Free FL-490 APPLICATION TO DETERMINE ARREARAGES - California

COURT ........ PETITIONER: . RESPONDENT: OTHER: COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. : :
Child support Spousal support Plaintiff(s)
CASE NUMBER:

FL-490

Index No. Calendar No.

APPLICATION TO DETERMINE ARREARAGES

Family JUDICIAL support

:

SUBPOENA Medical support

Unreimbursed expenses -against-Unreimbursed medical expenses : Other (specify): Attachment to Order to Show Cause (form FL-300)

: :

Notice of Motion (form FL-301)

1. I ask that arrearages be determined in this case. 2. I have attached (check all that apply): a. . . . . . .Declaration . . Payment History .(FL-420) . a . . . . . . . . of . . . . . . . . . . . . . . . . . . a Payment History Attachment (FL-421) b. c. Other (specify):

Defendant(s) : ..................

THE PEOPLE OF THE STATE OF NEW YORK
3. a. b. I ask that the support arrearage be changed as follows: some all of the support ordered. Proof of payment is attached. The children for whom support is to be paid were living with me full time for the period from to . I provided all of their support during that period. I am attaching a detailed declaration explaining these facts and supporting documentation, including any proof that the children were living with me. Other (specify): c. GREETINGS:

TO I have already paid

4.

5.

in room , on the day of , 20 , at o'clock in the noon, and at any recessed orAttorney fees and costs a. and Fees evidenceCostswitness in this action on the part of the adjourned date, to testify give b. as a
Income and Expense Declaration (form FL-150) is attached.

I parent the have previously asked the other parent for payment and the Honorable at provided the other Court with an itemized statement of the unreimbursed childcare expense medical expense (Attach copies of all bills being claimed and proof of any located at County of payments that you have made on these bills.)

WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before ,

6. Facts in support of the relief requested are (specify):

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

contained in the attached comply with Your failure to declaration.

(Attorney must sign above and type name below)

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date:

Attorney(s) for

(TYPE OR PRINT NAME)

(SIGNATURE OF DECLARANT)

Office and P.O. Address
Attorney

Petitioner/Plaintiff

Respondent/Defendant Other (specify):

NOTICE: This form must be attached to an Order to Show Cause (FL-300) or a Notice of Motion (FL-301).

Form Adopted for Mandatory Use Judicial Council of California FL-490 [Rev. July 1, 2003]

Telephone No.: Facsimile No.: NOT A COURT ORDER E-Mail Address: APPLICATION TO DETERMINE ARREARAGES Mobile Tel. No.:

Page ___ of ___ Family Code, §§ 4720­4732

www.courtinfo.ca.gov

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