Stanislaus — Download

Source: https://www.stanislaus.courts.ca.gov/system/files/forms-and-filings/jd-def.pdf

www.stanislaus.courts.ca.gov (209) 530-3100 Street Address: 1100 I Street Modesto, CA 95353 Mailing Address: P.O. Box 1098 Modesto, CA 95353 Self Help Center: 800 11th Street Room #220 Modesto, CA 95353 (PROVIDING ASSISTANCE TO PARTIES REPRESENTING THEMSELVES)

Request to Enter Default and Judgment Packet

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

This packet includes some of the necessary forms to file a Request to Enter Default and Judgment. The Supplemental Declaration and Judgment included in this packet do not include the necessary attachments. Every case is different and will require attachments specific to your case. For example, not everyone has minor children of the marriage. These additional forms are available at the Self Help Center or can be downloaded them from the courts website (www.stanislaus.courts.ca.gov). Judicial Council forms, local forms, and information are available in the Clerk’s Office, the Stanislaus County Law Library located at 1101 13th Street, Modesto, CA and on the following websites:

REQUIRED FORMS:

• FL-165 - Request to Enter Default • FL-170 - Declaration for Default or Uncontested Dissolution or Legal Separation • FL-019 – Supplemental Declaration to FL-170 (ATTACHMENTS NOT INCLUDED) TheattachmentsareavailableattheSelfHelpCenterorcanbedownloadedfromthecourtswebsite www.stanislaus.courts.ca.gov • FL-160 – Property Declaration (ONLYREQUIREDifyouhaveassetsordebtstobedivided) • FL-180 – Judgment (ATTACHMENTS NOT INCLUDED) TheattachmentsareavailableattheSelfHelpCenterorcanbedownloadedfromthecourtswebsite. • FL-192 -Notice of Rights and Responsibilities (ONLYREQUIREDthereareminorchildrenofthemarriage) • FL-190 - Notice of Entry of Judgment • FL-191 - Child Support Case Registry Form (ONLYREQUIREDthereareminorchildrenofthemarriage) • Notice to Department of Child Support Services of Intent to File Judgment (ONLYREQUIREDifthe Dept.ofChildSupportServicesis/wasenforcingchildsupport)

Revised 05/2023

STEP 1. PREPARE THE REQUEST FOR DEFAULT FORM (FL-165)

• A Request for Default ends the other spouse’s chance to file a response in the proceedings.
This means that you can get a Judgment based on a signed settlement agreement or, if
there is no agreement, based on what you requested in the Petition.
If you have reached a settlement agreement you will also need:
• A signed & NOTARIZED Marital Settlement Agreement
• Declaration Waiving Disclosures (Form FL-144)
(TheseadditionalformsareavailableattheSelfHelpCenterorcanbedownloadedfromthecourts
website(www.stanct.org).
• Take the original and 2 copies to the Clerk’s Office, along with 2 self-addressed, postage
paid envelopes; 1 envelope addressed to you and 1 envelope addressed to the other party.
• Once the Default has been entered a copy of the Default will be mailed to you and the
other party containing the date the Default was entered. (See bottom of form entitled “For
Court Use Only.”)

STEP 2. PREPARE THE FOLLOWING FORMS:

• DECLARATION FOR DEFAULT OR UNCONTESTED MATTER • SUPPLEMENTAL DECLARATION (Local Form FL-019) • JUDGMENT The orders set forth in the Judgment must match the orders requested in the Petition and the Supplemental Declaration. If you have existing court orders, copies of those orders have be attached to your judgment. Attach form FL-192 NOTICE OF RIGHTS AND RESPONSIBLITIES to the Judgment. (REQUIREDONLYIFTHEREAREMINORCHILDRENOFTHEMARRIAGE) • NOTICE OF ENTRY OF JUDGMENT • CHILD SUPPORT CASE REGISTRY FORM (REQUIREDONLYIFTHEREAREMINORCHILDRENOFTHEMARRIAGE)

Once completed, take the original and 2 copies to the Clerk’s Office, along with 2 self-addressed, postage paid envelopes; 1 envelope addressed to you and 1 envelope addressed to the other party. Please use large envelopes if your judgment has more than 6 pages.

IMPORTANT NOTICE IF FILING FEES WERE WAIVED:

It is the responsibility of the parties to pay any outstanding filing fees that have been waived WITHIN 60 DAYS after the entry of judgment pursuant to Government Code Section 68511.3.

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.

FL-165

PARTY WITHOUT ATTORNEY OR ATTORNEY STATE BAR NUMBER: FOR COURT USE ONLY

NAME:

FIRM NAME:

STREET ADDRESS:

CITY: STATE: ZIP CODE:

TELEPHONE NO.: FAX NO.:

EMAIL 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:

REQUEST TO ENTER DEFAULT CASE NUMBER:

1. To the clerk: Please enter the default of the respondent who has failed to respond to the petition.

2. A completed Income and Expense Declaration (form FL-150) or Financial Statement (Simplified) (form FL-155) is attached is not attached.

A completed Property Declaration (form FL-160) is attached is not attached because (check at least one of the following): (a) there have been no changes since the previous filing. (b) the issues subject to disposition by the court in this proceeding are the subject of a written agreement. (c) there are no issues of child, spousal, or partner support or attorney fees and costs subject to determination by the court. (d) the petition does not request money, property, costs, or attorney fees. (Family Code section 2330.5.) (e) there are no issues of division of community property. (f) this is an action to establish parental relationship.

Date:

(TYPE OR PRINT NAME) (SIGNATURE OF [ATTORNEY FOR] PETITIONER)

3. Declaration (a) No mailing is required because service was by publication or posting and the address of the respondent remains unknown. (b) A copy of this Request to Enter Default, including any attachments and an envelope with sufficient postage, was provided to the court clerk, with the envelope addressed as follows (address of the respondent’s attorney or, if none, the respondent’s last known address):

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 DECLARANT)

FOR COURT USE ONLY
Request to Enter Default mailed to the respondent or the respondent’s attorney on (date):
Default entered as requested on (date):
Default not entered. Reason:

Clerk, by , Deputy

Form Adopted for Mandatory Use REQUEST TO ENTER DEFAULT Code of Civil Procedure, §§ 585, 587; Judicial Council of California Family Code, § 2335.5 FL-165 [Rev. January 1, 2023] (Family Law—Uniform Parentage) www.courts.ca.gov

CASE NUMBER: PETITIONER:

RESPONDENT:

4. Memorandum of costs a. Costs and disbursements are waived.

   b. Costs and disbursements are listed as follows:

   (1) Clerk's fees ........................................................................................................................................................... $..............................................................

   (2) Process server's fees .................................................................................................................................... $..............................................................

   (3) Other (specify): ................................................................................................................................................... $..............................................................

   ..................................................................................................................................................................................................... $..............................................................

   ..................................................................................................................................................................................................... $..............................................................

   ..................................................................................................................................................................................................... $

   TOTAL ........................................................................................................................................................................................... $..............................................................

   c. I am the attorney, agent, or party who claims these costs. To the best of my knowledge and belief, the foregoing items of cost are correct and have been necessarily incurred in this cause or proceeding.

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 DECLARANT)

5. Declaration of nonmilitary status (required for a judgment). The respondent is not in the military service of the United States as defined by either the Servicemembers Civil Relief Act (see 50 U.S.C. § 3911(2)) or California Military and Veterans Code sections 400 and 402(f).

know that the respondent is not in the U.S. military service because (check all that apply):

(a) the search results that I received from https://scra.dmdc.osd.mil/ say the respondent is not in the U.S. military service. (b) I am in regular communication with the respondent and know that they are not in the U.S. military service. (c) I recently contacted the respondent, and they told me that they are not in the U.S. military service. (d) I know that the respondent was discharged from U.S. military service on or about (date): . (e) the respondent is not eligible to serve in the U.S. military because they are incarcerated (in jail or prison). (f) other (specify):

.

Note

U.S. military status can be checked online at https://scra.dmdc.osd.mil/. If the respondent is in the military service, or their military status is unknown, the respondent is entitled to certain rights and protections under federal and state law before a default judgment can be entered. For more information, see https://selfhelp.courts.ca.gov/military-defaults.

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 DECLARANT)

FL-165 [Rev. January 1, 2023] REQUEST TO ENTER DEFAULT Page 2 of 2 (Family Law—Uniform Parentage)

FL-170

PARTY WITHOUT ATTORNEY OR ATTORNEY STATE BAR NUMBER: 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:

DECLARATION FOR DEFAULT OR UNCONTESTED CASE NUMBER:
DISSOLUTION LEGAL SEPARATION

(NOTE: Items 1 through 12 apply to both dissolution and legal separation proceedings.)

