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FL-626
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):

To keep other people from seeing what you entered on your form, please press the Clear This Form button at the end of the form when finished.

Self Represented

SUPERIOR COURT OF CALIFORNIA, COUNTY OF


STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:

San Bernardino 655 W. Second St., 2nd Flr.


San Bernardino, CA 92415 Child Support

PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT:

STIPULATION AND ORDER WAIVING UNASSIGNED ARREARS (Governmental)

CASE NUMBER:

Instructions: This form is to be filled out if the party to whom support is owed wishes to give up the right to past-due support that is owed to him or her. If either party has any questions about the possible consequences of this waiver, he or she should ask an attorney. If either party has any questions about the case or the information on this form, he or she should ask the Family Law Facilitator or the local child support agency. PARTIES 1. The party waiving past support is petitioner/plaintiff respondent/defendant other parent other (specify):

2. The party ordered to pay support is petitioner/plaintiff respondent/defendant other parent other (specify):

3. The party ordered to pay support and the party waiving past support are the parties to this agreement. RIGHT TO AN ATTORNEY 4. The parties understand their right to be represented by an attorney, at their expense, in connection with these proceedings. NO TIME LIMIT FOR COLLECTION 5. The parties understand that the amounts owed for Non-Aid arrears (past-due child support ordered to be paid personally to the party waiving support) remain owed until paid. There is no time limit for the collection of past-due support. CONTINUING COLLECTION EFFORTS 6. All methods to collect or enforce the amounts past due may be used until the past due support is paid in full, including, but not limited to, wage assignments, levy on assets, tax refund interception, license suspension, property liens, and contempt. The parties understand that a waiver of support will stop all collection efforts of the support waived. RIGHT TO DETERMINATION OF DISPUTED PAST SUPPORT 7. If the amount of past-due support is unknown or uncertain, the parties understand that they have the right to have the local child support agency review and audit the amount due, including all amounts ordered, all payments, and all credits. The parties also understand that if they are not satisfied with the agency's audit, they have the right to have a court hearing to determine the amount due.
Page 1 of 4 Form Approved for Optional Use Judicial Council of California FL-626 [Rev. January 1, 2009]

STIPULATION AND ORDER WAIVING UNASSIGNED ARREARS


(Governmental)

Family Code, 4503, 17526 www.courtinfo.ca.gov

FL-626
PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT:
CASE NUMBER:

CONSEQUENCES OF WAIVING PAST SUPPORT 8. The parties understand that once the party waiving past support gives up his or her right to past-due support, he or she can never request payment of the amount given up or ask the local child support agency or court to reinstate the amount given up, UNLESS he or she has specifically retained the right to do so as part of item 16. 9. The parties understand that the party waiving past support cannot give up the right to collect Aid arrears (past-due child support that belongs to the county in exchange for receipt of public assistance benefits), nor can he or she give up the right to future child support. The parties understand that this stipulation does not affect the current child support order. If there is a current child support order, that order still remains in full force and effect. 10. The parties have had sufficient time to read and think about this stipulation and to discuss it with any and all advisors, counselors, or attorneys of their choosing. 11. The party waiving past support has not been promised anything by the party ordered to pay support, the local child support agency, the court, or anyone else, to induce him or her to give up amounts owed to him or her, except as specifically set forth in writing in this stipulation. 12. The party waiving past support has not been threatened in any way (physically, emotionally, or otherwise) by the party ordered to pay support, the local child support agency, the court, or anyone else, to force him or her to give up support amounts. 13. The party waiving past support has thought about and decided that it is in his or her best interest and the best interest of his or her children to give up this support arrearage. AMOUNT OF PAST-DUE SUPPORT 14. As of (date calculated): a. NON-AID ARREARS (these are the amounts owed personally to the party waiving past support before this waiver becomes effective): Type (1) (2) (3) (4) Child support: Spousal/family support: Other (specify): TOTAL: See attachment 14a. AID ARREARS (these are the amounts assigned and owed to a public agency and cannot be waived by the parties): Type Principal Interest Time Period (1) (2) (3) (4) Child support: Spousal/family support: Other (specify): TOTAL: See attachment 14b. c. The parties agree that the amounts in items 14a and 14b will be considered a final determination by the court of the amount of past-due support. $ $ $ $ $ $ $ $ _____ through _________ _____ through _________ _____ through _________ Principal $ $ $ $ Interest $ $ $ $ Time Period _____ through _________ _____ through _________ _____ through _________

b.

