Stanislaus — Responsive declaration

Source: https://www.stanislaus.courts.ca.gov/system/files/responsive-declaration-2016.pdf

www.stanct.org (209) 530-3100 Street Address: 1100 I Street Modesto, CA 95353 Mailing Address: P.O. Box 1098 Modesto, CA 95353

Self Help Center: 800 11 th Street Room #220 Modesto, CA 95353

(PROVIDING ASSISTANCE TO PARTIES REPRESENTING THEMSELVES) Responsive Declaration to Request for Order

All documents must be typed or printed legibly per Rules of Court 2.104, in blue or black ink.

This packet includes the necessary forms to respond to a Request for Order.

Judicial Council forms, local forms, and information are available in the Clerk’s Office, the Stanislaus County Law Library located at 1101 13 th Street, Modesto, CA and on the following websites:

Stanislaus County Superior Court: www.stanct.org Stanislaus County – Local Forms: www.stanct.org/Forms.aspx?id=3 Judicial Council’s Self Help: www.courts.ca.gov/selfhelp.htm Judicial Council Forms: www.courts.ca.gov/formsrules.htm Stanislaus County Law Library: www.stanislauslawlibrary.org Free Interactive Electronic Forms Program: www.icandocs.org/ca/california.html California’s Free Website for Legal Help: www.lawhelpcalifornia.org Law Libraries, Websites, or Self-Help Legal Books: www.courts.ca.gov/1091.htm

REQUIRED FORMS: FL-320 – Responsive Declaration to Order to Show Cause or Notice of Motion FL-335 – Proof of Service by Mail FL-321 – Witness List (If you intend to call a witness)

NOTES: If you are responding to orders regarding economic issues (example: child support or spousal support), you MUST file either an Income and Expense Declaration (FL–150) or a Financial Statement (FL-155). These forms are available on the Judicial Council’s website at: www.courts.ca.gov/formsrules.htm, at the clerk’s office or at the Self Help Center. The Income and Expense Declaration can be typed directly from the website and the calculations will be computed for you.

SERVICE: The other party must be served with copies of all documents except for confidential documents (example: fee waiver). The person who serves the other party with the forms must complete, date and sign the Proof of Service by Mail.

Revised 7/1/12

Parties are encouraged to review and comply with Local Rules regarding Family Law proceedings. Local Rules can be located on the following Superior Court website: www.stanct.org.

Material distributed by the Superior Court Clerk’s Office or Self Help Center IS INTENDED FOR INFORMATIONAL AND EDUCATIONAL PURPOSES ONLY. Such material is NOT LEGAL ADVICE and is not intended to be legal advice as to your specific case. IT IS NOT INTENDED TO TAKE THE PLACE OF LEGAL ADVICE FROM AN ATTORNEY. You are strongly urged to seek the advice of a licensed attorney before starting or completing your case in order to protect valuable legal rights that you may have, of which you may be unaware of. Please contact an attorney of your choice or contact the LAWYERS REFERRAL SERVICE of the Stanislaus County Bar Association at: (209) 571-5727 for a referral. The Clerk’s Office cannot give you legal advice.

Revised 7/1/12

FL-320-INFO Information Sheet: Responsive Declaration to Request for Order

1 If you received a Request for Order (form FL-300), • Carefully read the papers you received to make sure you understand what orders are being requested. • Note the date, time, and location of the court hearing. • Check to see if the court ordered a specific date for filing and serving your Responsive Declaration to Request for Order (form FL-320). • If you need more time before the hearing to prepare a responsive declaration or talk with a lawyer, you may ask the court to continue the hearing date. For more information, consult with a lawyer or contact the the Family Law Facilitator or Self-Help Center in your court (see item 16 ). 2 USE Responsive Declaration to Request for Order (form FL-320) Use form FL-320 to let the court and the other party know that you agree or disagree with each of the requests made in the Request for Order (form FL-300). • If you disagree, use form FL-320 to describe the orders you would like the court to make. • If you do not file and serve form FL-320, the court can still make orders without your input.