1. I declare that if I appeared in court and were sworn, I would testify to the truth of the facts in this declaration.
2. I agree that my case will be proven by this declaration and that I will not appear before the court unless I am ordered by the court to do so.
3. All the information in the amended Petition Response is true and correct.
4. Type of case (check a, b, or c): a. Default without agreement (1) No response has been filed and there is no written agreement or stipulated judgment between the parties; (2) The default of the respondent was entered or is being requested, and I am not seeking any relief not requested in the petition; and (3) The following statement is true (check one): (A) There are no assets or debts to be disposed of by the court. (B) The community and quasi-community assets and debts are listed on the completed current Property Declaration (form FL-160), which includes an estimate of the value of the assets and debts that I propose to be distributed to each party. The division in the proposed Judgment (form FL-180) is a fair and equal division of the property and debts, or if there is a negative estate, the debts are assigned fairly and equitably. b. Default with agreement (1) No response has been filed and the parties have agreed that the matter may proceed as a default matter without notice; and (2) The parties have entered into a written agreement regarding their property and their marriage or domestic partnership rights, including support, the original of which is being or has been submitted to the court. I request that the court approve the agreement. c. Uncontested (1) Both parties have appeared in the case; and (2) The parties have entered into a written agreement regarding their property and their marriage or domestic partnership rights, including support, the original of which is being or has been submitted to the court. I request that the court approve the agreement.
5. Declaration of disclosure (check a, b, c, or d): a. Both the parties have filed, or are filing concurrently, a Declaration Regarding Service of Declaration of Disclosure (form FL-141) and an Income and Expense Declaration (form FL-150). b. This matter is proceeding by default. I am the petitioner in this action and have filed a proof of service of the preliminary Declaration of Disclosure (form FL-140) with the court. I hereby waive receipt of the final Declaration of Disclosure (form FL-140) from the respondent. c. This matter is proceeding by default. I am the petitioner in this action, and service of the summons on respondent was done by publication or posting under court order. Service of the preliminary Declaration of Disclosure (form FL-140) is not required. I hereby waive receipt of the final Declaration of Disclosure (form FL-140) from the respondent.

Form Approved for Mandatory Use DECLARATION FOR DEFAULT OR UNCONTESTED Family Code, § 2336 Judicial Council of California www.courts.ca.gov FL-170 [Rev. January 17, 2020] DISSOLUTION OR LEGAL SEPARATION (Family Law)

FL-170 PETITIONER: CASE NUMBER:

RESPONDENT:

d. This matter is proceeding as an uncontested action. Service of the final Declaration of Disclosure (form FL-140) is
mutually waived by both parties. A waiver provision executed by both parties under penalty of perjury is contained on the
Stipulation and Waiver of Final Declaration of Disclosure (form FL-144), in the settlement agreement or proposed
judgment, or in another, separate stipulation.

6. Child custody and visitation (parenting time) should be ordered as set forth in the proposed Judgment (form FL-180).

   a. The information in Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) (form FL-105) has has not changed since it was last filed with the court. (If changed, attach updated form.) b. There is an existing court order for custody/parenting time in another case in (county): The case number is (specify): c. The current custody and visitation (parenting time) previously ordered in this case, or the current schedule is (specify):

   Contained on Attachment 6c.

   d. The facts that support the requested judgment are (In a default case, state your reasons below):

   Contained on Attachment 6d.

7. Child support should be ordered as set forth in the proposed Judgment (form FL-180).

   a. If there are minor children, check and complete item (1) if applicable and item (2) or (3): (1) Child support is being enforced in another case in (county): The case number is (specify): (2) The information in the child support calculation attached to the proposed judgment is correct based on my personal knowledge. (3) I request that this order be based on the Petitioner's Respondent’s earning ability. The facts in support of my estimate of earning ability are (specify): Continued on Attachment 7a(3). b. Complete items (1) and (2) regarding public assistance. (1) I am receiving am not receiving intend to apply for public assistance for the child or children listed in the proposed order. (2) To the best of my knowledge, the other party is is not receiving public assistance. Petitioner Respondent is presently receiving public assistance, and all support should be made payable to the local child support agency at the address set forth in the proposed judgment. A representative of the local child support agency has signed the proposed judgment.

8. Spousal, Partner, and Family Support (If a support order or attorney fees are requested, submit a completed Income and Expense Declaration (form FL-150) unless a current form is on file. Include your best estimate of the other party’s income. Check at least one of the following.) a. I knowingly give up forever any right to receive spousal or partner support. b. I ask the court to reserve jurisdiction to award spousal or partner support in the future to: Petitioner Respondent c. I ask the court to terminate forever spousal or partner support for: Petitioner Respondent d. Spousal support or domestic partner support should be ordered as set forth in the proposed Judgment (form FL-180) based on the factors described in: Spousal or Partner Support Declaration Attachment (form FL-157) written agreement attached declaration (Attachment 8d) e. Family support should be ordered as set forth in the proposed Judgment (form FL-180). f. Other (specify):

FL-170 [Rev. January 17, 2020] DECLARATION FOR DEFAULT OR UNCONTESTED Page 2 of 3 DISSOLUTION OR LEGAL SEPARATION (Family Law)

FL-170 PETITIONER: CASE NUMBER:

RESPONDENT:

9. Parentage of the children of the petitioner and respondent born prior to their marriage or domestic partnership should be ordered as set forth in the proposed Judgment (form FL-180).

   a. A voluntary declaration of parentage or paternity is attached. b. Parentage was previously established by the court in (county): The case number is (specify): The written agreement of the parties regarding parentage is attached here (Attachment 9b) or to the proposed Judgment (form FL-180).

10. Attorney fees should be ordered as set forth in the proposed Judgment (form FL-180). The facts in support of this request are on Request for Attorney's Fees and Costs Attachment (form FL-319). Other (specify facts below):

11. The judgment should be entered nunc pro tunc for the following reasons (specify):

12. Petitioner Respondent requests restoration of the former name as set forth in the proposed Judgment (form FL-180)

    (proceedings for dissolution or nullity of marriage only).

13. Irreconcilable differences have led to the irremediable breakdown of the marriage or domestic partnership, and there is no possibility of saving the marriage or domestic partnership through counseling or other means.

14. This declaration may be reviewed by a commissioner sitting as a temporary judge, who may determine whether to grant this request or require my appearance under Family Code section 2336.

    STATEMENTS IN THIS BOX APPLY ONLY TO DISSOLUTIONS

15. If this is a dissolution of a marriage or domestic partnership created in another state, the petitioner or the respondent has

been a resident of this county for at least three months and of the state of California for at least six months continuously and immediately preceding the date of the filing of the petition for dissolution of marriage or domestic partnership.

16. I ask that the court grant the request for a judgment of dissolution of marriage or domestic partnership based on irreconcilable

differences and that the court make the orders set forth in the proposed Judgment (form FL-180) submitted with this declaration.

17. Status only judgment: This declaration is only for the termination of marital or domestic partner status. I ask the court to reserve jurisdiction over all other issues not requested in this declaration for later determination.

    THIS STATEMENT APPLIES ONLY TO LEGAL SEPARATIONS

18. I ask that the court grant the request of a judgment for legal separation based on irreconcilable differences and that the court

make the orders set forth in the proposed Judgment (form FL-180) submitted with this declaration.

I understand that a judgment of legal separation does not terminate a marriage or domestic partnership, and that I am

still married or a partner in a domestic partnership.

19. Other (specify):

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 DECLARANT)

FL-170 [Rev. January 17, 2020] DECLARATION FOR DEFAULT OR UNCONTESTED Page 3 of 3 DISSOLUTION OR LEGAL SEPARATION (Family Law)

Petitioner: Case Number

Respondent:

1 Attachment 19 to Declaration for Default or Uncontested Dissolution or Legal Separation (Form FL-170) 2 1. STATUS OF CASE 3 a. The parties were married on __________________ and separated on __________________. 4 b. This is a marriage of ________ year(s) and _______ month(s). 5 c. Respondent was served with a Summons and Petition on _____________________. 6 d. Respondent has not filed a Response and default has been submitted or entered. 7 e. There is/are ______ minor child(ren) of this marriage. 8 2. NAME CHANGE (Only if you checked Item 7(1) of the Petition for Dissolution) 9 The Petitioner requests his/her former name be restored to 10 ________________________________. 11 3. CHILD PATERNITY (Select if your child was born prior to the date marriage AND checked Item 3(d), 7(d) or 12 both in the Petition for Dissolution) Petitioner requests that the Court find the minor child(ren), listed below and named on the13 Petition, was/were born to the parties prior to their marriage and request that judgment of 14 parentage be entered herein. 15 Child’s Name(s) Date of Birth _________________________________________ ___________ 16 _________________________________________ ___________ 17 4. CHILD CUSTODY AND VISITATION (Select all that apply) 18 Petitioner requests that the custody and visitation ordered on _____________ shall remain in 19 full force and effect.