WARNING: If the box at item 14c is checked you may be prohibited from any future challenge regarding the amount of past-due support indicated at items 14a and 14b. d. The parties agree that the amounts stated above represent the amount of past-due support indicated by the local child support agency records. However, in agreeing to this waiver of Non-Aid arrears, the parties have not reached an agreement regarding the accuracy of the amount of past-due support as stated.

FL-626 [Rev. January 1, 2009]

STIPULATION AND ORDER WAIVING UNASSIGNED ARREARS


(Governmental)

Page 2 of 4

FL-626
PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT:
CASE NUMBER:

WAIVER OF PAST-DUE SUPPORT 15. In consideration of the payment by the party ordered to pay support of the sums set forth below, and the performance of any other condition stated below, the parties agree as follows (check and complete either a or b, but not both, and add other applicable provisions): a. to the local child support agency on Upon payment by party ordered to pay support of the sum of $ , the Non-Aid arrears set forth in paragraph 14a above shall be deemed or before (date): paid in full. b. to the local child support agency on or before Upon payment by party ordered to pay support of the sum of $ , the parent ordered to pay support shall owe the following sums for Non-Aid support. (date): Type (1) (2) (3) (4) c. Child support: Spousal/family support: Other (specify): TOTAL: Other (specify): See attachment 15 for additional provisions. CONDITIONS OF WAIVER 16. This waiver of past-due support is conditioned on the party ordered to pay support agreements set forth in this document. If the party ordered to pay support fails to perform any condition, then this waiver is NULL and VOID and of no force or effect whatsoever. However, if box 14c is checked, the setting of support arrears in items 14a and 14b will continue to be valid as the court's determination of the amount of support arrearage. Specific conditions of this waiver are as follows: a. Additional conditions of this waiver (optional) (i.e., lump-sum payment, timely payment of current support, etc.): ____________________________________________________________________________________________ ____________________________________________________________________________________________ Principal $ $ $ $ Interest $ $ $ $ Time period as of (date): as of (date): as of (date):

b.

See attachment 16 for additional conditions of waiver. Each party must initial or sign all additional pages.

17. This stipulation and order does not modify or affect the duty of the party ordered to pay current support that accrues, or any support arrears that may accumulate, after the date set forth in item 14. 18. Each party understands that the local child support agency does not represent him or her in this matter. Neither party has been given legal advice from the local child support agency, or any of its attorneys, or the family law facilitator, in regard to this stipulation. 19. This form contains the entire understanding and agreement of the parties, and there have been no verbal or other written promises or conditions by anyone, except as stated in this form.
Date:

(TYPE OR PRINT NAME)

(SIGNATURE OF PARTY WAIVING PAST SUPPORT)

Date:

(TYPE OR PRINT NAME) FL-626 [Rev. January 1, 2009]

(SIGNATURE OF PARTY ORDERED TO PAY SUPPORT) Page 3 of 4

STIPULATION AND ORDER WAIVING UNASSIGNED ARREARS


(Governmental)

FL-626 ATTORNEY'S STATEMENT


I am the attorney of record for the party identified in this waiver. I have gone over this form and any attachments with my client. I have explained each provision of this form to my client and answered the client's questions with regard to this form. I have discussed the facts of the case with my client and possible alternatives to and conditions for waiver. I have explained the consequences of the waiver and benefits and detriments of any agreement.
Date:
(TYPE OR PRINT NAME) (SIGNATURE OF ATTORNEY FOR PARTY ORDERED TO PAY SUPPORT)

Date:
(TYPE OR PRINT NAME) (SIGNATURE OF ATTORNEY FOR PARTY WAIVING PAST SUPPORT)

LOCAL CHILD SUPPORT AGENCY


Date:
(TYPE OR PRINT NAME, TITLE, AND COUNTY) (SIGNATURE OF REPRESENTATIVE OF LOCAL CHILD SUPPORT AGENCY)

DECLARATION OF PERSON PROVIDING INTERPRETATION/TRANSLATION (if applicable)


The party/parties indicated below is/are unable to read or understand this Stipulation and Order Waiving Unassigned Arrears because The party waiving past support's primary language is (specify): The party ordered to pay support's primary language is (specify): and he or she has has not read the form stipulation translated into this language. and he or she has has not read the form stipulation translated into this language.

I certify under penalty of perjury under the laws of the State of California that I am competent to interpret or translate in the primary language indicated above and that I have, to the best of my ability, read to, interpreted for, or translated for the above-named party/parties the Stipulation and Order Waiving Unassigned Arrears in the party's primary language. The above-named party/parties stated he or she understood the terms of the Stipulation and Order Waiving Unassigned Arrears before signing it.