3 DO NOT USE Responsive Declaration to Request for Order (form FL-320) to: • Ask for court orders that were not requested in the Request for Order (form FL-300). Instead, file and serve your own Request for Order (form FL-300) to ask for orders about other issues. • Respond to Request for Domestic Violence Restraining Order (form DV-100). Instead, you must use Response to Request for Domestic Restraining Order (form DV-120).

4 Forms checklist a. Form FL-320, Responsive Declaration to Request for Order is the basic form you need. Depending on the requests made in the Request for Order (form FL-300), you may need other forms. b. For child custody or visitation (parenting time) orders, you may need to complete some of these forms: FL-105, Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act FL-311, Child Custody and Visitation (Parenting Time) Application Attachment FL-312, Request for Child Abduction Prevention Orders FL-341(C), Children’s Holiday Schedule Attachment FL-341(D), Additional Provisions—Physical Custody Attachment FL-341(E), Joint Legal Custody Attachment c. For child support, you need: A current form FL-150, Income and Expense Declaration. You may use form FL-155, Financial Statement (Simplified) instead of form FL-150 if you meet the requirements listed on page 2 of form FL-155. Notice: • The court will order child support based on the income of the parents. • Child support normally continues until the child is 18 years and has graduated from high school. • You must give the court information about your finances. If you do not, the child support order will be based on information about your income that the court receives from other sources. d. For spousal or domestic partner support or orders about your finances, you need these forms: FL-150, Income and Expense Declaration FL-157, Spousal or Partner Support Declaration Attachment (if the request is to change a support judgment) e. For attorney’s fees and costs, you need these forms: FL-150, Income and Expense Declaration FL-158, Supporting Declaration for Attorney’s Fees and Costs (or provide the information in a declaration) FL-319, Request for Attorney’s Fees and Costs Attachment (or provide the information in a declaration) f. If you plan on having witnesses testify at the hearing, you need this form: FL-321, Witness List

Form Approved for Optional Use Information Sheet: Responsive Declaration to FL-320-INFO, Page 1 of 3Judicial Council of California www.www.courts.ca.govNew July 1, 2016 Request for Order (Family Law)

FL-320-INFO Information Sheet: Responsive Declaration to Request for Order

To respond to a Request for Order, you must: Complete caption of the form

Complete the top portion including your name, 5 address, and telephone number, the court address, the name of all the parties in the case, and the case number. Also, print or type the same hearing date, time, and department that appears on the Request for Order (form FL-300). 6 Specify a response to orders requested Items 1–9: Each item on the form matches the item numbers on the Request for Order (form FL-300). Complete item 1. Next, mark the same box that is marked on form FL-300. Then, specify if you consent (agree) or do not consent to (disagree with) the orders requested. If you disagree, describe the order you would like the court to make. Note: you may file one form FL-150 to respond to items 3, 4, and 6. Item 10: Use the space to explain your responses to items 1–9. Include the reasons why you do not agree with the orders requested by the other party and why the court should make the orders you described. If you need more space, write your responses on a separate sheet of paper and attach it to the form (Attached Declaration (form MC-031) may be used for this purpose). Sign and date: Print your name, sign, and write 8 Pay filing fees the date you signed form FL-320. Generally, you do not have to pay a fee to file the Responsive Declaration. However, if you have 7 Next steps: file or serve your paperwork never filed any papers in the case, you may have to You must file your paperwork with the court clerk pay a “first appearance fee,” which, in general, at least 9 court days before the hearing. If the court everyone has to pay when filing court papers in a orders a shorter time to file your papers, file them case for the first time. by the date specified in the order. If you cannot afford to pay the filing fee, you can Make 2 copies of your original paperwork. Then, ask the court to waive the fees. To do so, complete do one of the following before the filing deadline: and file form FW-001, Request to Waive Court • Take your paperwork and copies to the court Fees and form FW-003, Order on Court Fee clerk to process (or e-file them, if available in Waiver. your county). The clerk will keep the original and 9 Serve your papers on the other party give you back copies with a court stamp on them. “Service” is the act of giving your legal papers to Have a stamped copy served; or all persons named as parties in the case so that they • Have an unstamped copy of your paperwork know what orders you want the court to make. served before you take (or e-file) the Note: If a party has a lawyer in the originals and copies to the court clerk to file. case, the papers should be served on that party’s Be sure the original documents are not served. lawyer.