20 The Petitioner requests that the Court order: 21 Petitioner Respondent shall have SOLE LEGAL JOINT LEGAL and Petitioner Respondent shall have SOLE PHYSICAL SHARED PHYSICAL 22 CUSTODY of the minor child(ren), namely: 23 Child’s Name(s) Date of Birth _________________________________________ ___________24 _________________________________________ ___________ 25

Attachment 19 to Declaration for Default or Uncontested
Dissolution or Legal Separation (Form FL-170)
Local Form FL-019 Rev. 6/2012 Page ___ of ___
Optional

Petitioner: Case Number

Respondent:

11 Petitioner Respondent be designated primary caretaker. (Not applicable if you requested sole physical custody above) 22 Petitioner Respondent to have reasonable rights of visitation as the parties can agree. 33 Petitioner Respondent to have no visitation rights for the following reasons: 44 ___________________________________________________________________________ 55 ___________________________________________________________________________ 66 5. CHILD SUPPORT (Select one) 77 Petitioner requests that the child support ordered on _____________ shall remain in full force and effect. 88 Petitioner requests that the Court order child support as set forth in the attachment. 99 6. SPOUSAL SUPPORT (Only if you checked Item 7(f), 7(g) or both in the Petition for Dissolution)1010 1111 Petitioner requests that the Court find that Petitioner has WAIVED spousal support and that Respondent has not requested spousal support. Accordingly, spousal support is denied to 1212 both parties and the Courts jurisdiction to award spousal support is terminated.

1313 Petitioner requests that the Court find the issue of spousal support as to both parties is RESERVED effective forthwith upon entry of Judgment. 1414 Petitioner requests that the Court order permanent spousal support based on the facts set 1515 forth in the attached Spousal Support Questionnaire, pursuant to Family Code Section 4320.

1616 7. PROPERTY DIVISION (Only if you checked Item 4, 5(a or b) or 7(h) of the Petition for Dissolution) 1717 Petitioner requests that the Court find that there are no community assets and or debts to divide.1818 Petitioner requests that the Court order the community assets and debts to be divided as set 1919 forth in the attached COMMUNITY PROPERTY DECLARATION (FL-160). 2020 Petitioner requests that the Court confirm the separate property assets and/or debts as set forth in the attached SEPARATE PROPERTYATTACHMENT. 2121 8. OTHER ORDERS (Optional) 2222 Petitioner requests that the Court make other orders as set forth on OTHER ORDERS attachment. 2323 I declare under penalty of perjury under the laws of the State of California that the above stated facts are 2424 true and correct. Dated: ____________________________________________(Sign) 2525 __________________________________(Print name), Petitioner

Attachment 19 to Declaration for Default or Uncontested
Dissolution or Legal Separation (Form FL-170)
Local Form FL-019 Rev. 6/2012 Page ___ of ___
Optional

Petitioner: Case Number

Respondent:

1 CHILD SUPPORT (Use this attachment if the Department of Child Support Services is NOT involved 2 in your case AND no prior court order has been entered. SELECT ONLY ONE.) 3 The Petitioner requests that the Court order Petitioner Respondent to pay the sum of 4 $_________________ per month for child support to Petitioner Respondent, payable on the first day of each month commencing __________________. A computer calculation printout is attached 5 as Exhibit A. 6 Petitioner requests that the obligation to pay child support shall continue until further order of the Court, or until the child(ren) marries, dies, is emancipated, or reaches age 18. The duty of support continues as to 7 an unmarried child(ren) who has attained the age of 18 years, if a full-time high school student, and resides with a parent, until the time the child completes the 12th grade or attained the age of 19 years, 8 whichever first occurs. 9 10 Petitioner requests that the Court order that child support is RESERVED effective forthwith upon entry of Judgment. The request is being made without coercion or duress and in the best interest of the 11 children involved as their needs will be adequately met. The right to support has not been assigned to the County pursuant to Section 11477 of the Welfare and Institutions Code and no public assistance 12 application is pending. A computer calculation printout is attached as Exhibit A.

13 Petitioner requests that the obligation to pay child support shall continue until further order of the Court, or until the child(ren) marries, dies, is emancipated, or reaches age 18. The duty of support continues as to 14 an unmarried child(ren) who has attained the age of 18 years, if a full-time high school student, and resides with a parent, until the time the child completes the 12th grade or attained the age of 19 years, 15 whichever first occurs. 16

17 18

19

20 21

22

23 24

25

Attachment 19 to Declaration for Default or Uncontested
Dissolution or Legal Separation (Form FL-170)
Local Form FL-019 Rev. 6/2012 Page ___ of ___
Optional

Petitioner: Case Number

Respondent:

CHILD SUPPORT

11 (Use this attachment ONLY if the Department of Child Support Services has established a support order) 22 Petitioner requests that the Court find the matter of child support is currently assigned to the County of Stanislaus. This case is currently enforced by the Department of Child Support Services under the 33 jurisdiction of Superior Court case #________________, entitled __________________________________ vs. ________________________, in the 44 amount of $ per month. 55 Petitioner requests that the Court finds that sufficient notice has been given and payment shall be made to the Department of Child Support Services. Only payments made to the Department of Child 66 Support Services shall be considered as payments towards the above obligation. 77 Petitioner requests that Respondent shall apply for, obtain, and maintain health insurance coverage of the 88 minor if it is available at no or reasonable costs, and notify the Department of Child Support Services or the local child support agency within 30 days of obtaining such insurance coverage. A health insurance 99 coverage assignment shall issue as provided by law.

1010 Petitioner requests that Petitioner and Respondent are ordered to notify the Department of Child Support Services of any change of address, employment, or employment status within 10 days of such change. 1111 Petitioner requests that the obligation to pay child support shall continue until further order of the Court, or 1212 until the child(ren) marries, dies, is emancipated, or reaches age 18. The duty of support continues as to an unmarried child(ren) who has attained the age of 18 years, if a full-time high school student, and 1313 resides with a parent, until the time the child completes the 12th grade or attained the age of 19 years, whichever first occurs. 1414 1515

1616

1717 1818

1919

2020 2121

2222

2323 2424

2525

Attachment 19 to Declaration for Default or Uncontested
Dissolution or Legal Separation (Form FL-170)
Local Form FL-019 Rev. 6/2012 Page ___ of ___
Optional

Petitioner: Case Number

Respondent:

CHILD SUPPORT

11 (Use this attachment ONLY if you are receiving public assistance and the Department of Child Support Services has not yet established a support order) 22 Petitioner requests that the Court find the matter of child support is currently assigned to the County 33 of Stanislaus. This case is pending enforcement by the Department of Child Support Services. A Superior Court case WILL BE DETERMINED in the monthly amount TO BE DETERMINED. 44 Petitioner requests that the Court finds that sufficient notice has been given and payment shall be made 55 to the Department of Child Support Services. Only payments made to the Department of Child Support Services shall be considered as payments towards the above obligation. 66 Petitioner requests that Respondent shall apply for, obtain, and maintain health insurance coverage of the 77 minor if it is available at no or reasonable costs, and notify the Department of Child Support Services or the local child support agency within 30 days of obtaining such insurance coverage. A health insurance 88 coverage assignment shall issue as provided by law. 99 Petitioner requests that Petitioner and Respondent are ordered to notify the Department of Child Support Services or the local child support agency of any change of address, employment, or employment status 1010 within 10 days of such change. 1111 Petitioner requests that the obligation to pay child support shall continue until further order of the Court, or until the child(ren) marries, dies, is emancipated, or reaches age 18. The duty of support continues as to1212 an unmarried child(ren) who has attained the age of 18 years, if a full-time high school student, and resides with a parent, until the time the child completes the 12th grade or attained the age of 19 years,1313 whichever first occurs. 1414 1515

1616

1717 1818

1919

2020 2121

2222

2323 2424

2525

Attachment 19 to Declaration for Default or Uncontested
Dissolution or Legal Separation (Form FL-170)
Local Form FL-019 Rev. 6/2012 Page ___ of ___
Optional

Petitioner: Case Number

Respondent:

