Free FL-461 ATTACHMENT TO QUALIFIED DOMESTIC RELATIONS ORDER FOR SUPPORT (EARNINGS ASSIGNMENT ORDER FOR SUPPORT) - California

COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PETITIONER/PLAINTIFF: ........ .. : RESPONDENT/DEFENDANT:
OTHER PARENT:

FL-461
CASE NUMBER:

Index No. Calendar No.

:
ATTACHMENT TO Plaintiff(s)

: : :

QUALIFIED DOMESTIC RELATIONS ORDER FOR SUPPORT (form FL-460)

JUDICIAL SUBPOENA

-against-

STATEMENT OF CONFIDENTIAL INFORMATION DO NOT FILE WITH COURT

:

Defendant(s) : ....... ........... ......... .......... ... ... ... . This separate. statement of .confidential. information .sets .forth. the .social security number of the Employee and any alternate participant for whose benefit spousal or family support is being withheld under the Qualified Domestic Relations Order for Support (form FL-460). The Plan will require this information for tax reporting purposes. PEOPLE OF THE STATE OF NEW YORK persons receiving child support or for a child alternate THE Do not include social security numbers for payee. This form must be completed and served on the Plan with a copy of the order. TO 1. EMPLOYEE INFORMATION
a. Employee name: GREETINGS: b. Employee social security number: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court 2. SPOUSAL OR FAMILY ALTERNATE PAYEE INFORMATION (for spousal or family support only): located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed a. or adjourned family alternate payee's name: as a witness in this action on the part of the Spousal or date, to testify and give evidence b. Spousal or family alternate payee's social security number:

Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, , one of the Justices of the day of , 20

(Attorney must sign above and type name below)

Attorney(s) for

Office and P.O. Address

Form Approved for Optional Use Judicial Council of California FL-461 [Rev. January 1, 2003]

Telephone No.: Facsimile No.: E-Mail Address: ATTACHMENT TO QUALIFIED DOMESTIC RELATIONS ORDER Mobile Tel. No.:
FOR SUPPORT (EARNINGS ASSIGNMENT ORDER FOR SUPPORT)

Page 1 of 1 Family Code, § 5208; 42 U.S.C. § 405 www.courtinfo.ca.gov

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