New July 1, 2016 Information Sheet: Responsive Declaration to FL-320-INFO, Page 2 of 3 Request for Order (Family Law)

FL-320-INFO Information Sheet: Responsive Declaration to Request for Order

10 How to “serve” 13 File the Proof of Service before your Server. You cannot serve the papers. Have hearing date someone else (who is at least 18 years old) do it. The Proof of Service shows the judge that the The “server” can be a friend, a relative who is not person received a copy of your Responsive involved in your case, a county sheriff, or a Declaration to Request for Order. Make three professional process server. copies of the completed Proof of Service. Take the original and copies to the court clerk as soon as Personal service. possible before your hearing. Your papers may be The clerk will keep the original and give you back served by “personal the copies stamped “Filed.” Bring a copy stamped service.” “Personal “Filed” to your hearing. (If unstamped copies of service” means that your paperwork were served, you can file the your “server” walks up to each person to be served, completed Proof of Service when you file the makes sure he or she is the right person, and then original Responsive Declaration.) gives a copy of all the papers to him or her. 14 Participate in child custody mediation or Service by mail. child custody recommending counseling “Service by mail” If the Request for Order includes a court order for means that your you to attend mediation or child custody “server” places copies recommending counseling, the date, time, and of all the documents location is found on page 1 of the Request for in a sealed envelope Order. For more information, read Child Custody and mails them to the Information Sheet (form FL-313-INFO or form address of each party FL-314-INFO). being served (or to the party’s lawyer, if he or she has one.) The server must be 18 years of age or over 15 Get ready for your hearing and must live or work in the county where the • Take at least two copies of your documents and mailing took place. filed forms to the hearing. Include a filed Proof of 11 Deadline for service Service form. Personal service or service by mail on the other • Find more information about preparing for the party must be completed at least 9 court days before hearing at www.courts.ca.gov/1094.htm. the court hearing. If the court has ordered a shorter time to serve your responsive papers, be sure to 16 Still have questions or need help? have them served by the date specified in the court • Contact the Family Law Facilitator or Self-Help order. Center for information, local rules, and referrals 12 Server must complete a Proof of Service to local legal services providers. Go to http:// After personal service, the server should complete a www.courts.ca.gov/1083.htm/. form FL-330, Proof of Personal Service. Form • Talk to a lawyer if you want legal advice, FL-330-INFO, Information Sheet for Proof of someone to go to court with you, or other legal Personal Service has instructions to help the person help. Find an attorney through your local bar complete the form. association, the State Bar of California at calbar. After service by mail, the server should complete ca.gov, or the Lawyer Referral Service at form FL-335, Proof of Service by Mail. Form 1-866-442-2529. FL-335-INFO, Information Sheet for Proof of • For free and low-cost legal help (if you qualify), Service by Mail has instructions to help the person go to lawhelpcalifornia.org. complete the form.

New July 1, 2016 Information Sheet: Responsive Declaration to FL-320-INFO, Page 3 of 3 Request for Order (Family Law)

FL-320 PARTY WITHOUT ATTORNEY OR ATTORNEY: STATE BAR NO.: FOR COURT USE ONLY NAME:

FIRM NAME:

STREET ADDRESS:

CITY: STATE: ZIP CODE:

TELEPHONE NO.: FAX NO.:

E-MAIL ADDRESS:

ATTORNEY FOR (name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF Stanislaus STREET ADDRESS: 1100 I Street MAILING ADDRESS: P.O. Box 1098 CITY AND ZIP CODE: Modesto, CA 95353 BRANCH NAME:

PETITIONER: RESPONDENT:

OTHER PARENT/PARTY:

RESPONSIVE DECLARATION TO REQUEST FOR ORDER CASE NUMBER:

HEARING DATE: TIME: DEPARTMENT OR ROOM:

Read Information Sheet: Responsive Declaration to Request for Order (form FL-320-INFO) for more information about this form.

1. RESTRAINING ORDER INFORMATION
   a. No domestic violence restraining/protective orders are now in effect between the parties in this case.
   b. I agree that one or more domestic violence restraining/ protective orders are now in effect between the parties in
   this case.

