San Bernardino — SB-12039

Source: https://sanbernardino.courts.ca.gov/system/files/sb-12039.pdf

FOR COURT USE ONLYDATE OF THIS HEARING TIME DEPARTMENT

NAME, ADDRESS AND TELEPHONE NUMBER OF PETITIONER’S ATTORNEY or PETITIONER

BAR NO: NAME, ADDRESS AND TELEPHONE NUMBER OF RESPONDENT’S ATTORNEY or RESPONDENT

BAR NO:

TITLE OF CASE : CASE NUMBER:

, PETITIONER

, RESPONDENT

STIPULATION AND ORDER ON REQUEST FOR ORDER (FAMILY LAW)

Petitioner (Husband/Wife/Mother/Father/Other) not present. Pendente Lite Respondent (Husband/Wife/Mother/Father/Other) not present. Modification

THE PARTIES HEREBY STIPULATE AND AGREE TO THE ITEMS CHECKED BELOW AND

THAT THE COURT SHALL MAKE THE FOLLOWING: Temporary order pending the trial of this action or further order of the Court.

Order of modification.

1. CHILD CUSTODY AND VISITATION Custody and visitation have been agreed to by the parties. See attached Mediation Report

(Mediation Date: ______________________).

Custody of the minor child/ren shall be ordered as follows, and such arrangements are in the

best interests of the minor child/ren:

Child’s Name: Date of Birth:

Petitioner’s Initials _______ Form SB12039 Respondent’s Initials ______ STIPULATION AND ORDER rev 11/05/12 ON REQUEST FOR ORDER (FAMILY LAW)

Child’s Name: (continued) Date of Birth:

LEGAL CUSTODY JOINT LEGAL CUSTODY of the minor child/ren shall be awarded to both parties, with:

BOTH PARTIES TO SHARE the physical care, custody and control of the minor

child/ren reasonably between them in such a manner as to insure that the minor

child/ren maintain frequent and continuing contact with both parents.

SOLE LEGAL CUSTODY of the minor child/ren shall be awarded to ____________________.

Additional Joint Legal Custody Provisions as stated in the Attached Form FL-341(E)

PHYSICAL CUSTODY SOLE PHYSICAL CUSTODY shall be awarded to ___________________________________.

JOINT PHYSICAL CUSTODY shall be shared between both parties.

Additional Physical Custody Provisions as stated in the Attached Form FL-341(D)

AND

VISITATION AS FOLLOWS: PRIMARY PHYSICAL CUSTODY to __________________________, with the right of

REASONABLE visitation to ___________________________________ as follows:

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OR

As contained in the attached Family Court Services report, consisting of _____ pages with

mediation date of //______.

OR

Petitioner’s Initials _______ Form SB12039 Respondent’s Initials ______ STIPULATION AND ORDER rev 11/05/12 ON REQUEST FOR ORDER (FAMILY LAW)

SPECIFIC VISITATION as follows:

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Holiday Schedule as stated in the Attached Form FL-341(C)

OTHER ORDERS RE: MINOR CHILDREN Neither party shall remove the child/ren from the following geographic areas ___________ ____________________ without prior written consent of the other party or prior order of the Court first having been obtained except for vacation periods.

Neither party shall use or make, nor allow any other persons to use or make, any disparaging, or derogatory remarks about the absent parent in the presence of said child/ren.

Each party shall keep the other party informed of his or her current address and telephone number and those of the child/ren and shall notify the other within _____ days of any change of address or telephone number.

___________________ shall not consume any alcoholic beverages, narcotic, or restricted dangerous drug (except upon prescription) within _____ hours of visitation or during the visitation with the minor children.

Neither party shall discuss the facts of this case with the minor child/ren.

Party receiving physical custody shall be responsible for the child’s/ren’s transportation on
the custody exchanges.

Transportation for visitation shall be as follows:

Transport TO visit provided by _________________________. Transport FROM

visit provided by _______________________________________.

Drop Off & Pickup will be at ______________________________________________.

