San Bernardino — 13-19117-360

Source: https://sanbernardino.courts.ca.gov/system/files/13-19117-360stipulationforentryofjudgment.pdf

Stipulation for Entry of Judgment Re: Establishment of Parentage

Use Black Ink!

SUPERIOR COURT OF CALIFORNIA COUNTY OF SAN BERNARDINO

Fill out each section in black ink, initial the bottom of each page, and sign & date the last page.

Section 1: Fill-in the names of each party and mark the boxes to indicate who is the mother and who is the father of the child(ren). Fill-in the name and birthdate of each child.

Section 2: Mark the boxes and fill-in the details about your agreement regarding custody and visitation. You may fill out and attach form FL-341(C) if your agreement includes a specific schedule for holidays.

Section 3: Fill-in details regarding your agreement for child support, arrears, and child care costs. You may reserve jurisdiction for one of the reasons provided. (Reserving jurisdiction means that you do not want the Court to order child support payments right now. You may apply for it later.)

Section 4: Read the statements and mark the boxes that you agree with. You may write any additional orders you want included as part of your judgment.

Next Step—Creation of Complete Judgment Package For your judgment, you will need to have additional forms attached to your agreement before filing it with the clerk’s office for submission to the judge for signature. The Resource Center can fill out the additional forms that are needed for your judgment.

I f you wish the Resource Center staff to prepare the judg ment package for you , then both parties need to take this paperwork to the Resource Center.

PROTECT YOUR PRIVACY --- The party filing a document is responsible for excluding or redacting (removing) personal identifying information such as social security and financial account numbers from documents filed with the court. When filing a document with the court, use only the last four digits of the social security and financial account numbers.

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Petitioner: Case Number:

Respondent:

STIPULATION FOR ENTRY OF JUDGMENT

THE PARTIES STIPULATE THAT

1. The parties have read and understand the Advisement and Waiver of Rights Re: Establishment of Parental Relationship (form FL-235), which is submitted with this Stipulation for Entry of Judgment. The parties give up those rights and freely agree that a judgment may be entered in accordance with this stipulation. Name: Mother Father Name: Mother Father are the parents of the following children:

   Child’s Name: Date of Birth:

   Check here if there are additional children.

2. CHILD CUSTODY AND VISITATION (“Parenting Time”)

CUSTODY SHALL BE AWARDED AS FOLLOWS: Custody of the minor child/ren shall

be ordered as follows, and such arrangements are in the best interests of the minor child/ren:

LEGAL CUSTODY:

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

JOINT LEGAL CUSTODY of the minor child/ren shall be awarded to both parties.

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

PHYSICAL CUSTODY: SOLE PHYSICAL CUSTODY of the minor child/ren 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)

Form No. 13-19117-360 rev. 040418 Page - 1 of 5
Stipulation for Entry of Judgment Re:
Establishment of Parental Relationship

Petitioner Initials: Respondent Initials:

Petitioner: Case Number:

Respondent:

VISITATION (“Parenting Time”) AS FOLLOWS: PRIMARY PHYSICAL CUSTODY to , with the right of REASONABLE visitation to as follows:

OR
As contained in the attached Family Court Services report, consisting of
pages (Mediation date: / / ).

OR
SPECIFIC VISITATION to as follows:

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

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 child/ren is the United States unless marked

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

Page - 2 of 5

Petitioner Initials: Form No. 13-19117-360 rev. 040418 Respondent Initials: Stipulation for Entry of Judgment Re: Establishment of Parental Relationship

Petitioner: Case Number:

Respondent:

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) prior to hours of visitation or during the
visitation with the minor children.

Transportation for visitation shall be as follows:

Transport TO visit provided by .

Transport FROM visit provided by .

Drop Off & Pickup will be at .

Other:

3. CHILD SUPPORT

   _____ Petitioner _ ____ Respondent shall pay to the other party as and for child support the sum of $ per month, commencing and continuing until each child dies, marries, becomes emancipated, reaches the age of 18 or reaches the age of 19 and is a full-time high school student, or until further order of the Court, whichever first occurs, Payable one-half on the and one-half on the day of each month Payable once a month on the of each month

The allocation of support per child is as stated in the attached Child Support Calculation.

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

Page - 3 - of Form No. 13-19117-360 rev. 040418
Stipulation for Entry of Judgment Re: 11
Establishment Parental Relationship

Petitioner Initials: Respondent Initials:

Petitioner: Case Number:

Respondent:

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 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

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 % Respondent

$ Petitioner $ Respondent

NO CHILD SUPPORT ORDER because child support has been previously established in

another case. Case Number:

RESERVED. The court’s jurisdiction to award child support is reserved for the following

reason:

Petitioner and Respondent have equal time with the children and equal income.

Supporting party has no income at this time.

Other: .

Form No. 13-19117-360 rev. 040418 Page - 4 of 5
Stipulation for Entry of Judgment Re:
Establishment Parental Relationship

Petitioner Initials: Respondent Initials:

Petitioner: Case Number:

Respondent:

4. OTHER ORDERS

   Change the last names of the children as follows: from to from to from to from to

   The birth certificates must be amended to conform to this court order by (1) adding the father's name. (2) changing the last name of the children.

Each of the parties shall pay his/her own fees, expenses of litigation and court costs, excepting those previously ordered.

Both parties waive Statement of Decision and any right to appeal.

Restraining orders have already been issued in this case and a copy of the personal conduct

restraining order is attached to this Judgment.

Additional orders

NOTICE AND OPPORTUNITY TO BE HEARD The responding party was given notice and an opportunity to be heard as provided by the laws of the State of California. PENALTIES FOR VIOLATION OF ORDERS If either party violates orders contained herein, party may be subject to civil or criminal penalties, or both.

The foregoing is agreed to by:

x x Petitioner Date Respondent Date

IT IS SO ORDERED:

Dated: JUDGE OF THE SUPERIOR COURT

Page - 5 of 5

Form No. 13-19117-360 rev. 040418 Stipulation For Entry of Judgment Re:

Petitioner Initials: Establishment of Parental Relationship Respondent Initials:

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