2. CHILD CUSTODY
   VISITATION (PARENTING TIME)
   a. I consent to the order requested for child custody (legal and physical custody).
   b. I consent to the order requested for visitation (parenting time).
   c. I do not consent to the order requested for child custody visitation (parenting time)
   but I consent to the following order:

3. CHILD SUPPORT
   a. I have completed and filed a current Income and Expense Declaration (form FL-150) or, if eligible, a current Financial
   Statement (Simplified) (form FL-155) to support my responsive declaration.
   b. I consent to the order requested.
   c. I consent to guideline support.
   d. I do not consent to the order requested but I consent to the following order:

4. SPOUSAL OR DOMESTIC PARTNER SUPPORT
   a. I have completed and filed a current Income and Expense Declaration (form FL-150) to support my responsive
   declaration.
   b. I consent to the order requested.
   c. I do not consent to the order requested but I consent to the following order:

Form Adopted for Mandatory Use RESPONSIVE DECLARATION TO REQUEST FOR ORDER CodeCal.ofRulesCivil Procedure,of Court, rule§ 10055.92Judicial Council of California FL-320 [Rev. July 1, 2016] www.courts.ca.gov

FL-320 PETITIONER: CASE NUMBER: RESPONDENT: OTHER PARENT/PARTY:

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

6. ATTORNEY'S FEES AND COSTS
   a. I have completed and filed a current Income and Expense Declaration (form FL-150) to support my responsive
   declaration.
   b. I have completed and filed with this form a Supporting Declaration for Attorney's Fees and Costs Attachment (form
   FL-158) or a declaration that addresses the factors covered in that form.
   c. I consent to the order requested.
   d. I do not consent to the order requested but I consent to the following order:

7. DOMESTIC VIOLENCE ORDER
   a. I consent to the order requested.
   b. I do not consent to the order requested but I consent to the following order:

8. OTHER ORDERS REQUESTED
   a. I consent to the order requested.
   b. I do not consent to the order requested but I consent to the following order:

9. TIME FOR SERVICE / TIME UNTIL HEARING
   a. I consent to the order requested.
   b. I do not consent to the order requested but I consent to the following order:

10. FACTS TO SUPPORT my responsive declaration are listed below. The facts that I write and attach to this form cannot be
    longer than 10 pages, unless the court gives me permission. Attachment 10.

I declare under penalty of perjury under the laws of the State of California that the information provided in this form and all attachments is true and correct. Date:

(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)

FL-320 [Rev. July 1, 2016] RESPONSIVE DECLARATION TO REQUEST FOR ORDER Page 2 of 2

MC-025 SHORT TITLE: CASE NUMBER:

ATTACHMENT (Number): (This Attachment may be used with any Judicial Council form.)

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(If the item that this Attachment concerns is made under penalty of perjury, all statements in this Page of Attachment are made under penalty of perjury.) (Add pages as required)

Form Approved for Optional Use ATTACHMENT Judicial Council of California MC-025 [Rev. July 1, 2009] to Judicial Council Form

FL-321 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY

TELEPHONE NO.: FAX NO. (Optional):

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF Stanislaus STREET ADDRESS: 1100 I Street MAILING ADDRESS: P. O. Box 1098 CITY AND ZIP CODE: Modesto, CA 95353

BRANCH NAME:

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

OTHER PARENT/PARTY:

CASE NUMBER(S):

WITNESS LIST

Attachment to Request for Order (FL-300) Responsive Declaration (FL-320) Other (specify):

Petitioner Respondent Other intends to call the following witnesses to testify

at the time of hearing or trial scheduled on (date):

Name Subject and Brief Description of Testimony

Form Approved for Optional Use WITNESS LIST Family Code, § 217(c); Judicial Council of California Cal.Rules of Court, rule 5.113 FL-321 [New July 1, 2012] www.courts.ca.gov

FL-335 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY

TELEPHONE NO.: FAX NO. (Optional):

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS STREET ADDRESS: 1100 I Street MAILING ADDRESS: PO Box 1098 CITY AND ZIP CODE: Modesto, CA 95353 BRANCH NAME:

CASE NUMBER:

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT: (If applicable, provide):

OTHER PARENT/PARTY: HEARING DATE:
HEARING TIME:
PROOF OF SERVICE BY MAIL DEPT.:

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 business’s 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 Verification—Postjudgment 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) (SIGNATURE OF PERSON COMPLETING THIS FORM)

Form Approved for Optional Use PROOF OF SERVICE BY MAIL Code of Civil Procedure, §§ 1013, 1013a Judicial Council of California FL-335 [Rev. January 1, 2012]

FL-335-INFO INFORMATION SHEET FOR PROOF OF SERVICE BY MAIL

Use these instructions to complete the Proof of Service by Mail (form FL-335).