SPOUSAL SUPPORT QUESTIONNAIRE

11 (Complete if requesting a permanent spousal support order)

22 The Petitioner requests spousal support commencing (date) ________________, in the amount TO BE DETERMINED by court based upon the following facts: 33 EARNING CAPACITY/MARITAL STANDARD OF LIVING: 44 Marketable skills: 55 I have the following job skills: ____________________________________________________________________________________ 66 ____________________________________________________________________________________ 77 ____________________________________________________________________________________ 88 Job market for those skills: 99 I am currently employed with (employer’s name) __________________________________________ 1010 _______________________________________ and have been since (date) __. My position there is as a (position title) ________________________________ earning $ per 1111 hour/week/month. 1212 I am currently unemployed. I am making the following attempts to seek employment: 1313 ____________________________________________________________________________________ ____________________________________________________________________________________ 1414 ____________________________________________________________________________________ 1515 I have been unable to find employment that utilizes my marketable job skills for the following reasons: 1616 (Describe the possible need for retraining or education to get more marketable skills or employment, the time and expense to get education/training to develop skills, and if your earning ability was impaired by periods of unemployment during the marriage 1717 devoted to domestic duties.) ____________________________________________________________________________________ 1818 ____________________________________________________________________________________ ____________________________________________________________________________________ 1919

2020 CONTRIBUTIONS TO SUPPORTING SPOUSE: 2121 During the marriage I contributed to the education, training, career, or license of my spouse or partner as follows: 2222 ____________________________________________________________________________________ ____________________________________________________________________________________ 2323 ____________________________________________________________________________________ 2424 /// 2525 ///

Attachment 19 to Declaration for Default or Uncontested
Dissolution or Legal Separation (Form FL-170)
Local Form FL-019 Rev. 6/2012 Page ___ of ___
Optional

Petitioner: Case Number

Respondent:

ABILITY TO PAY/EARNING CAPACITY:

11 The other party has the ability to pay spousal support because: (Describe current employment and earning 22 capacity, all other sources of income other than employment and their current standard of living.) ____________________________________________________________________________________ 33 ____________________________________________________________________________________ 44 ____________________________________________________________________________________ 55 NEEDS OF EACH PARTY/MARITAL STANDARD OF LIVING: 66 During the marriage I was able to do the following which I am currently unable to do without an order for spousal support: (Describe whether you were able to buy property, vehicles or other assets; if you took vacations, had club 77 memberships, etc.; and, if you were able to build a savings or incurred debt.) ____________________________________________________________________________________ 88 ____________________________________________________________________________________ 99 ____________________________________________________________________________________ 1010 OBLIGATIONS AND ASSETS: 1111 I currently have the following assets and obligations: 1212 ____________________________________________________________________________________ ____________________________________________________________________________________ 1313 ____________________________________________________________________________________ 1414 The other party has the following assets and obligations: 1515 ____________________________________________________________________________________ ____________________________________________________________________________________ 1616 ____________________________________________________________________________________ 1717 DURATION OF MARRIAGE: 1818 We were married on _________________, and separated on ___________________, which is _______ 1919 year(s) and _______ month(s) of marriage. 2020 GAINFUL EMPLOYMENT/INTERESTS OF CHILDREN: 2121 My ability to work will will not unduly interfere with the interests of the dependent children in my custody because:2222 ____________________________________________________________________________________ 2323 ____________________________________________________________________________________ ____________________________________________________________________________________ 2424

2525

Attachment 19 to Declaration for Default or Uncontested
Dissolution or Legal Separation (Form FL-170)
Local Form FL-019 Rev. 6/2012 Page ___ of ___
Optional

Petitioner: Case Number

Respondent:

AGE AND HEALTH:

11 I am _________ years old and my health is as follows: 22 ____________________________________________________________________________________ ____________________________________________________________________________________ 33 ____________________________________________________________________________________ 44 The other party is ________ years old and his her health is as follows: 55 ____________________________________________________________________________________ 66 ____________________________________________________________________________________ ____________________________________________________________________________________ 77 HISTORY OF DOMESTIC VIOLENCE: 88 There is is not a history of domestic violence between myself and the other party which has been 99 documented by the following: (Describe any restraining orders, arrests, convictions and any emotional distress and consequences of such violence against you by the other party.) 1010 ____________________________________________________________________________________ 1111 ____________________________________________________________________________________ ____________________________________________________________________________________ 1212 1313 TAX CONSEQUENCES: I understand that any award of spousal support will be tax deductible to the other party and will be taxable1414 to me. 1515 BALANCE OF HARDSHIPS: 1616 I understand that the court will be considering the status of both parties based upon the information contained herein. 1717 GOAL OF BECOMING SELF-SUPPORTING: 1818 I understand that it is the goal of the State of California that a supported party will be self-supporting within a “reasonable period of time” and except in marriages of long duration (10 years or more, or as1919 determined by the court), a “reasonable period of time” to be self-supporting may be one-half the length of the marriage (calculated from date of marriage to date of separation) or as determined by the court. 2020 JUST AND EQUITABLE: 2121 In considering this request, I ask the court to consider the following additional factors: (Describe any other 2222 factors you would like the court to know in making its order.) ____________________________________________________________________________________ 2323 ____________________________________________________________________________________ ____________________________________________________________________________________ 2424

2525

Attachment 19 to Declaration for Default or Uncontested
Dissolution or Legal Separation (Form FL-170)
Local Form FL-019 Rev. 6/2012 Page ___ of ___
Optional

Petitioner: Case Number

Respondent:

COMMUNITY ASSETS AND DEBTS 11 Petitioner requests that the Court order the community assets and or debts are divided as follows: 22 Petitioner be awarded the following community assets and or debts as his/her sole and separate 33 property: 44 Description of Asset/Debt Market Value Loan or Debt Net Value - = 55 - = - = 66 - = 77 - = - = 88 - = - = 99 - = - = 1010 Total awarded to Petitioner: $ 1111 1212 Respondent be awarded the following community assets and or debts as his/her sole and separate property:1313 Description of Asset/Debt Market Value Loan or Debt Net Value 1414 - = - =1515 - = 1616 - = - = 1717 - = - = 1818 - = - = 1919 - = Total awarded to Respondent: $ 2020 2121

2222

2323 2424

2525

Attachment 19 to Declaration for Default or Uncontested Dissolution or Legal Separation (Form FL-170) Local Form FL-019 Rev. 6/2012 Page ___ of ___ Optional

Petitioner: Case Number

Respondent:

EQUALIZATION OF PROPERTY DIVISION

11

22 Equalizing Amount (Check and complete only if property division was unequal) 33 Petitioner requests that the Court find the division of assets and debts results in Petitioner Respondent receiving $_______________ more in net assets and debts 44 resulting in an equalization payment due to Petitioner Respondent in the amount of 55 $______________ which is one-half the difference between the total net assets and debts going 66 to each party.

77 Payment Terms (Check and complete if you are NOT waiving an equalizing payment) 88 In order to equalize the division of assets and debts, Petitioner Respondent requests 99 that Petitioner Respondent pay the sum of $_____, payable as follows: 1010 $ per month commencing within thirty (30) days of entry of judgment 1111 until paid in full. 1212 Per the following terms: _______________________________________________________________________ 1313 _______________________________________________________________________ 1414 _______________________________________________________________________ 1515 Waiver of Equalizing Payment (Check box below if you are waiving the right to receive an equalizing payment. Note: you CANNOT waive the Respondent’s right to receive an equalizing payment.) 1616 Petitioner requests that the Court find the division of assets and debts results in Respondent 1717 more in net assets and debts than the other party. Petitioner knowingly, freely and without duress 1818 or undo pressure WAIVES and releases all rights and claims to receive an equalizing payment from the other party at any time. 1919 2020 Equal Division (Check if the division of property was equal) Petitioner acknowledges the division of community assets and debts constitutes an equal 2121 division of property. 2222

2323 2424

2525

Attachment 19 to Declaration for Default or Uncontested
Dissolution or Legal Separation (Form FL-170)
Local Form FL-019 Rev. 6/2012 Page ___ of ___
Optional

Petitioner: Case Number

Respondent:

RETIREMENT BENEFITS

11

22 WAIVER OF RETIREMENT BENEFITS 33 Petitioner requests that the Court order that all benefits accrued during the marriage, now or in the future 44 by Respondent under the employee benefit plan: 55 ___________________________________________________________________________________, 66 [Name of pension or other employee benefit plan] based on Respondent’s employment with ________________________________________________, 77 shall be awarded to Respondent as his/her sole and separate property. Petitioner will not assert any 88 claim to these benefits, and WAIVES and releases all claims, rights, and interest in and to these benefits under the plan, including, but not limited to, survivor benefits and agrees to execute all documents 99 required by the Plan or employer to release said interest. 1010

