Page 199 — Imperial — Local Rules July 2026

SHORT TITLE: CASE NUMBER:

Change in income or ability to earn of the other parent: Since the last order for child support was made, the other parent: a. has become employed, earning $ ____________ per hour, working , hours per week. b. has received an increase in earnings and now earns $, per month. c. now has the ability to obtain employment and earn at least $___, per month. Attached please find possible job openings for which the other parent is qualified to apply.
Recent release from incarceration and decrease in earnings and/or current unemployment: I was incarcerated from: ___________ to . I am currently unemployed as a result of my incarceration and am actively looking for work. A list of my job contacts is attached or will be provided at the hearing. I have no current income. I ask the court to reduce my child support to zero until I find a job. I am in a recovery program called: _________________________________________________ and have been there since . The program requires______________. I am not allowed to work for the first _____ weeks/months. Thereafter, I can work as follows: _______________________________________. I have attached verification of my enrollment and participation in this program. I ask the court to reduce my child support to zero until I find a job.
Change in child custody and/or timeshare with children in this case: a. I now have primary custody substantial increased timeshare with the children in this case. The children are now with me as follows: . b. My child, ____________________________________, is emancipated because of turning 18 and not in high school turning 19 getting married joining the military by judicial decree. I request support for that child be terminated.

. b. My child, ____________________________________, is emancipated because of turning 18 and not in high school turning 19 getting married joining the military by judicial decree. I request support for that child be terminated.

Financial hardship: Since the last order was made, I have sustained the following financial hardship(s): a. Statutory Hardship: 1. Expenses of natural or adopted children in the home (Family Code §4071(a)(2)). I provide support for the following or adopted minor children who reside in my home: ___________________________________________________________________________. Attached please find their birth certificates. 2. Extraordinary health expenses and uninsured catastrophic losses (Family Code § 4071(a)(1)): ___________________________________________________________________________. b. Low income adjustment: I request the court order a low income adjustment in this case because I net less than $1000 per month, taking into consideration all allowable deductions and hardships. c. Court discretion: I request the court use its discretion and deviate from the guideline amount because application of the guideline formula would be unjust or inappropriate due to the special circumstances in my case. The facts supporting the special circumstances in my case are: __________________________________________________________________________________.
Other change of circumstance: ______________________________________________________________

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

Print Name Signature of Declarant

FL-23 (Adopted 01/01/13) DECLARATION IN SUPPORT OF CHILD SUPPORT MODIFICATION Page 2 of 2