A person at least 18 years of age or older must serve the documents. There are two ways to serve documents: (1) personal delivery and (2) by mail. See the Proof of Personal Service (form FL-330) if the documents are being personally served. The person who serves the documents must complete a proof of service form for the documents being served. You cannot serve documents if you are a party to the action.

INSTRUCTIONS FOR THE PERSON WHO SERVES THE DOCUMENTS (TYPE OR PRINT IN BLACK INK)

You must complete a proof of service for each package of documents you serve. For example, if you serve the respondent and the other parent, you must complete two proofs of service; one for the respondent and one for the other parent.

Complete the top section of the proof of service forms as follows: First box, left side: In this box print the name, address, and phone number of the person for whom you are serving the documents. Second box, left side: Print the name of the county in which the legal action is filed and the court’s address in this box. Use the same address for the court that is on the documents you are serving. Third box, left side: Print the names of the petitioner/plaintiff, respondent/defendant, and other parent in this box. Use the same names listed on the documents you are serving. First box, top of form, right side: Leave this box blank for the court’s use. Second box, right side: Print the case number in this box. This number is also stated on the documents you are serving. Third box, right side: Print the hearing date, time, and department. Use the same information that is on the documents you are serving.

You cannot serve a temporary restraining order by mail. You must serve those documents by personal service.

1. You are stating that you are at least 18 years old and that you are not a party to this action. You are also stating that you either live in or are employed in the county where the mailing took place.
2. Print your home or business address.
3. List the name of each document that you mailed (the exact names are listed on the bottoms of the forms). a. Check this box if you put the documents in the regular U.S. mail. b. Check this box if you put the documents in the mail at your place of employment.
4. a. Print the name you put on the envelope containing the documents. b. Print the address you put on the envelope containing the documents. c. Print the date that you put the envelope containing the documents in the mail. d. Print the city and state you were in when you mailed the envelope containing the documents.
5. Check this box if you are serving an address verification form (required for service by mail of a postjudgment request to change a child custody, visitation, or child support order).
6. You are stating under penalty of perjury that the information you have provided is true and correct. Print your name, fill in the date, and sign the form.

If you need additional assistance with this form, contact the family law facilitator in your county.

FL-335-INFO [New January 1, 2012] INFORMATION SHEET FOR PROOF OF SERVICE BY MAIL Code of Civil Procedure, §§ 1013, 1013a

FL-330 ATTORNEY OR PARTY WITHOUT ATTORNEY OR GOVERNMENTAL AGENCY (under Family Code, §§ 17400, 17406 FOR COURT USE ONLY (Name, State Bar number, and address):

TELEPHONE NO.: FAX NO.:

ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS STREET ADDRESS: 1100 I Street MAILING ADDRESS: PO Box 1098 CITY AND ZIP CODE: Modesto, CA 95353 BRANCH NAME: PETITIONER/PLAINTIFF: CASE NUMBER:

RESPONDENT/DEFENDANT: (If applicable, provide): OTHER PARENT/PARTY: HEARING DATE: HEARING TIME: PROOF OF PERSONAL SERVICE DEPT.:

1. I am at least 18 years old, not a party to this action, and not a protected person listed in any of the orders.

2. Person served (name):

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

4. By personally delivering copies to the person served, as follows: a. Date: b. Time: c. Address:

5. I am a. not a registered California process server. d. exempt from registration under Business & Profession

b. a registered California process server. Code section 22350(b).
c. an employee or independent contractor of a e. a California sheriff or marshal.
registered California process server.