1111 1212 DIVISION OF RETIREMENT BENEFITS Petitioner requests that the Court find that based on Petitioner’s Respondent’s employment with1313 ______________________________________________________, during the marriage, a community 1414 interest has arisen in the following plan: 1515 ___________________________________________________________________________________, 1616 [Name of pension or other employee benefit plan] The parties shall cooperate in the preparation of a Qualified Domestic Relations Order (QDRO) or 1717 retirement benefits order for each plan, which proposed order(s) shall set forth the respective community 1818 interests of the parties and govern the disposition of benefits upon qualification by the plan(s) based upon the time rule. The court shall reserve jurisdiction over the preparation of the order(s), and division of said1919 retirement benefits. 2020 2121

2222

2323 2424

2525

Attachment 19 to Declaration for Default or Uncontested
Dissolution or Legal Separation (Form FL-170)
Local Form FL-019 Rev. 6/2012 Page ___ of ___
Optional

Petitioner: Case Number

Respondent:

SEPARATE PROPERTY

11 Petitioner requests that the Court find the following assets and or debts shall be established as 22 Petitioner’s separate property: 33 Description of Asset/Debt Date Why do you believe this is Separate Property? Acquired (Examples: Acquired prior to Marriage, After 44 Separation, Inheritance, Gift or Bequest)

55 66

77

88 99

1010

1111 1212 1313 Petitioner requests that the Court find the following assets and or debts shall be established as Respondent’s separate property: 1414 Description of Asset/Debt Date Why do you believe this is Separate Property? Acquired (Examples: Acquired prior to Marriage, After 1515 Separation, Inheritance, Gift or Bequest) 1616

1717 1818

1919

2020 2121

2222

2323 2424

2525

Attachment 19 to Declaration for Default or Uncontested
Dissolution or Legal Separation (Form FL-170)
Local Form FL-019 Rev. 6/2012 Page ___ of ___
Optional

Petitioner: Case Number

Respondent:

11 OTHER ORDERS: 22 ______________________________________________________________________ 33 ______________________________________________________________________ 44 ______________________________________________________________________ 55 ______________________________________________________________________ 66 ______________________________________________________________________ 77 ______________________________________________________________________ 88 ______________________________________________________________________ 99 ______________________________________________________________________ 1010 ______________________________________________________________________ 1111 ______________________________________________________________________ 1212 ______________________________________________________________________ 1313 ______________________________________________________________________ 1414 ______________________________________________________________________ 1515 ______________________________________________________________________ 1616 ______________________________________________________________________ 1717 ______________________________________________________________________ 1818 ______________________________________________________________________ 1919 ______________________________________________________________________ 2020 ______________________________________________________________________ 2121 ______________________________________________________________________ 2222 ______________________________________________________________________ 2323 ______________________________________________________________________ 2424 ______________________________________________________________________ 2525 ______________________________________________________________________

Attachment 19 to Declaration for Default or Uncontested
Dissolution or Legal Separation (Form FL-170)
Local Form FL-019 Rev. 6/2012 Page ___ of ___
Optional

FL-160

PARTY WITHOUT ATTORNEY OR ATTORNEY STATE BAR NO.:

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 PETITIONER'S RESPONDENT'S CASE NUMBER: COMMUNITY AND QUASI-COMMUNITY PROPERTY DECLARATION SEPARATE PROPERTY DECLARATION

See Instructions on page 4 for information about completing this form. For additional space, use Continuation of Property Declaration (form FL-161).

A B C - D = E F
GROSS FAIR NET FAIR PROPOSAL FOR DIVISION

ITEM BRIEF DESCRIPTION DATE MARKET AMOUNT MARKET Award or Confirm to: NO. ACQUIRED VALUE OF DEBT VALUE PETITIONER RESPONDENT

1. REAL ESTATE $ $ $ $ $

2. HOUSEHOLD FURNITURE, FURNISHINGS, APPLIANCES

3. JEWELRY, ANTIQUES, ART, COIN COLLECTIONS, etc.

4. VEHICLES, BOATS, TRAILERS

5. SAVINGS ACCOUNTS

6. CHECKING ACCOUNTS

Form Approved for Mandatory Use Family Code, §§ 115, 2104, 2500-2660 Judicial Council of California PROPERTY DECLARATION www.courts.ca.gov FL-160 [Rev. July 1, 2016] (Family Law)

FL-160 A B C - D = E F GROSS FAIR NET FAIR PROPOSAL FOR DIVISION DATE ITEM BRIEF DESCRIPTION MARKET AMOUNT MARKET Award or Confirm to: ACQUIRED NO. VALUE OF DEBT VALUE PETITIONER RESPONDENT

7. CREDIT UNION, OTHER $ $ $ $ DEPOSITORY ACCOUNTS

8. CASH

9. TAX REFUND

10. LIFE INSURANCE WITH CASH SURRENDER OR LOAN VALUE

11. STOCKS, BONDS, SECURED NOTES, MUTUAL FUNDS

12. RETIREMENT AND PENSIONS

13. PROFIT-SHARING, IRAS, DEFERRED COMPENSATION, ANNUITIES

14. ACCOUNTS RECEIVABLE, UNSECURED NOTES

15. PARTNERSHIP, OTHER BUSINESS INTERESTS

16. OTHER ASSETS

17. ASSETS FROM CONTINUATION SHEET

18. TOTAL ASSETS

FL-160 [Rev. July 1, 2016] PROPERTY DECLARATION Page 2 of 4 (Family Law)

FL-160 A B C D PROPOSAL FOR DIVISION ITEM DEBTS - DATE INCURRED TOTAL OWING Award or Confirm to: NO. SHOW TO WHOM OWED PETITIONER RESPONDENT

19. STUDENT LOANS $ $ $

20. TAXES

21. SUPPORT ARREARAGES

22. LOANS-UNSECURED

23. CREDIT CARDS

24. OTHER DEBTS

25. OTHER DEBTS FROM CONTINUATION SHEET

26. TOTAL DEBTS

    A Continuation of Property Declaration (form FL-161) is attached and incorporated by reference.

I declare under penalty of perjury under the laws of the State of California that, to the best of my knowledge, the foregoing is a true and correct listing of assets and obligations and the amounts shown are correct. Date:

(TYPE OR PRINT NAME) SIGNATURE

FL-160 [Rev. July 1, 2016] PROPERTY DECLARATION Page 3 of 4 (Family Law)

FL-160 INFORMATION AND INSTRUCTIONS FOR COMPLETING FORM FL-160

Property Declaration (form FL-160) is a multipurpose form, which may be filed with the court as an attachment to a Petition or Response or served on the other party to comply with disclosure requirements in place of a Schedule of Assets and Debts (form FL-142). Courts may also require a party to file a Property Declaration as an attachment to a Request to Enter Default (form FL-165) or Judgment (form FL-180).

When filing a Property Declaration with the court, do not include private financial documents listed below.

Identify the type of declaration completed

1. Check "Community and Quasi-Community Property Declaration" on page 1 to use Property Declaration (form FL-160) to provide a combined list of community and quasi-community property assets and debts. Quasi-community property is property you own outside of California that would be community property if it were located in California.

2. Do not combine a separate property declaration with a community and quasi-community property declaration. Check "Separate Property Declaration" on page 1 when using Property Declaration to provide a list of separate property assets and debts.

Description of the Property Declaration chart Pages 1 and 2

1. Column A is used to provide a brief description of each item of separate or community or quasi-community property.
2. Column B is used to list the date the item was acquired.
3. Column C is used to list the item's gross fair market value (an estimate of the amount of money you could get if you sold the item to another person through an advertisement).
4. Column D is used to list the amount owed on the item.
5. Column E is used to indicate the net fair market value of each item. The net fair market value is calculated by subtracting the dollar amount in column D from the amount in column C ("C minus D").
6. Column F is used to show a proposal on how to divide (or confirm) the item described in column A. Page 3
7. Column A is used to provide a brief description of each separate or community or quasi-community property debt.
8. Column B is used to list the date the debt was acquired.
9. Column C is used to list the total amount of money owed on the debt.
10. Column D is used to show a proposal on how to divide (or confirm) the item of debt described in column A.