Date:

Date:

(TYPE OR PRINT NAME)

(TYPE OR PRINT NAME)

(SIGNATURE)

(SIGNATURE)

COURT'S FINDINGS AND ORDER


The court, having reviewed and considered this stipulation, and any attachments, finds that the party owed support expressly, knowingly, voluntarily, and intelligently has waived past-due support as more specifically set forth in this document. The court accepts this stipulation, approves it, and orders that all further enforcement is terminated as to the waived support. IT IS SO ORDERED.
Date:
(JUDICIAL OFFICER OF THE SUPERIOR COURT)

FL-626 [Rev. January 1, 2009]

STIPULATION AND ORDER WAIVING UNASSIGNED ARREARS


(Governmental)

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FL-300
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):

To keep other people from seeing what you entered on your form, please press the Clear This Form button at the end of the form when finished.

Self Represented

SUPERIOR COURT OF CALIFORNIA, COUNTY OF


STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:

San Bernardino 655 W. Second St., 2nd Flr.

San Bernardino, CA 92415 Child Support

PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT/PARTY:

REQUEST FOR ORDER Child Custody Child Support Attorney Fees and Costs 1. TO (name):

MODIFICATION Visitation Spousal Support

Temporary Emergency Court Order Other (specify): Accept and approve Stipulation

CASE NUMBER:

2. A hearing on this Request for Order will be held as follows: If child custody or visitation is an issue in this proceeding, Family Code section 3170 requires mediation before or at the same time as the hearing (see item 7.) a. Date: b. Address of court Time: same as noted above Dept.: other (specify): Room.:

3. Attachments to be served with this Request for Order: a. A blank Responsive Declaration (form FL-320) Completed Income and Expense Declaration (form b. FL-150) and a blank Income and Expense Declaration Date:
(TYPE OR PRINT NAME)

c. d. e.

Completed Financial Statement (Simplified) (form FL-155) and a blank Financial Statement (Simplified) Points and authorities Other (specify): Stipulation and Order waiving Unassigned Arrears; DCSS Accounting

(SIGNATURE)

COURT ORDER
4. 5. YOU ARE ORDERED TO APPEAR IN COURT AT THE DATE AND TIME LISTED IN ITEM 2 TO GIVE ANY LEGAL REASON WHY THE ORDERS REQUESTED SHOULD NOT BE GRANTED.

service Time for hearing is shortened. Service must be on or before (date): 6. Any responsive declaration must be served on or before (date): 7. The parties are ordered to attend mandatory custody services as follows:

8. 9. Date:

You are ordered to comply with the Temporary Emergency Court Orders (form FL-305) attached. Other (specify):

JUDICIAL OFFICER

To the person who received this Request for Order: If you wish to respond to this Request for Order, you must file a Responsive Declaration to Request for Order (form FL-320) and serve a copy on the other parties at least nine court days before the hearing date unless the court has ordered a shorter period of time. You do not have to pay a filing fee to file the Responsive Declaration to Request for Order (form FL-320) or any other declaration including an Income and Expense Declaration (form FL-150) or Financial Statement (Simplified) (form FL-155).
Page 1 of 4 Form Adopted for Mandatory Use Judicial Council of California FL-300 [Rev. July 1, 2012] Family Code, 2045, 2107, 6224, 6226, 63206326, 63806383 Government Code, 26826 www.courts.ca.gov

REQUEST FOR ORDER


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FL-300
PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT/PARTY:
CASE NUMBER:

REQUEST FOR ORDER AND SUPPORTING DECLARATION


Petitioner 1. Respondent Other Parent/Party requests the following orders: c. Physical custody to (name of person with whom child will live) CHILD CUSTODY a. Child's name and age To be ordered pending the hearing b. Legal custody to (name of person who makes decisions about health, education, etc.)

d.

As requested in form

Child Custody and Visitation Application Attachment (form FL-311) Request for Child Abduction Prevention Orders (form FL-312) Children's Holiday Schedule Attachment (form FL-341(C)) Additional ProvisionsPhysical Custody Attachment (form FL-341(D)) Joint Legal Custody Attachment (form FL-341(E)) Other (Attachment 1d)

e.

Modify existing order (1) filed on (date): (2) ordering (specify):

2.