6. My name, address, and telephone number, and, if applicable, county of registration and number (specify):

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

8. I am a California sheriff or marshal and I certify that the foregoing is true and correct.

Date:

(TYPE OR PRINT NAME OF PERSON WHO SERVED THE PAPERS) (SIGNATURE OF PERSON WHO SERVED THE PAPERS)

Form Approved for Optional Use PROOF OF PERSONAL SERVICE Code of Civil Procedure, § 1011 Judicial Council of California FL-330 [Rev. January 1, 2012]

FL-330-INFO INFORMATION SHEET FOR PROOF OF PERSONAL SERVICE

Use these instructions to complete the Proof of Personal Service (form FL-330).

A person at least 18 years of age or older must serve the documents. There are two ways to serve documents: (1) personal delivery and (2) by mail. See the Proof of Service by Mail (form FL-335) if the documents are being served by mail. The person who serves the documents must complete a proof of service form for the documents being served. You cannot serve documents if you are a party to the action.

INSTRUCTIONS FOR THE PERSON WHO SERVES THE DOCUMENTS (TYPE OR PRINT IN BLACK INK)

You must complete a proof of service for each package of documents you serve. For example, if you serve the respondent and the other parent, you must complete two proofs of service; one for the respondent and one for the other parent.

Complete the top section of the proof of service forms as follows: First box, left side: In this box print the name, address, and phone number of the person for whom you are serving the documents. Second box, left side: Print the name of the county in which the legal action is filed and the court’s address in this box. Use the same address for the court that is on the documents you are serving. Third box, left side: Print the names of the petitioner/plaintiff, respondent/defendant, and other parent in this box. Use the same names listed on the documents you are serving. First box, top of form, right side: Leave this box blank for the court’s use. Second box, right side: Print the case number in this box. This number is also stated on the documents you are serving. Third box, right side: Print the hearing date, time, and department. Use the same information that is on the documents you are serving.

1. You are stating that you are over the age of 18 and that you are neither a party of this action nor a protected person listed in any of the orders.
2. Print the name of the party to whom you handed the documents.
3. List the name of each document that you delivered to the party.
4. a. Write in the date that you delivered the documents to the party. b. Write in the time of day that you delivered the documents to the party. c. Print the address where you delivered the documents.
5. Check the box that applies to you. If you are a private person serving the documents for a party, check box “a.”
6. Print your name, address, and telephone number. If applicable, include the county in which you are registered as a process server and your registration number.
7. You must check this box if you are not a California sheriff or marshal. You are stating under penalty of perjury that the information you have provided is true and correct.
8. Do not check this box unless you are a California sheriff or marshal.

Print your name, fill in the date, and sign the form.

If you need additional assistance with this form, contact the family law facilitator in your county.

FL-330-INFO [New January 1, 2012] INFORMATION SHEET FOR PROOF OF PERSONAL SERVICE Code of Civil Procedure, § 1011

FL-150 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY NAME:

ADDRESS:

TELEPHONE NO.:

E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): IN PRO PER SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS STREET ADDRESS: 1100 I Street MAILING ADDRESS: PO Box 1098 CITY AND ZIP CODE: Modesto, CA 95353-1098 BRANCH NAME: PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT/CLAIMANT: CASE NUMBER: INCOME AND EXPENSE DECLARATION

1. Employment (Give information on your current job or, if you're unemployed, your most recent job.) a. Employer:

Attach copies b. Employer's address: of your pay c. Employer's phone number: stubs for last d. Occupation: two months e. Date job started: (black out f. If unemployed, date job ended: social security g. I work about hours per week. numbers). h. I get paid $ gross (before taxes) per month per week per hour.

(If you have more than one job, attach an 8½-by-11-inch sheet of paper and list the same information as above for your other jobs. Write "Question 1—Other Jobs" at the top.) 2. Age and education a. My age is (specify): b. I have completed high school or the equivalent: Yes No If no, highest grade completed (specify): c. Number of years of college completed (specify): Degree(s) obtained (specify): d. Number of years of graduate school completed (specify): Degree(s) obtained (specify): e. I have: professional/occupational license(s) (specify): vocational training (specify): 3. Tax information a. I last filed taxes for tax year (specify year): b. My tax filing status is single head of household married, filing separately

married, filing jointly with (specify name):
c. I file state tax returns in California other (specify state):

d. I claim the following number of exemptions (including myself) on my taxes (specify):