When using this form only as an attachment to a Petition or Response

1. Attach a Separate Property Declaration (form FL-160) to respond to item 9. Only columns A and F on pages 1 and 2 and columns A and D on page 3 are required.
2. Attach a Community or Quasi-Community Declaration (form FL-160) to respond to item 10, and complete column A on all pages. When serving this form on the other party as an attachment to Declaration of Disclosure (form FL-140)
3. Complete columns A through E on pages 1 and 2, and columns A through C on page 3.
4. Copies of the following documents must be attached and served on the other party: (a) For real estate (item 1): deeds with legal descriptions and the latest lender's statement. (b) For vehicles, boats, trailers (item 4): the title documents. (c) For all bank accounts (item 5, 6, 7): the latest statement. (d) For life insurance policies with cash surrender or loan value (item 10): the latest declaration page. (e) For stocks, bonds, secured notes, mutual funds (item 11): the certificate or latest statement. (f) For retirement and pensions (item 12): the latest summary plan document and latest benefit statement. (g) For profit-sharing, IRAs, deferred compensation, and annuities (item 13): the latest statement. (h) For each account receivable and unsecured note (item 14): documentation of the account receivable or note. (i) For partnerships and other business interests (item 15): the most current K-1 and Schedule C. (j) For other assets (item 16): the most current statement, title document, or declaration. (k) For support arrearages (item 21): orders and statements. (l) For credit cards and other debts (items 23 and 24): the latest statement.
5. Do not file copies of the above private financial documents with the court.

When filing this form with the court as an attachment to Request to Enter Default (FL-165) or Judgment (FL-180) Complete all columns on the form.

For more information about forms required to process and obtain a judgment in dissolution, legal separation, and nullity cases, see http://www.courts.ca.gov/8218.htm. FL-160 [Rev. July 1, 2016] PROPERTY DECLARATION Page 4 of 4 (Family Law)

FL-180

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:

MARRIAGE OR PARTNERSHIP OF PETITIONER:

RESPONDENT:

JUDGMENT CASE NUMBER:
DISSOLUTION LEGAL SEPARATION NULLITY
Status only
Reserving jurisdiction over termination of marital or domestic
partnership status
Judgment on reserved issues

Date marital or domestic partnership status ends:

1. This judgment contains personal conduct restraining orders modifies existing restraining orders.
   The restraining orders are contained on page(s) of the attachment. They expire on (date):

2. This proceeding was heard as follows: Default or uncontested By declaration under Family Code section 2336 Contested Agreement in court a. Date: Dept.: Room: b. Judicial officer (name): Temporary judge c. Petitioner present in court Attorney present in court (name): d. Respondent present in court Attorney present in court (name): e. Claimant present in court (name): Attorney present in court (name): f. Other (specify name):

3. The court acquired jurisdiction of the respondent on (date): a. The respondent was served with process. b. The respondent appeared.

THE COURT ORDERS, GOOD CAUSE APPEARING 4. a. Judgment of dissolution is entered. Marital or domestic partnership status is terminated and the parties are restored to the status of single persons (1) on (specify date): (2) on a date to be determined on noticed motion of either party or on stipulation. b. Judgment of legal separation is entered. c. Judgment of nullity is entered. The parties are declared to be single persons on the ground of (specify):

d. This judgment will be entered nunc pro tunc as of (date):
e. Judgment on reserved issues.
f. The petitioner's respondent's former name is restored to (specify):
g. Jurisdiction is reserved over all other issues, and all present orders remain in effect except as provided below.
h. This judgment contains provisions for child support or family support. Each party must complete and file with the court a
Child Support Case Registry Form (form FL-191) within 10 days of the date of this judgment. The parents must notify the
court of any change in the information submitted within 10 days of the change, by filing an updated form. The Notice
of Rights and Responsibilities—Health-Care Costs and Reimbursement Procedures and Information Sheet on Changing a
Child Support Order (form FL-192) is attached. Page 1 of 2

Form Adopted for Mandatory Use JUDGMENT Family Code, §§ 2024, 2340, Judicial Council of California 2343, 2346 FL-180 [Rev. July 1, 2012] (Family Law) www.courts.ca.gov

FL-180 CASE NAME (Last name, first name of each party): CASE NUMBER:

4. i. The children of this marriage or domestic partnership are: (1) Name Birthdate (2) Parentage is established for children of this relationship born prior to the marriage or domestic partnership j. Child custody and visitation (parenting time) are ordered as set forth in the attached (1) Settlement agreement, stipulation for judgment, or other written agreement which contains the information required by Family Code section 3048(a). (2) Child Custody and Visitation Order Attachment (form FL-341). (3) Stipulation and Order for Custody and/or Visitation of Children (form FL-355). (4) Previously established in another case. Case number: Court:

k. Child support is ordered as set forth in the attached
(1) Settlement agreement, stipulation for judgment, or other written agreement which contains the declarations
required by Family Code section 4065(a).
(2) Child Support Information and Order Attachment (form FL-342).
(3) Stipulation to Establish or Modify Child Support and Order (form FL-350).
(4) Previously established in another case. Case number: Court:
l. Spousal, domestic partner, or family support is ordered:
(1) Reserved for future determination as relates to petitioner respondent
(2) Jurisdiction terminated to order spousal or partner support to petitioner respondent
(3) As set forth in the attached Spousal, Partner, or Family Support Order Attachment (form FL-343).
(4) As set forth in the attached settlement agreement, stipulation for judgment, or other written agreement.
(5) Other (specify):

m. Property division is ordered as set forth in the attached (1) Settlement agreement, stipulation for judgment, or other written agreement. (2) Property Order Attachment to Judgment (form FL-345). (3) Other (specify):

n. Attorney fees and costs are ordered as set forth in the attached
(1) Settlement agreement, stipulation for judgment, or other written agreement.
(2) Attorney Fees and Costs Order (form FL-346).
(3) Other (specify):

o. Other (specify):

Each attachment to this judgment is incorporated into this judgment, and the parties are ordered to comply with each attachment's provisions. Jurisdiction is reserved to make other orders necessary to carry out this judgment.

Date:

JUDICIAL OFFICER

5. Number of pages attached: SIGNATURE FOLLOWS LAST ATTACHMENT

NOTICE Dissolution or legal separation may automatically cancel the rights of a spouse or domestic partner under the other spouse's or domestic partner's will, trust, retirement plan, power of attorney, pay-on-death bank account, transfer-on-death vehicle registration, survivorship rights to any property owned in joint tenancy, and any other similar property interest. It does not automatically cancel the rights of a spouse or domestic partner as beneficiary of the other spouse's or domestic partner's life insurance policy. You should review these matters, as well as any credit cards, other credit accounts, insurance policies, retirement plans, and credit reports, to determine whether they should be changed or whether you should take any other actions. A debt or obligation may be assigned to one party as part of the dissolution of property and debts, but if that party does not pay the debt or obligation, the creditor may be able to collect from the other party. An earnings assignment may be issued without additional proof if child, family, partner, or spousal support is ordered. Any party required to pay support must pay interest on overdue amounts at the "legal rate," which is currently 10 percent.

FL-180 [Rev. July 1, 2012] JUDGMENT Page 2 of 2 (Family Law)

NOTICE OF RIGHTS AND RESPONSIBILITIES FL-192

Health-Care Costs and Reimbursement Procedures

If you have a child support order that includes a provision for b. Nonpayment. If you claim that the other parent has failed the reimbursement of a portion of the child's or children's to pay you back for a payment, or they have failed to make health-care costs and those costs are not paid by insurance, a payment to the provider after proper notice, you may file the law says: a request for the court to resolve the dispute. The court will presume that if uninsured costs have been paid, those

1. Notice. You must give the other parent an itemized costs were reasonable.

statement of the charges that have been billed for any health- care costs not paid by insurance. You must give this c. Attorney's fees. If the court decides one parent has been statement to the other parent within a reasonable time, but no unreasonable, it can order that parent to pay the other more than 30 days after those costs were given to you. parent's attorney's fees and costs.