CHILD VISITATION (PARENTING TIME) Attachment 2a (2) a. As requested in: (1) (3) Other (specify): b. Modify existing order (1) filed on (date): (2) ordering (specify):

To be ordered pending the hearing Child Custody and Visitation Application Attachment (form FL-311)

c. (1) (2)

One or more domestic violence restraining/protective orders are now in effect. (Attach a copy of the orders if you have one.) The orders are from the following court or courts (specify county and state): Criminal: County/state: Case No. (if known): Family: County/state: Case No. (if known): (3) (4) Juvenile: County/state: Case No. (if known): Other: County/state: Case No. (if known):

3.

CHILD SUPPORT (An earnings assignment order may be issued.) a. Child's name and age b. I request support based on the child support guidelines c. Monthly amount requested (if not by guideline) $

d.

Modify existing order (1) filed on (date): (2) ordering (specify):

Notice: The court is required to order child support based on the income of both parents. It normally continues until the child is 18. You must supply the court with information about your finances by filing an Income and Expense Declaration (form FL-150) or a Financial Statement (Simplified) (form FL-155). Otherwise, the child support order will be based on information about your income that the court receives from other sources, including the other parent.
FL-300 [Rev. July 1, 2012]

REQUEST FOR ORDER

Page 2 of 4

FL-300
PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT/PARTY:
CASE NUMBER:

4.

SPOUSAL OR PARTNER SUPPORT (An earnings assignment order may be issued.) c. a. Modify existing order Amount requested (monthly): $ b. (1) filed on (date): Terminate existing order (2) ordering (specify): (1) filed on (date): (2) ordering (specify): d. The Spousal or Partner Support Declaration Attachment (form FL-157) is attached (for modification of spousal or partner support after judgment only) e. An Income and Expense Declaration (form FL-150) must be attached

5.

ATTORNEY FEES AND COSTS are requested on Request for Attorney Fees and Costs Order Attachment (form FL-319) or a declaration that addresses the factors covered in that form. An Income and Expense Declaration (form FL-150) must be attached. A Supporting Declaration for Attorney Fees and Costs Order Attachment (form FL-158) or a declaration that addresses the factors covered in that form must also be attached. PROPERTY RESTRAINT To be ordered pending the hearing

6.

a. The petitioner claimant is restrained from transferring, encumbering, hypothecating, respondent concealing, or in any way disposing of any property, real or personal, whether community, quasi-community, or separate, except in the usual course of business or for the necessities of life. The applicant will be notified at least five business days before any proposed extraordinary expenditures, and an accounting of such will be made to the court. b. Both parties are restrained and enjoined from cashing, borrowing against, canceling, transferring, disposing of, or changing the beneficiaries of any insurance or other coverage, including life, health, automobile, and disability, held for the benefit of the parties or their minor children. Neither party may incur any debts or liabilities for which the other may be held responsible, other than in the ordinary course of business or for the necessities of life.

c.

7.

To be ordered pending the hearing PROPERTY CONTROL The petitioner respondent is given the exclusive temporary use, possession, and control of the following a. property that we own or are buying (specify):

b.

The petitioner respondent is ordered to make the following payments on liens and encumbrances coming due while the order is in effect: Amount of payment Debt Pay to

8.

OTHER RELIEF (specify):

Acceptance and approval of the Stipulation and Order Waiving Unassigned Arrears.

NOTE: To obtain domestic violence restraining orders, you must use the forms Request for Order (Domestic Violence Prevention) (form DV-100), Temporary Restraining Order (Domestic Violence) (form DV-110), and Notice of Court Hearing (Domestic Violence) (form DV-109).
FL-300 [Rev. July 1, 2012]

REQUEST FOR ORDER


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FL-300
PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT/PARTY:
CASE NUMBER:

9.

I request that time for service of the Request for Order and accompanying papers be shortened so that these documents may days before the time set for the hearing. I need to have this be served no less than (specify number): order shortening time because of the facts specified in item 10 or the attached declaration. FACTS IN SUPPORT of orders requested and change of circumstances for any modification are (specify): Contained in the attached declaration. (You may use Attached Declaration (form MC-031) for this purpose. The attached declaration must not exceed 10 pages in length unless permission to file a longer declaration has been obtained from the court.)

10.