Petitioner’s Initials _______ Form SB12039 Respondent’s Initials ______ STIPULATION AND ORDER rev 11/05/12 ON REQUEST FOR ORDER (FAMILY LAW)

Other: _________________________________________________________________

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2. CHILD SUPPORT

_____ Petitioner _____ Respondent shall pay to the other party as and for child support the sum of $__________ per month. The allocation of support per child is as stated in the attached Child Support Calculation.

Child Support shall be: due one-half on the first and one-half on the fifteenth day of each month

due on the first of the month

due on the _______ day of each month

commencing ___________ and continuing until further order of the Court or until the child

marries, dies, is emancipated, reaches age 19, or reaches age 18 and is not a full-time high

school student, whichever occurs first.

GUIDELINE: A printout of a computer calculation and findings is attached and incorporated in this

order. The amount of support per the guideline formula is $___________.

The amount of child support is set forth as calculated under the guideline.

OR

WE AGREE TO NON-GUIDELINE CHILD SUPPORT. The child support agreed to by the

parties is below or above guideline. Pursuant to Family Code Section 4065(a), the parties

declare that they have been fully informed of their rights concerning child support. Neither

party is acting out of duress or coercion. Neither party is receiving public assistance and no

application for public assistance is pending. The needs of the children will be adequately met

by this agreed-upon amount of child support; the agreement is in the best interests of the

children involved. Application of the guideline amount would be unjust or inappropriate in this

case. If the order is below the guideline, no change of circumstances will be required to

Petitioner’s Initials _______ Form SB12039 Respondent’s Initials ______ STIPULATION AND ORDER rev 11/05/12 ON REQUEST FOR ORDER (FAMILY LAW)

modify this order. If the order is above the guideline, a change of circumstances will be

required to modify this order.

Health insurance coverage for the minor children of the parties shall be maintained by the

petitioner respondent if available at no or reasonable cost through their respective

places of employment or self-employment. Both parties are ordered to cooperate in the

presentation, collection and reimbursement of any health-care claims. Any health expenses

not paid by insurance shall be shared: _____% Petitioner _____% Respondent

The parent ordered to provide health insurance must seek continuation of coverage for the child

after the child attains the age when the child is no longer considered eligible for coverage as a

dependent under the insurance contract, if the child is incapable of self-sustaining employment

because of a physically or mental disabling injury, illness, or condition and is chiefly dependent

upon the parent providing health insurance for support and maintenance when health insurance

coverage is available at no cost or at a reasonable cost to the parent or parents, as applicable.

ARREARS. _____Petitioner _____ Respondent shall pay to the other party the child support

arrears in the principal sum of $________ for the period of //___ to //___.

These arrears shall be paid as follows:

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CHILD CARE COSTS

______ Petitioner ______ Respondent shall pay reasonable child care costs related to

employment or necessary job training in the amount of $__________, per month:

Each party shall pay one-half.

Petitioner’s Initials _______ Form SB12039 Respondent’s Initials ______ STIPULATION AND ORDER rev 11/05/12 ON REQUEST FOR ORDER (FAMILY LAW)

_____ % Petitioner _____% Respondent

$______ Petitioner $______ Respondent

RESERVED. The Court’s jurisdiction to award child support is reserved.

NOT APPLICABLE. Child Support is not a subject of this stipulation.

3. SPOUSAL SUPPORT

WAIVER. Petitioner Respondent freely, knowingly and intelligently waives spousal

support forever. The Court’s jurisdiction to award spousal support to that/those parties shall

be terminated. The Court shall have no jurisdiction to award spousal support, and therefore

no support can be ordered regardless of future hardship. The Parties agree and the Court

finds that the Party/Parties waiving spousal support have considered the factors listed in

Family Code Section 4320.

ZERO SUPPORT/RESERVED – LONG-TERM MARRIAGE. Neither party shall receive spousal support from the other. The court reserves jurisdiction over this issue for the benefit

of either party as this was a long-term marriage.

SPOUSAL SUPPORT PAYMENTS. Petitioner Respondent shall pay spousal support

to the other Party the sum of $________ per month,

due one-half on the first and one-half on the fifteenth day of each month

due on the first of the month

due on the _______ day of each month

commencing _____________ and continuing until _________________. Spousal

support shall terminate upon the death of either party or the remarriage of the supported

party, or further order of the Court, whichever occurs first.

