th e p are nt o rd ere d to p ay s u pport) isp etit io ner resp ond entoth e r (sp ecify) :Thi s o rd er is b ase d o n p re su m ed in co m e fo r th e obl ig or u nder F am ily C ode s e ctio n 5 002. Att a ch ed is a c om put er p rin to u t sh ow in g the p are nts ’ inc om e a n d perc e n ta ge of tim e e ach p are n t s pe nd s w it h the c h ild re n. The pr intou t, w hic h s ho ws th e c a lc u la tio n of c h ild s u pport pa ya ble , s ha ll b eco m e th e co urt’s fin di ngs. Thi s o rd er is b ase d o n th e at ta ch ed d ocu m ents (s p ecif y ):6 .T H E C O URT O RDER S:a.O blig o ris th e p ar en t of t h e c h ild re n n am ed in it e m 6b . has p re vio usly be en d ete rm ined to b e th e p are n t of th e ch ild re n n a m ed in it em 6 b.b .O blig o r m us t p a y cu rre nt c hi ld s u pport as fo llo w s: Na m e Date o f b ir th Month ly s u pp ort am ount(1 )Ot her (s p ecif y ):N O TI CE: A ny p ar ty re q ui red t o pa y c h il d su ppo rt m ust p ay in te res t on o verd ue am ount s at t h e leg al ra te , w hi ch is cur re nt ly 1 0 p erc en t p er yea r.Fo rm Ad opted for Mand ato ry Use Jud ic ia l C ou ncil of C alif o rni a FL-5 30 [R ev. Ju ly 1, 2005 ]JU D G M EN T R EG ARDI NG P A REN TA L O BLIG ATIO NS (UIF S A ) Pa ge 1 of 2 Fam ily C od e §§ 4 92 1, 5 00 2 ele ctr o nic f o rm  2 005 WWW.LawCA.com La w P ublis h ers PE TITIO NER: CAS E NUM BER : RESPO NDE NT: OTH ER:(3 ) In te re st ac cru es o n the e nt ir e p rin cip al b ala nc e owi ng a nd n o t on each insta llm en t a s it b eco m es d ue.F or a to ta l o f: $ paya bl e: $ be gin nin g (d ate ):A n e a rn in gs a ss ig nm ent order fo r sup port m ust iss ue. Obl ig o r Obli g ee must (1) p ro vid e and m aint ain h ealt h in su ra nce c o ve ra ge fo r th e chi ld re n if it is ava ila ble th ro ug h e m plo ym en t o r a g ro up p la n , o r oth erwise a va ila ble at n o o r re aso na ble c o st, a nd k e ep th e loc al ch ild s u pport a ge ncy in fo rm ed of the av aila bi lit y o f t h e co ve ra ge ; (2) if h ealt h insu ra nce is no t a va ila ble , p rovi de c o ve ra ge w hen it b eco m es a va ila bl e; (3 ) w ith in 20 d ays of t h e lo ca l ch ild s u pp ort agenc y’s re que st, co m ple te a n d re tur n a he al th ins uran ce f o rm ; (4 ) p ro vide to th e lo ca l ch ild su pp ort a g en cy a ll inf orm atio n a nd fo rm s n ece ssa ry to ob tai n h ealt h -c a re s er vic e s f or th e ch ild re n; (5 ) pr es en t a ny cla im to s e cu re p aym en t o r r e im bu rs em en t to th e o the r par en t o r c ar etake r w ho in cu rs co sts fo r he alt h -c a re se rv ic e s fo r the child re n; a n d (6 ) a ssig n a n y righ ts to re imb urs e m ent to th e o th e r pa re nt or ca re ta ke r w ho in cu rs co sts f o r h ealt h -c a re s e rv ic e s fo r t h e c h ild re n. If t h e “ O blig or” b ox is ch ecke d, a h e al th ins uran ce c o ve ra ge as sign men t m ust is su e.T he N otic e o f R ig hts a n d Resp o nsib ili tie s and In fo rm atio n S he et o n C han g in g a C hild S uppor t O rd er ( for m F L-1 9 2 ) is a tta ch ed. Ob lig or m ust p a y c o sts o f: $ Th e c o urt fu rth e r o rd ers (s p ec ify):           6. b .(2 )Fo r a to ta l o f: $ be gin nin g (d ate ):p aya b le o n t h e: da y of e ach month( 3 ) The lo w-in co m e ad ju stm ent applie s. The lo w -in co m e a dju stm en t d o es not a pply b eca use (s p ecif y r e aso ns ):c.( 4 ) Any s u p port ord ere d will c o nt inu e u ntil fu rth er or der o f c ou rt, un le ss te rm in ate d b y op era tio n o f la w . Obl ig or m us t p a y c h ild s u pport fo r t h e p ast p er iods a nd in th e am ount s s et for th b elo w: Nam e Date o f b ir th Perio d of s u pport Am oun t(1 ) Oth e r (s p e cif y):(2 )on th e :d a y of e a ch monthd . e.N o p ro vis io n o f th is ju dgm en t o pera te s to lim it an y rig h t to c o lle ct th e princ ipal ( to ta l a m ount o f u npai d s up port) or t o c ha rg e an d colle ct in te re st a nd p e na lt ie s as a llo wed b y la w. A ll p aym ents o rd e re d are s u bjec t to m odif ic a tio n. All p aym ents m ust b e m ad e to ( n a m e a nd a ddre ss o f a g e ncy):f. g.h . T he p a re nts m ust n otif y t h e lo ca l ch ild su ppo rt a genc y in w rit in g w it hi n 1 0 d ays of a n y ch an ge in r e sid ence o r e m ploym en t.i. j. k.D ate :JU DIC IA L O FFIC ER7.Nu mbe r o f pa ges a tta ch ed:SIGN ATU RE FOL LO WS L AS T A TTAC HM EN TApp ro ve d a s c on fo rm in g to c ou rt o rd er: Da te :(S IGN ATUR E O F AT TO RNEY F O R O BLI GO R)FL -530 [R ev. Jul y 1, 20 05]J UD GM EN T R EG AR DIN G P A RE NTAL O BLIG ATIO NS (UIF S A )Pa ge 2 of 2ele ctr o nic f o rm  2 005 WWW.LawCA.com La w P ublis h ers