Fill and Sign the Stipulation Judgment Form

FL-615 GOVERNMENTAL AGENCY (pursuant to Welf. & Inst. Code, §§ 11475.1 , 11478.2): TELEPHONE AND FAX NOS.: ––––– ––––– ––––– ––––– E - MAIL A DDRE SS ( O p t io n a l ): ––––– attorney for ––––– 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: ––––– STIPULATION FOR JUDGMENT SUPPLEMENTAL JUDGMENT REGARDING PARENTAL OBLIGATIONS AND JUDGMENT CASE NUMBER: ––––– 1. THIS MATTER PROCEEDED AS FOLLOWS: a. By written stipulation without court appearance. b. By court hearing, appearances as follows: (1) Date: ––––– Dept.: ––––– Judicial officer: ––––– (2) Petitioner/Plaintiff present Attorney present (name) : ––––– (3) Respondent/Defendant present Attorney present (name): ––––– (4) Other parent present Attorney present (name): ––––– (5) L oca l c h il d support a gency ( F am i ly C o de, § § 17 4 00, 1 7 406 ) b y (name): ––––– (6) Other (specify): ––––– c. The Obligor (the parent ordered to pay support) is Petitioner/Plaintiff Respondent/Defendant Other parent 2. This order is based on the attached documents (specify) : ––––– ––––– 3. THE PARTIES AGREE THAT a. Obligor has read and understands the Advisement and Waiver of Rights on page four of this form. Obligor gives up these rights and freely agrees that a judgment may be entered in accordance with this stipulation. b. The amount of support payable by obligor as calculated under the guideline is: $ ––––– per month. We agree to guideline support. The guideline amount should be rebutted because of the following: (1) We have been fully informed of the guideline amount of support; we agree voluntarily to child support in the amount of: $ ––––– per month; the agreement is in the best interest of the children; the needs of the children will be met adequately by the agreed amount; the children are not receiving public assistance; no application for public assistance is pending; and application of the guideline would be unjust and inappropriate in this case. We understand that if the order is below guideline, no change of circumstances need be shown to raise this order to the guideline amount. If the order is above the guideline, a change of circumstances will be required to modify this order. (2) Other rebutting factors (specify) : ––––– ––––– ––––– ––––– ––––– c. Attached is a computer printout showing the parent's income and percentage of time each parent spends with the child(ren). The printout, which shows the calculation of child support payable, shall become the court's findings. NOTICE: Any party required to pay child support must pay interest on overdue amounts at the "legal" rate, which is currently 10 percent. This can be a large added amount. Page one of four STIPULATION FOR JUDGMENT OR SUPPLEMENTAL JUDGMENT REGARDING PARENTAL OBLIGATIONS AND JUDGMENT Family Code §§ 17400,17402, 17406Form Adopted by for Optional Use Judicial Council of California FL- [Rev. July 1, 2006] el ectr onic form ã 2006,5 WWW.LawCA.co m L a w P u b l i s h e r s (Governmental) 1299.07 [Rev. January 1, 1998] STIPULATION FOR JUDGMENT OR SUPPLEMENTAL JUDGMENT REGARDING PARENTAL OBLIGATIONS AND JUDGMENT (Governmental) Page four of four Electronic form (c) 1997- 98 www.lawca.com PETITIONER/PLAINTIFF: ––––– ––––– RESPONDENT/DEFENDANT: ––––– ––––– OTHER PARENT: ––––– CASE NUMBER ––––– 3. d. Petitioner/Plaintiff Respondent/Defendant Other Parentare the parents of the children named in item 3e below. e. Obligor shall pay current child support as follows: Name Date of birth Monthly support amount ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– (1) Other (specify): ––––– (2) For a total of: $ ––––– payable on the: ––––– day of each month beginning (date) : ––––– (3) T h e l ow-income a djustm e n t app l ies . T h e l ow-income adjustm e nt do e s not apply becaus e (specify reasons): ––––– ––––– ––––– (4) Any support ordered shall continue until further order of court, unless terminated by operation of law. f. Obligor shall pay child support for the past periods and in the amounts set forth below (specify) : Name Date of birth Period of support Amount ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– (1) Other (specify): ––––– ––––– ––––– (2) For a total of: $ ––––– payable on the: ––––– day of each month beginning (date) : ––––– (3) Interest shall accrue on the entire principal balance owing and not on each installment as it becomes due. g. 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. h. No provision of this judgment shall 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. I. All payments shall be made to ( name and address of agency ): ––––– ––––– ––––– ––––– ––––– j. A Wage and Earnings Assignment Order shall issue. k. Obligor Obligee shall (1) provide and maintain health insurance coverage for the children if it is available through employment, a group plan, or otherwise available at no or reasonable cost, and shall keep the district attorney's 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 district attorney's request, complete and return a health insurance form; (4) provide to the district attorney 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 to the children; (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 shall issue. STIPULATION FOR JUDGMENT OR SUPPLEMENTAL JUDGMENT REGARDING PARENTAL OBLIGATIONS AND JUDGMENT Page two of fourFL-615 [Rev. July 1, 2006] elec troni c form ã 2006, WWW.LawCA.co m L a w P u b l i s h e r s (Governmental) PETITIONER/PLAINTIFF: ––––– ––––– RESPONDENT/DEFENDANT: ––––– ––––– OTHER PARENT: ––––– CASE NUMBER ––––– 3. l. T he p arents must no t ify th e l ocal child supp o rt agency in wr i ti ng w i th in 1 0 d ay s of a ny cha n g e in res i denc e or emp l oyme n t. m. The 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 n. Obligor shall pay costs of: $ ––––– to (specify) : ––––– on the following terms and conditions (specify) : ––––– ––––– ––––– ––––– o. The following person (the "Other Parent") is added as a party to this action under Welfare and Institutions Code section 11350.1 (name) : ––––– p. Other (specify) : ––––– ––––– ––––– ––––– Date: ––––– ––––– (TYPE OR PRINT NAME) (SIGNATURE OF DISTRICT ATTORNEY BY PROSECUTING ATTORNEY) Date: ––––– ––––– (TYPE OR PRINT NAME) (SIGNATURE OF FATHER) Date: ––––– ––––– (TYPE OR PRINT NAME) (SIGNATURE OF ATTORNEY FOR FATHER) Date: ––––– ––––– (TYPE OR PRINT NAME) (SIGNATURE OF MOTHER) Date: ––––– ––––– (TYPE OR PRINT NAME) (SIGNATURE OF ATTORNEY FOR MOTHER) JUDGMENT 4. The court so orders. Date: ––––– (JUDICIAL OFFICER) Signature follows last attachment 5. Number of pages attached: ––––– (Continued on reverse) STIPULATION FOR JUDGMENT OR SUPPLEMENTAL JUDGMENT REGARDING PARENTAL OBLIGATIONS AND JUDGMENT (Governmental) FL-615 [Rev. July 1, 2006] el ectr onic form ã 2006, WWW.LawCA.co m L a w P u b l i s h e r s PETITIONER/PLAINTIFF: ––––– ––––– RESPONDENT/DEFENDANT: ––––– ––––– OTHER PARENT: ––––– CASE NUMBER ––––– ADVISEMENT AND WAIVER OF RIGHTS FOR STIPULATION 1. RIGHT TO BE REPRESENTED BY A LAWYER . I understand that I have the right to be represented by a lawyer of my choice at my expense. If I cannot afford a lawyer to represent me, I can ask the court to appoint one to represent me free of charge. I understand that the district attorney does not represent me. 2. RIGHT TO A TRIAL . I understand that I have a right to have a judicial officer: (a) determine if I am the parent of the children named in the stipulation; (b) decide how much child support I must pay; and (c) decide how much I owe for arrearages (unpaid support). 3. RIGHT TO CONFRONT AND CROSS EXAMINE WITNESSES. I understand that in a trial any allegations made against me must be proved. At the trial I may be present with a lawyer when witnesses testify, and I may ask them questions. I may also present evidence and witnesses 4. RIGHT TO HAVE PARENTAGE TESTS WHERE THE LAW PERMITS . I understand that, where the law permits, I have the right to have the court order parentage tests. The court will decide who pays for the tests. The court could order that I pay none, some, or all of the costs of the tests. 5. I understand that by signing the Stipulation for Judgment , I am admitting that I am the parent of the children named in the stipulation and I am giving up the rights stated above. 6. W H E R E T H E S T I P U L A T I O N I N C L U D E S C H I L D S U P P O R T . a. I understand that I will have the duty to obey the support order for the children named in the stipulation until the order is changed by the court or ended by law. b. I also understand that the court will order any support payments to be paid directly from my wages or other earnings and sent to the district attorney. 7. WHERE THE STIPULATION IN- CLUDES A PROVISION FOR HEALTH INSURANCE . I understand that I must keep health insurance coverage for the minor children if insur ance is available, or becomes available to me at reasonable cost. A health insurance coverage assignment may be ordered to get health insurance for my children. 8. I am signing the stipulation freely and voluntarily. 9. I understand that the district attorney is required by state law to enforce the duty of support 10. I UNDERSTAND THAT I MAY BE PROSECUTED UNDER CALIFORNIA LAW IF I WILLFULLY FAIL TO SUP- PORT MY CHILDREN, WHETHER OR NOT THERE IS A SUPPORT ORDER . 11. I understand that any support I owe may be collected from any of my property. This collection may be made by intercepting money owed to me by the state or federal government (such as tax refunds, unemployment and disability benefits, and lottery winnings), by taking property I own, by placing a lien on my property, or by any other lawful means. 12. IF I AM REPRESENTED BY AN ATTORNEY, MY ATTORNEY HAS READ AND EXPLAINED TO ME THE STIPULATION, AND THIS ADVISEMENT AND WAIVER OF RIGHTS AND I UNDERSTAND THEM . I have read and understand the Stipulation and Advisement and Waiver of Rights ; or Attached is a translation of this advisement in (specify language) : ––––– I understand the translation. Date: ––––– ––––– (TYPE OR PRINT NAME) (PARTY'S SIGNATURE ) INTERPRETER'S DECLARATION. The defendant is unable to read or understand this advisement because his or her primary language is (specify) : ––––– other (specify) : ––––– ––––– I certify under penalty of perjury under the laws of the State of California that I have, to the best of my ability, read or translated for the defendant the Stipulation and Advisement and Waiver of Rights . The defendant said he or she understood the Stipulation and Advisement and Waiver of Rights before signing it. Date: ––––– ––––– (TYPE OR PRINT NAME OF INTERPRETER) (INTERPRETER'S SIGNATURE) STIPULATION FOR JUDGMENT OR SUPPLEMENTAL JUDGMENT REGARDING PARENTAL OBLIGATIONS AND JUDGMENT (Governmental) Page four of four FL-615 [Rev. July 1, 2006] el ectr onic form ã 2006 WWW.LawCA.co m L a w P u b l i s h e r s