SPECIAL ORDERS re SPOUSAL SUPPORT:

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Petitioner’s Initials _______ Form SB12039 Respondent’s Initials ______ STIPULATION AND ORDER rev 11/05/12 ON REQUEST FOR ORDER (FAMILY LAW)

NOTICE: It is the goal of this State that each party must make reasonable good faith efforts to

become self-supporting as provided for in Family Code section 4320. The failure to make

reasonable good faith efforts may be one of the factors considered by the Court as a basis for

modifying or terminating support.

RESERVED. The Court’s jurisdiction to award spousal support to Petitioner

Respondent is reserved for later determination upon Request for Order.

NOT APPLICABLE. Spousal Support is not a subject of this stipulation.

4. ATTORNEY’S FEES, LITIGATION EXPENSES AND COURT COSTS The issue of attorney’s fees for either party is reserved until further order of the Court.

_____________________ shall pay directly to ____________________ counsel as

attorney’s fees, expenses of litigation and Court costs the sum of $ __________, payable in

installments of $ __________ per ____________ payable on the __________ and

___________ days of each month commencing ________________ and continuing until

paid in full. If any ______ installment payments are not paid when due, the entire unpaid

balance will become immediately due and payable and shall bear interest at the legal rate

from date of default.

Each of the parties shall pay his/her own attorney’s fees, expenses of litigation and Court

costs, excepting those previously ordered.

NOT APPLICABLE. Attorney Fees are not a subject of this stipulation.

5. OTHER ORDERS Additional orders ___________________________________________________

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Petitioner’s Initials _______ Form SB12039 Respondent’s Initials ______ STIPULATION AND ORDER rev 11/05/12 ON REQUEST FOR ORDER (FAMILY LAW)

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Check here if additional pages attached for Other Additional Orders.

All other issues are reserved until time of trial next hearing date.

ThisThisThisThisThis mattermattermattermattermatter isisisisis continuedcontinuedcontinuedcontinuedcontinued tototototo _______________________________________________________________________________________________ atatatatat a.m.p.m. for further hearing on

all issues the following issues only:

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Counsel for Petitioner Respondent to prepare a formal order.

This stipulation covers all matters in dispute in the Request for Order. This Order when

signed is the formal Order. No further documents are necessary.

This stipulation shall be deemed incorporated in and made a part of the minute order by reference thereto, and as though the same were fully set forth therein.

SIGNATURE OF PARTIES

We have read the entire stipulation and agreement. We understand it fully and request the Court to make our stipulation and agreement the Court’s order. We understand that willful failure to comply

Petitioner’s Initials _______ Form SB12039 Respondent’s Initials ______ STIPULATION AND ORDER rev 11/05/12 ON REQUEST FOR ORDER (FAMILY LAW)

with the provisions of this order will be a contempt of Court and may be punished by fine and imprisonment. We waive all further notice of this order.

The foregoing is agreed to by:

x______________________x______________________ ______ x________________________ _______ Petitioner Date Respondent Date

Approved as conforming to the agreement of the parties:

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(Petitioner’s Attorney, if any) (Respondent’s Attorney, if any)

IT IS SO ORDERED THIS ___________ day of _________________, _____________.

PURSUANT TO FAMILY CODE SECTION 3048 (A)

This Court exercises jurisdiction under the Uniform Child Custody and Jurisdiction Enforcement Act (part 3 of the California Family code, commencing with section 3400) Notice and opportunity to be heard were given under Family Code Section 3425. Violation of the order may subject the party in violation to civil or criminal penalties, or both. The habitual residence of the children is the United States of America

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JUDGE OF THE SUPERIOR COURT

NOTICE TO PARTIES WITHOUT ATTORNEYS

If this stipulation is reached as a temporary order pre-trial, this order shall remain in effect until further order of the Court. If you wish notice of the trial date and to present information to the Court at time of trial, you must have filed a Response to the Petition.

If other agencies require a copy, counsel will be directed to prepare and forward same or prepare and file a formal order and serve all opposing parties.

Petitioner’s Initials _______ Form SB12039 Respondent’s Initials ______ STIPULATION AND ORDER rev 11/05/12 ON REQUEST FOR ORDER (FAMILY LAW)