4. Other party's income. I estimate the gross monthly income (before taxes) of the other party in this case at (specify): $ This estimate is based on (explain):

   (If you need more space to answer any questions on this form, attach an 8½-by-11-inch sheet of paper and write the question number before your answer.) Number of pages attached:

I declare under penalty of perjury under the laws of the State of California that the information contained on all pages of this form and any attachments is true and correct. Date:

(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)

Form Adopted for Mandatory Family Code, §§ 2030–2032, Use INCOME AND EXPENSE DECLARATION Judicial Council of California 2100–2113, 3552, 3620–3634, FL-150 [Rev. January 1, 2007] 4050–4076, 4300–4339

FL-150 PETITIONER/PLAINTIFF: CASE NUMBER: RESPONDENT/DEFENDANT: OTHER PARENT/CLAIMANT:

Attach copies of your pay stubs for the last two months and proof of any other income. Take a copy of your latest federal tax return to the court hearing. (Black out your social security number on the pay stub and tax return.)

5. Income (For average monthly, add up all the income you received in each category in the last 12 months Average and divide the total by 12.) Last month monthly a. Salary or wages (gross, before taxes) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

   b. Overtime (gross, before taxes) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

   c. Commissions or bonuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

   d. Public assistance (for example: TANF, SSI, GA/GR) currently receiving . . . . . . . . . . . . . $

   e. Spousal support from this marriage from a different marriage . . . . . . . . . . . . . . . . . . . $

   f. Partner support from this domestic partnership from a different domestic partnership $

   g. Pension/retirement fund payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

   h. Social security retirement (not SSI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ i. Disability: Social security (not SSI) State disability (SDI) Private insurance . . . . $ j. Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

   k. Workers' compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

   l. Other (military BAQ, royalty payments, etc.) (specify): . . . . . . . . . . . . . . . . . . . . . . . . .. .. .. .. .. .. .. .. .. .. .. .. .. . $

6. Investment income (Attach a schedule showing gross receipts less cash expenses for each piece of property.) a. Dividends/interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ b. Rental property income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ c. Trust income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ d. Other (specify): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

7. Income from self-employment, after business expenses for all businesses . . . . . . . . . . . . . . . $ I am the owner/sole proprietor business partner other (specify): Number of years in this business (specify): Name of business (specify): Type of business (specify):

   Attach a profit and loss statement for the last two years or a Schedule C from your last federal tax return. Black out your social security number. If you have more than one business, provide the information above for each of your businesses.

8. Additional income. I received one-time money (lottery winnings, inheritance, etc.) in the last 12 months (specify source and amount):

9. Change in income. My financial situation has changed significantly over the last 12 months because (specify):

10. Deductions Last month a. Required union dues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ b. Required retirement payments (not social security, FICA, 401(k), or IRA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ c. Medical, hospital, dental, and other health insurance premiums (total monthly amount) . . . . . . . . . . . . . . . . . . . . . . $ d. Child support that I pay for children from other relationships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ e. Spousal support that I pay by court order from a different marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ f. Partner support that I pay by court order from a different domestic partnership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ g. Necessary job-related expenses not reimbursed by my employer (attach explanation labeled "Question 10g") . . . $

11. Assets Total a. Cash and checking accounts, savings, credit union, money market, and other deposit accounts . . . . . . . . . . . . . . . $ b. Stocks, bonds, and other assets I could easily sell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $. c. All other property, real and personal (estimate fair market value minus the debts you owe) . . . . . . $

FL-150 [Rev. January 1, 2007] INCOME AND EXPENSE DECLARATION Page 2 of 4

FL-150 PETITIONER/PLAINTIFF: CASE NUMBER: RESPONDENT/DEFENDANT: OTHER PARENT/CLAIMANT: 12. The following people live with me:

How the person is That person's gross Pays some of the

Name Age related to me? (ex: son) monthly income household expenses?

