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ATTO RN EY F OR (N am e): SU PER IO R C O URT OF C ALIF O RNIA , C O UNTY O FOTH ER P A R EN T: SH O RT F O RM O RDER A FTE R H EA RIN G3. TH E C O URT ORDER S: a. A ll o rd ers p re vio usly m ade in th is actio n w ill r e m ain in fu ll f o rc e a nd e ffe ct exce pt a s s p ec ific a lly m odif ie d bel ow .O blig or is o rd ere d to a ppear on th e co ntin ua nce d ate . Cu rre n t ch ild s up port is m od if ie d to $ p er m on th be gin ni ng (d ate ):e . The c ou rt ret ain s ju ris di ctio n to ord er s up port r e tr o activ e to : (1) (S pecif y d ate) : (2) The d ate th e o blig or be co m es e m plo ye d o r o th erw is e h a s th e a b ility to p ay s u p po rt. (3 ) The d ate th e o blig or a ba ndons o r s ep ara te s fr o m th e c h ild re n at is su e in th is cas e.                   GO VE RNM EN TA L AG EN CY (u nd er Fam ily Code , § § 17 400,17 406) :FO R C O URT USE ONLYF L-6 88TE LE P H O NE NO. (Optional ):FAX NO. (Op tio na l):E- MAI L AD DR ES S (O ptional ):ST REE T A D D RESS:M AIL IN G AD DRESS:C IT Y AN D Z IP CO DE: BR AN CH N AM E: PETI TI ONER /PL AIN TIF F: RESPO NDENT/DEFENDANT:CAS E NUM BE R :1 . T his m atte r p ro ceed ed as fo llow s: a. D ate :D ep t.:U nco nte ste d B y s tip ulat ion Ju d ic ia l o ffic e r: C on te ste db . c. d.P etit io ne r/pl ain tif f p re se nt Resp on de nt/d efe n d ant p re se nt Oth er p a re n t p re sen tAtt o rn ey p re se n t (nam e): Att o rn ey p re se n t (nam e): Att o rn ey p re se n t (nam e):e. Atto rn ey fo r loc al c h ild sup port a g ency p re se nt u nde r F am ily C ode se ctio ns 1 7400 a nd 17406 b y (n am e) :f.Ot her (s p ecif y ):2 . TH E C O URT FIN DS, base d up on th e m ovin g p a pe rs : a. (N am e):is t h e o b lig or ( th e pare n t or de re d to p ay s u pport) in th is pr oc ee din g.b.T he o blig or isa n d bas ed t h ere o n ha s n o ab ilit y t o p ay s u p po rt.c.H ea lt h in sur an ce c ov era ge at no o r r e a son able c o st is cu rr en tly n ot a va ila bl e to th e o bli go r t o co ve r the m in or c h ildr en in this a ctio n.b.T his m att e r is c o ntin ued to in D ept. : fo r t h e fo llo w ing pu rp ose s on ly :c. d.f.A ny o rd e r to liq uid a te the su p port a rre ara ge is su sp end e d un til f u rth er ord e r o f th is c o urt.g . The pare nts m ust n otif y th e lo ca l c h ild su ppo rt a gency in w rit ing with in 10 days of a ny ch a ng e in r es idence o r em plo ym ent .h. i.T he o b lig or is ord er ed t o o bta in h e alth in su ra nc e c o ve ra g e fo r th e ch ildr en in t h is action if it b e co m es ava il ab le at n o or rea so nab le c o st. Oth e r (s p ecif y ):4 . Nu mber o f pa ges atta ch ed: Date : App ro ve d a s c on fo rm in g to c ou rt o rd er: (SI GN ATURE O F AT TO RNEY FOR O BLIG O R) JU DIC IA L OFFIC ER Form A do pted fo r M and ator y UsePag e 1 o f 1 Fa mi ly Co de, §§ 174 00, 17 40 2, Ju di cia l C ou ncil of Cal if o rni a FL-688 [Re v. July 1 , 20 05]SH O RT F O RM O RDER A FTE R H EA RI NG (Go ver nm ent al) 17 40, 17 406 ele ctr o nic f o rm  2 005 WWW.LawCA.com La w P ublis h ers