2. Proof of full payment. If you have already paid all of the d. Court forms. Use forms FL-300 and FL-490 to get a court uninsured costs, you must (1) give the other parent proof that date. See form FL-300-INFO for information about you paid them and (2) ask for reimbursement for the other completing, filing, and serving your court papers. parent's court-ordered share of those costs. 6. Court-ordered insurance coverage. If a parent provides
3. Proof of partial payment. If you have paid only your share health-care insurance as ordered by the court, that insurance of the uninsured costs, you must (1) give the other parent must be used at all times to the extent that it is available for proof that you paid your share, (2) ask that the other parent health-care costs. pay his or her share of the costs directly to the health-care a. Burden to prove. The parent claiming that the coverage is

provider, and (3) give the other parent the information inadequate to meet the child's needs has the burden of necessary for that parent to be able to pay the bill. proving that to the court. 4. Payment by notified parent. If you receive notice from a b. Cost of additional coverage. If a parent purchases parent that an uninsured health-care cost has been incurred, health-care insurance in addition to that ordered by the you must pay your share of that cost within the time the court court, that parent must pay all the costs of the additional orders; or if the court has not specified a period of time, you coverage. In addition, if a parent uses alternative coverage must make payment (1) within 30 days from the time you were that costs more than the coverage provided by court order, given notice of the amount due, (2) according to any payment that parent must pay the difference. schedule set by the health-care provider, (3) according to a schedule agreed to in writing by you and the other parent, or 7. Preferred health providers. If the court-ordered coverage (4) according to a schedule adopted by the court. designates a preferred health-care provider, that provider must be used at all times consistent with the terms of the 5. Going to court. Sometimes parents get into disagreements health insurance policy. When any parent uses a health-care about health-care costs. If you and the other parent cannot provider other than the preferred provider, any health-care resolve the situation after talking about it, you can request that costs that would have been paid by the preferred health the court make a decision. provider if that provider had been used must be the sole a. Disputed charges. If you dispute a charge made by the responsibility of the parent incurring those costs. other parent, you may file a request for the court to resolve the dispute, but only if you pay that charge before filing your request.

Information About Child Support for Incarcerated or Detained Parents

1. Child support. Under current California law, child support 3. Timing. Child support will automatically restart at the old ordered or changed after December 31, 2020, automatically amount the first day of the first full month after the parent is stops if the parent who has to pay released. If you need to change your child support order, see page 2. is confined against their will for more than 90 days in a row in jail, prison, juvenile detention, a mental health facility, or 4. Past confinement. If your child support order was entered other institution. or modified between October 8, 2015, and December 31, 2019, and you were confined against your will for more than 90 days
2. Exceptions. Child support does not automatically stop if in a row during the same time frame, you may also qualify for

the parent who has to pay relief. See item 5 for how to obtain more information. is confined for domestic violence against the other parent or child, or 5. More info. For more information about child support and failing to pay a child support order; or incarcerated parents, see Family Code section 4007.5 or talk has money available to pay child support. to the family law facilitator or self-help center in your county.

Form Adopted for Mandatory Use NOTICE OF RIGHTS AND RESPONSIBILITIES Family Code, §§ 4007.5, 4010, 4062, 4063 Judicial Council of California www.courts.ca.gov FL-192 [Rev. January 1, 2022] Health-Care Costs and Reimbursement Procedures

NOTICE OF RIGHTS AND RESPONSIBILITIES FL-192

Information Sheet on Changing a Child Support Order

General Info What forms do I need? The court has made a child support order in your case. This If you are asking to change a child support order, you must fill order will remain the same unless one of the parents requests out one of these forms: that the support be changed (modified). An order for child Form FL-300, Request for Order or support can be modified by filing a request to change child Form FL-390, Notice of Motion and Motion for Simplified support and serving the other parent. If both parents agree on Modification of Order for Child, Spousal, or Family Support a new child support amount, they can complete, sign, and file with the court a Stipulation to Establish or Modify Child Support You must also fill out one of these forms, and attach proof of and Order (form FL-350) (Note: If the local child support income for the past two months (like your paycheck stubs): agency is involved in your case, it must be served with any Form FL-150, Income and Expense Declaration or request to change child support and approve any agreement.) Form FL-155, Financial Statement (Simplified)

Online Self-Help Guide What if I am not sure which forms to fill out? For more information about how child support works, visit: Contact the family law facilitator or self-help center in your https://selfhelp.courts.ca.gov/child-support. county.

When a Child Support Order May Be Changed After you fill out the forms, file them with the court clerk and The court considers several things when ordering the payment ask for a hearing date. Write the hearing date on the form. of child support. The clerk may ask you to pay a filing fee. If you cannot afford the fee, fill out these forms, too: First, the number of children is considered, along with the percentage of time each parent has physical custody of the Form FW-001, Request to Waive Court Fees and children. Form FW-003, Order on Court Fee Waiver (Superior Court)

Next, the net disposable incomes of both parents are You must serve the other parent. If the local child support

determined (which is how much money is left each month agency is involved, serve it too. after taxes and certain other items like health insurance, This means someone 18 or over—not you—must serve the union dues, or other child support ordered and paid are other parent copies of your filed court forms at least 16 subtracted from a parent's paycheck). The court can also court days before the hearing. Add 5 calendar days if look at earning ability if a parent is not working. you serve by mail within California (see Code of Civil The court considers both parents’ tax filing status and may Procedure section 1005 for other situations). consider hardships, such as the cost of raising a child of Court days are weekdays when the court is open for another relationship who lives with a parent. business (Monday through Friday except court holidays). A parent can request to change an existing order for child Calendar days include all days of the month, including support when the net disposable income of one of the parents weekends and holidays. To find court holidays, go to changes, parenting time changes, or a new child is born. www.courts.ca.gov/holidays.htm.

Examples The server must also serve blank copies of both of these forms: You have been ordered to pay $500 per month in child Form FL-320, Responsive Declaration to Request for Order support. You lose your job. You will continue to owe $500 Form FL-150, Income and Expense Declaration per month, plus 10 percent interest on any unpaid support, Then the server fills out and signs a Proof of Service (form unless you file a motion to modify your child support to a FL-330 or form FL-335). Take this form, plus one copy, to the lower amount and the court orders a reduction. clerk and file it at least one week before your hearing. You are currently receiving $300 per month in child support Go to your hearing and ask the judge to change the from the other parent, whose net income has just increased support. Bring your tax returns from the last two years and substantially. You will continue to receive $300 per month your last two months' pay stubs. The judge will look at your unless you file a motion to modify your child support to a information, listen to both parents, and make an order. After higher amount and the court orders an increase. the hearing, fill out: You are paying child support based upon having physical Form FL-340, Findings and Order After Hearing and custody of your children 30 percent of the time. After several months it turns out that you actually have physical Form FL-342, Child Support Information and Order custody of the children 50 percent of the time. You may file Attachment a motion to modify child support to a lower amount. Need help? How to Change a Child Support Order Contact the family law facilitator or self-help center in your To change a child support order, you must file papers with the county, or call your county's bar association and ask for an court. Remember: You must follow the order you have now. experienced family lawyer.

FL-192 [Rev. January 1, 2022] NOTICE OF RIGHTS AND RESPONSIBILITIES Page 2 of 2 Information Sheet on Changing a Child Support Order

FL-190

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:

RESPONDENT:

CASE NUMBER:

NOTICE OF ENTRY OF JUDGMENT

You are notified that the following judgment was entered on (date) : 1. Dissolution 2. Dissolution - status only 3. Dissolution - reserving jurisdiction over termination of marital status or domestic partnership 4. Legal separation 5. Nullity 6. Parent-child relationship 7. Judgment on reserved issues 8. Other (specify) :

Date:

Clerk, by , Deputy

-NOTICE TO ATTORNEY OF RECORD OR PARTY WITHOUT ATTORNEY-

Under the provisions of Code of Civil Procedure section 1952, if no appeal is filed the court may order the exhibits destroyed or otherwise disposed of after 60 days from the expiration of the appeal time.

STATEMENT IN THIS BOX APPLIES ONLY TO JUDGMENT OF DISSOLUTION

Effective date of termination of marital or domestic partnership status (specify) : WARNING: Neither party may remarry or enter into a new domestic partnership until the effective date of the termination of marital or domestic partnership status, as shown in this box.

CLERK'S CERTIFICATE OF MAILING

I certify that I am not a party to this cause and that a true copy of the Notice of Entry of Judgment was mailed first class, postage fully prepaid, in a sealed envelope addressed as shown below, and that the notice was mailed

at (place) : , California, on (date) :

Date: Clerk, by , Deputy Name and address of petitioner or petitioner's attorney Name and address of respondent or respondent's attorney

Form Adopted for Mandatory Use NOTICE OF ENTRY OF JUDGMENT Family Code, §§ 2338, 7636, 7637 Judicial Council of California www.courtinfo.ca.gov FL-190 [Rev. January 1, 2005] (Family Law-Uniform Parentage-Custody and Support)

FL-191

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address) : COURT PERSONNEL:

STAMP DATE RECEIVED HERE

TELEPHONE NO.: FAX NO.(Optional): DO NOT FILE

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:
CHILD SUPPORT CASE REGISTRY FORM CASE NUMBER:
Mother First form completed
Father Change to previous information

THIS FORM WILL NOT BE PLACED IN THE COURT FILE. IT WILL BE
MAINTAINED IN A CONFIDENTIAL FILE WITH THE STATE OF CALIFORNIA.