a. Yes No
b. Yes No
c. Yes No
d. Yes No
e. Yes No

13. Average monthly expenses Estimated expenses Actual expenses Proposed needs a. Home: h. Laundry and cleaning . . . . . . . . . . . . . . $ (1) Rent or mortgage . . . . . . . $ i. Clothes . . . . . . . . . . . . . . . . . . . . . . . . . $ If mortgage: (a) average principal: $ j. Education . . . . . . . . . . . . . . . . . . . . . $ (b) average interest: $ k. Entertainment, gifts, and vacation . . . . . $ (2) Real property taxes . . . . . . . . . . . . . . . . $ l. Auto expenses and transportation (3) Homeowner's or renter's insurance (insurance, gas, repairs, bus, etc.) . . . . . $ (if not included above) . . . . . . . . . . . . . . $ m. Insurance (life, accident, etc.; do not include auto, home, or health insurance) $ (4) Maintenance and repair . . . . . . . . . . . . $ n. Savings and investments . . . . . . . . . . . . $ b. Health-care costs not paid by insurance . . . $ o. Charitable contributions. . . . . . . . . . . . . . $ p. Monthly payments listed in item 14 c. Child care . . . . . . . . . . . . . . . . . . . . . . . . . . . $ (itemize below in 14 and insert total here) $

    d. Groceries and household supplies . . . . . . . . $ q. Other (specify): . . . . . . . . . . . . . . . . . . . . . $ e. Eating out . . . . . . . . . . . . . . . . . . . . . . . . . . . $ r. TOTAL EXPENSES (a–q) (do not add in f. Utilities (gas, electric, water, trash) . . . . . . . $ the amounts in a(1)(a) and (b)) $ g. Telephone, cell phone, and e-mail . . . . . . . $ s. Amount of expenses paid by others $

14. Installment payments and debts not listed above

    Paid to For Amount Balance Date of last payment

    $ $

    $ $

    $ $
    $ $
    $ $
    $ $

15. Attorney fees (This is required if either party is requesting attorney fees.): a. To date, I have paid my attorney this amount for fees and costs (specify): $ b. The source of this money was (specify): c. I still owe the following fees and costs to my attorney (specify total owed): $ d. My attorney's hourly rate is (specify): $ I confirm this fee arrangement.

Date:

NAME: (TYPE OR PRINT NAME OF ATTORNEY) (SIGNATURE OF ATTORNEY)

FL-150 [Rev. January 1, 2007] INCOME AND EXPENSE DECLARATION Page 3 of 4

FL-150 PETITIONER/PLAINTIFF: CASE NUMBER: RESPONDENT/DEFENDANT: OTHER PARENT/CLAIMANT:

CHILD SUPPORT INFORMATION

(NOTE: Fill out this page only if your case involves child support.)

16. Number of children a. I have (specify number): children under the age of 18 with the other parent in this case. b. The children spend percent of their time with me and percent of their time with the other parent. (If you're not sure about percentage or it has not been agreed on, please describe your parenting schedule here.)

17. Children's health-care expenses a. I do I do not have health insurance available to me for the children through my job. b. Name of insurance company: c. Address of insurance company:

    d. The monthly cost for the children's health insurance is or would be (specify): $ (Do not include the amount your employer pays.)

18. Additional expenses for the children in this case Amount per month a. Child care so I can work or get job training . . . . . . . . . . . . . . . . . . . . . . . . . $ b. Children's health care not covered by insurance . . . . . . . . . . . . . . . . . . . . . $ c. Travel expenses for visitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ d. Children's educational or other special needs (specify below): . . . . . . . . . . $

19. Special hardships. I ask the court to consider the following special financial circumstances (attach documentation of any item listed here, including court orders): Amount per month For how many months?

    a. Extraordinary health expenses not included in 18b . . . . . . . . . . . . . . . . . . $

    b. Major losses not covered by insurance (examples: fire, theft, other insured loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ c. (1) Expenses for my minor children who are from other relationships and are living with me . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ (2) Names and ages of those children (specify): (3) Child support I receive for those children . . . . . . . . . . . . . . . . . . . . . . . $

    The expenses listed in a, b, and c create an extreme financial hardship because (explain):

20. Other information I want the court to know concerning support in my case (specify):

FL-150 [Rev. January 1, 2007] INCOME AND EXPENSE DECLARATION Page 4 of 4