Fill and Sign the Statement for Registration of California Support Order Family Law 128582 Fl 440 Form

N FL-440 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and Address) : TELEPHONE NO.: TELEPHONE NO.: FAX NO.: ATTORNEY FOR (Name): FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE:  BRANCH NAME:PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT: STATEMENT FOR REGISTRATION OF CALIFORNIA SUPPORT ORDER Child Support Order Order for Wage or Income Withholding CASE NUMBER:  The statement of the Obligee (the person to whom support is owed) to register a California support order a California order for wage or income withholding is as follows: 1. The Obligor (the parent ordered to pay support) is Petitioner/Plaintiff Respondent/Defendant Other Parent 2. A file stamped copy (endorsed) of the most recent support order or order for wage or income withholding (or a copy) is attached.(A certified copy is not required.) 3. a. A Declaration of Arrearage (form 1285.62) is attached. b. The arrearage balance is unknown. 4.The Obligee's mailing address is (specify): .5The Obligor's last known place of residence or mailing address is (specify ): .6States and counties in which the original order for support or order for wage or income withholding, and any modifications, areregistered (specify): None, or unknown. NOTICE TO OBLIGOR You have 20 days after the date of mailing of this STATEMENT FOR REGISTRATION OF CALIFORNIA SUPPORT ORDER to petition the court to cancel (vacate) this registration or for other relief (Family Code, § 5603). (See the date on the clerk's Certificate of Mailing on page 2 of this form.) page 1 o f 2 STATEMENT FOR REGISTRATION OF CALIFORNIA SUPPORT ORDERFamily Code, § 5602 Form Adopted by for Optional Use Judicial Council of California FL-440 [Rev. January 1, 2003]electronic form 2002 WWW.LawCA.com Law Publishers N PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT: CASE NUMBER: DECLARATION 7.I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.Date: (TYPE OR PRINT NAME) (SIGNATURE OF OBLIGEE, PERSON HAVING LEGAL CUSTODY OF MINOR OBLIGEE, OR PERSON ACTING ON BEHALF OF OBLIGEE PURSUANT TO AN ASSIGNMENT OF RIGHTS) NOTICE TO OBLIGOR 8. TO OBLIGOR (name): 9. You are notified that a California Support Order California Order for Assignment of Wages for Support has been registered with this court. A copy of the order is attached and the mailing address of the obligee is shown in this statement. Date: Clerk, by , Deputy CLERK'S CERTIFICATE OF MAILING I certify that I am not a party to this cause and that a copy of the Statement for Registration of California Support Order with a copy of the California order were sent to the Obligor by certified mail, return receipt from the addressee only requested. The copies were enclosed in an envelope with postage fully prepaid. The envelope was addressed to the Obligor only at the address listed in item 5 on page one of this form, sealed, and deposited with the United States Postal Serviceat (place): on (date): Date: Clerk, by , Deputy STATEMENT FOR REGISTRATION OF CALIFORNIA SUPPORT ORDER (Family Law) page 2 of 2 FL-440 [Rev. January 1, 2003]electronic form 2002 WWW.LawCA.com Law Publishers