Free FL-350 Stipulation to Establish or Modify Child Support and Order - California


File Size: 27.4 kB
Pages: 2
Date: June 24, 2009
File Format: PDF
State: California
Category: Court Forms - State
Author: Judicial Council of California
Word Count: 869 Words, 5,431 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.courtinfo.ca.gov/forms/documents/fl350.pdf

Download FL-350 Stipulation to Establish or Modify Child Support and Order ( 27.4 kB)


Preview FL-350 Stipulation to Establish or Modify Child Support and Order
FL-350
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY

TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name):

FAX NO. (Optional):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:

PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT:

STIPULATION TO ESTABLISH OR MODIFY CHILD SUPPORT AND ORDER
1. a. -ORb. 2. 3. a. Mother's net monthly disposable income: $ Father's net monthly disposable income: $

CASE NUMBER:

A printout of a computer calculation of the parents' financial circumstances is attached. Percentage of time each parent has primary responsibility for the children: Mother % Father per month because of (specify): A hardship is being experienced by the mother for: $ The hardship will last until (date): A hardship is being experienced by the father for: $ The hardship will last until (date): %

b.

per month because of (specify):

, referred to as the "obligor" below, 4. The amount of child support payable by (name): per month. as calculated under the guideline is: $ 5. We agree to guideline support. The guideline amount should be rebutted because of the following: 6. per month; the agreement is in the best interest of We agree to child support in the amount of: $ a. the children; the needs of the children will be adequately met by the agreed amount; and application of the guideline would be unjust or inappropriate in this case. b. Other rebutting factors (specify): 7. Obligor must pay child support as follows beginning (date): a. BASIC CHILD SUPPORT Monthly amount Payable to (name) Child's name

Total: $ b.

payable

on the first of the month

other (specify): on (date): on (date): on (date):

In addition obligor must pay the following: $ per month for child care costs to (name):
$ $

per month for health care costs not deducted from gross income to (name): per month for special educational or other needs of the children to (name):

other (specify): c. Total monthly child support payable by obligor will be: $ payable on the first of the month other (specify):
Page 1 of 2 Form Adopted for Mandatory Use Judicial Council of California FL-350 [Rev. July 1, 2008] Family Code, 4065 www.courtinfo.ca.gov American LegalNet, Inc. www.FormsWorkflow.com

STIPULATION TO ESTABLISH OR MODIFY CHILD SUPPORT AND ORDER

FL-350
PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT:
CASE NUMBER:

8. a. Health insurance will be maintained by (specify name): b. A health insurance coverage assignment will issue if available through employment or other group plan or otherwise available at reasonable cost. Both parents are ordered to cooperate in the presentation, collection, and reimbursement of any medical claims. c. Any health expenses not paid by insurance will be shared: Mother % Father % b. We agree that service of the earnings assignment be stayed because we have made the following alternative arrangements to ensure payment (specify): Travel expenses for visitation will be shared: Mother % Father %

9.

a. An Income Withholding for Support (form FL-195) will be issued.

10. 11. 12.

We agree that we will promptly inform each other of any change of residence or employment, including the employer's name, address, and telephone number. Other (specify):

13. We agree that we are fully informed of our rights under the California child support guidelines. 14. We make this agreement freely without coercion or duress. 15. The right to support a. has not been assigned to any county and no application for public assistance is pending. b. has been assigned or an application for public assistance is pending in (county name): If you checked b., an attorney for the local child support agency must sign below, joining in this agreement. Date:
(TYPE OR PRINT NAME) (SIGNATURE OF ATTORNEY FOR LOCAL CHILD SUPPORT AGENCY)

Notice: If the amount agreed to is less than the guideline amount, no change of circumstances need be shown to obtain a change in the support order to a higher amount. If the order is above the guideline, a change of circumstances will be required to modify this order. This form must be signed by the court to be effective. Date:

Date: Date: Date:

(TYPE OR PRINT NAME)

(SIGNATURE OF PETITIONER)

(TYPE OR PRINT NAME)

(SIGNATURE OF RESPONDENT)

(TYPE OR PRINT NAME)

(SIGNATURE OF ATTORNEY FOR PETITIONER)

(TYPE OR PRINT NAME)

(SIGNATURE OF ATTORNEY FOR RESPONDENT)

THE COURT ORDERS 16. a. The guideline child support amount in item 4 is rebutted by the factors stated in item 6. b. Items 7 through 12 are ordered. All child support payments must continue until further order of the court, or until the child marries, dies, is emancipated, or reaches age 18. The duty of support continues as to an unmarried child who has attained the age of 18 years, is a full-time high school student, and resides with a parent, until the time the child completes the 12th grade or attains the age of 19 years, whichever first occurs. Except as modified by this stipulation, all provisions of any previous orders made in this action will remain in effect. Date:
JUDGE OF THE SUPERIOR COURT

NOTICE: Any party required to pay child support must pay interest on overdue amounts at the "legal" rate, which is currently 10 percent per year. This can be a large added amount.
FL-350 [Rev. July 1, 2008]

STIPULATION TO ESTABLISH OR MODIFY CHILD SUPPORT AND ORDER

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