The other party and I have entered into an agreement to waive the unassigned arrears in our case. Attached hereto is a true and correct copy of the most recent accounting of the arrears from the Deparment of Child Support Services. We agree that we are fully informed of our rights under the California child support guidelines and we make this agreement freely without coercion or duress. The reason/(s) that we have agreed to waive the unassigned arrearages is/are that:

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 APPLICANT)

Requests for Accommodations Assistive listening systems, computer-assisted real-time captioning, or sign language interpreter services are available if you ask at least five days before the proceeding. Contact the clerks office or go to www.courts.ca.gov/forms for Request for Accommodations by Persons With Disabilities and Response (form MC-410). (Civil Code, 54.8.)
FL-300 [Rev. July 1, 2012]

REQUEST FOR ORDER


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Do not write on the papers below!!!!

This is the BLANK paperwork you are required to have served on the other party. What gets served: 1. Copy of papers you filled out 2. Blank sheets (following this sheet)

FL-320
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 PARTY:

RESPONSIVE DECLARATION TO REQUEST FOR ORDER


HEARING DATE: TIME: DEPARTMENT OR ROOM:

CASE NUMBER:

1.

CHILD CUSTODY I consent to the order requested. a. b. I do not consent to the order requested, but I consent to the following order:

2.

CHILD VISITATION (PARENTING TIME) I consent to the order requested. a. b. I do not consent to the order requested, but I consent to the following order:

3.

CHILD SUPPORT a. I consent to the order requested. b. I consent to guideline support. c. I do not consent to the order requested, but I consent to the following order: Guideline (1) Other (specify): (2)

4.

SPOUSAL OR PARTNER SUPPORT I consent to the order requested. a. b. I do not consent to the order requested. c. I consent to the following order:

Page 1 of 2 Form Adopted for Mandatory Use Judicial Council of California FL-320 [Rev. July 1, 2012] www.courts.ca.gov

RESPONSIVE DECLARATION TO REQUEST FOR ORDER

FL-320
PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARTY:
CASE NUMBER:

5.

ATTORNEY'S FEES AND COSTS a. b. c. I consent to the order requested. I do not consent to the order requested. I consent to the following order:

6.

PROPERTY RESTRAINT a. I consent to the order requested. b. I do not consent to the order requested. c. I consent to the following order:

7.

PROPERTY CONTROL a. I consent to the order requested. b. I do not consent to the order requested. c. I consent to the following order:

8.

OTHER RELIEF I consent to the order requested. a. b. I do not consent to the order requested. c. I consent to the following order:

9.

SUPPORTING INFORMATION Contained in the attached declaration. (You may use Attached Declaration (form MC-031) for this purpose).

NOTE: To respond to domestic violence restraining orders requested in the Request for Order (Domestic Violence Prevention) (form DV-100), you must use the Answer to Temporary Restraining Order (Domestic Violence Prevention) (form DV-120).

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

(TYPE OR PRINT NAME) FL-320 [Rev. July 1, 2012]

(SIGNATURE OF DECLARANT) Page 2 of 2

RESPONSIVE DECLARATION TO REQUEST FOR ORDER

FL-335
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:

CASE NUMBER:

(If applicable, provide):

OTHER PARENT/PARTY:

HEARING DATE: HEARING TIME: DEPT.:

PROOF OF SERVICE BY MAIL

NOTICE: To serve temporary restraining orders you must use personal service (see form FL-330). 1. I am at least 18 years of age, not a party to this action, and I am a resident of or employed in the county where the mailing took place. 2. My residence or business address is:

3. I served a copy of the following documents (specify) :

by enclosing them in an envelope AND a. depositing the sealed envelope with the United States Postal Service with the postage fully prepaid. b. placing the envelope for collection and mailing on the date and at the place shown in item 4 following our ordinary business practices. I am readily familiar with this businesss practice for collecting and processing correspondence for mailing. On the same day that correspondence is placed for collection and mailing, it is deposited in the ordinary course of business with the United States Postal Service in a sealed envelope with postage fully prepaid. 4. The envelope was addressed and mailed as follows: a. Name of person served: b. Address: c. Date mailed: d. Place of mailing (city and state): 5. I served a request to modify a child custody, visitation, or child support judgment or permanent order which included an address verification declaration. (Declaration Regarding Address VerificationPostjudgment Request to Modify a Child Custody, Visitation, or Child Support Order (form FL-334) may be used for this purpose.)

6. 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) Form Approved for Optional Use Judicial Council of California FL-335 [Rev. January 1, 2012]

(SIGNATURE OF PERSON COMPLETING THIS FORM) Page 1 of 1

PROOF OF SERVICE BY MAIL

Code of Civil Procedure, 1013, 1013a www.courts.ca.gov