Notice: Pages 1 and 2 of this form must be completed and delivered to the court along with the court order for support. Pages 3 and 4 are instructional only and do not need to be delivered to the court. If you did not file the court order, you must complete this form and deliver it to the court within 10 days of the date on which you received a copy of the support order. Any later change to the information on this form must be delivered to the court on another form within 10 days of the change. It is important that you keep the court informed in writing of any changes of your address and telephone number.

1. Support order information (this information is on the court order you are filing or have received). a. Date order filed: b. Initial child support or family support order Modification c. Total monthly base current child or family support amount ordered for children listed below, plus any monthly amount ordered payable on past-due support: Child Support: Family Support: Spousal Support: (1) Current $ Current $ Current $ base child base family spousal Reserved order Reserved order Reserved order support: support: support: $0 (zero) order $0 (zero) order $0 (zero) order (2) Additional $ Additional $ monthly monthly support: support: (3) Total $ Total $ Total $ past-due past-due past-due support: support: support: (4) Payment $ Payment $ Payment $ on past- on past- on past- due support: due support: due support: (5) Wage withholding was ordered ordered but stayed until (date) :

2. Person required to pay child or family support (name): Relationship to child (specify):

3. Person or agency to receive child or family support payments (name): Relationship to child (if applicable):

   TYPE OR PRINT IN INK

Form Adopted for Mandatory Use CHILD SUPPORT CASE REGISTRY FORM Family Code, § 4014 Judicial Council of California www.courtinfo.ca.gov FL-191 [Rev. July 1, 2005]

PETITIONER/PLAINTIFF: CASE NUMBER: RESPONDENT/DEFENDANT:

OTHER PARENT:

4. The child support order is for the following children: Child's name Date of birth Social security number a. b. c.

   Additional children are listed on a page attached to this document.

You are required to complete the following information about yourself. You are not required to provide information about the other person, but you are encouraged to provide as much as you can. This form is confidential and will not be filed in the court file. It will be maintained in a confidential file with the State of California.

5. Father's name: 6. Mother's name:

   a. Date of birth: a. Date of birth:

   b. Social security number: b. Social security number:

   c. Street address: c. Street address:

   City, state, zip code: City, state, zip code:

   d. Mailing address: d. Mailing address:

   City, state, zip code: City, state, zip code:

   e. Driver's license number: e. Driver's license number:

   State: State:

   f. Telephone number: f. Telephone number:

   g. Employed Not employed Self-employed g. Employed Not employed Self-employed

   Employer's name: Employer's name:

   Street address: Street address:

   City, state, zip code: City, state, zip code:

   Telephone number: Telephone number:

6. A restraining order, protective order, or nondisclosure order due to domestic violence is in effect.
   a. The order protects: Father Mother Children
   b. From: Father Mother
   c. The restraining order expires on (date) :

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)

FL-191 [Rev. July 1, 2005] CHILD SUPPORT CASE REGISTRY FORM Page 2 of 4

INFORMATION SHEET FOR CHILD SUPPORT CASE REGISTRY FORM

(Do NOT deliver this Information Sheet to the court clerk.)

Please follow these instructions to complete the Child Support Case Registry Form (form FL-191) if you do not have an attorney to represent you. Your attorney, if you have one, should complete this form.

Both parents must complete a Child Support Case Registry Form. The information on this form will be included in a national database that among other things, is used to locate absent parents. When you file a court order, you must deliver a completed form to the court clerk along with your court order. If you did not file a court order, you must deliver a completed form to the court clerk WITHIN 10 DAYS of the date you received a copy of your court order. If any of the information you provide on this form changes, you must complete a new form and deliver it to the court clerk within 10 days of the change. The address of the court clerk is the same as the one shown for the superior court on your order. This form is confidential and will not be filed in the court file. It will be maintained in a confidential file with the State of California.

INSTRUCTIONS FOR COMPLETING THE CHILD SUPPORT CASE REGISTRY FORM (TYPE OR PRINT IN INK):

If the top section of the form has already been filled out, skip down to number 1 below. If the top section of the form is blank, you must provide this information.

Page 1, first box, top of form, left side: Print your name, address, telephone number, fax number, and e-mail address, if any, in this box. Attorneys must include their State Bar identification numbers.

Page 1, second box, top of form, left side: Print the name of the county and the court's address in this box. Use the same address for the court that is on the court order you are filing or have received.

Page 1, third box, top of form, left side: Print the names of the petitioner/plaintiff, respondent/defendant, and other parent in this box. Use the same names listed on the court order you are filing or have received.

Page 1, fourth box, top of form, left side: Check the box indicating whether you are the mother or the father. If you are the attorney for the mother, check the box for mother. If you are the attorney for the father, check the box for father. Also, if this is the first time you have filled out this form, check the box by "First form completed." If you have filled out form FL-191 before, and you are changing any of the information, check the box by "Change to previous information."

Page 1, first box, right side: Leave this box blank for the court's use in stamping the date of receipt.

Page 1, second box, right side: Print the court case number in this box. This number is also shown on the court papers.

Instructions for numbered paragraphs:

1. a. Enter the date the court order was filed. This date is shown in the "COURT PERSONNEL: STAMP DATE RECEIVED HERE" box on page 1 at the top of the order on the right side. If the order has not been filed, leave this item blank for the court clerk to fill in.

b. If the court order you filed or received is the first child or family support order for this case, check the box by "Initial child support or family support order." If this is a change to your order, check the box by "Modification."

c. Information regarding the amount and type of support ordered and wage withholding is on the court order you are filing or have received.

(1) If your order provides for any type of current support, check all boxes that describe that support. For example, if your order provides for both child and spousal support, check both of those boxes. If there is an amount, put it in the blank provided. If the order says the amount is reserved, check the "Reserved order" box. If the order says the amount is zero, check the "$0 (zero) order" box. Do not include child care, special needs, uninsured medical expenses, or travel for visitation here These amounts will go in (2). Do NOT complete the Child Support Case Registry form if you receive spousal support only.

(2) If your order provides for a set monthly amount to be paid as additional support for such needs as child care, special needs, uninsured medical expenses or travel for visitation check the box in Item 2 and enter the monthly amount. For example, if your order provides for base child support and in addition the paying parent is required to pay $300 per month, check the box in item 2 underneath the "Child Support" column and enter $300. Do NOT check this box if your order provides only for a payment of a percentage, such as 50% of the childcare.

FL-191 [Rev. July 1, 2005] CHILD SUPPORT CASE REGISTRY FORM Page 3 of 4

(3) If your order determined the amount of past due support, check the box in Item 3 that states the type of past due support and enter the amount. For example, if the court determined that there was $5000 in past due child support and $1000 in past due spousal support, you would check the box in item 3 in the "Child Support" column and enter $5000 and you would also check the box in item 3 in the "Spousal Support" column and enter $1000.

(4) If your order provides for a specific dollar amount to be paid towards any past due support, check the box in item 4 that states the type of past due support and enter the amount. For example, the court ordered $350 per month to be paid on the past due child support, you would check the box in Item 4 in the "Child Support" column and enter $350.

(5) Check the "ordered" box if wage withholding was ordered with no conditions. Check the box "ordered but stayed until" if wage withholding was ordered but is not to be deducted until a later date. If the court delayed the effective date of the wage withholding, enter the specific date. Check only one box in this item.

2. a. Write the name of the person who is supposed to pay child or family support.

   b. Write the relationship of that person to the child.

3. a. Write the name of the person or agency supposed to receive child or family support payments.

   b. Write the relationship of that person to the child.

4. List the full name, date of birth, and social security number for each child included in the support order. If there are more than five children included in the support order, check the box below item 4e and list the remaining children with dates of birth and social security numbers on another sheet of paper. Attach the other sheet to this form.

The local child support agency is required, under section 466(a)(13) of the Social Security Act, to place in the records pertaining to child support the social security number of any individual who is subject to a divorce decree, support order, or paternity determination or acknowledgment. This information is mandatory and will be kept on file at the local child support agency.

Top of page 2, box on left side: Print the names of the petitioner/plaintiff, respondent/defendant, and other parent in this box. Use the same names listed on page 1.

Top of page 2, box on right side: Print your court case number in this box. Use the same case number as on page 1, second box, right side.

You are required to complete information about yourself. If you know information about the other person, you may also fill in what you know about him or her.

5. If you are the father in this case, list your full name in this space. See instructions for a-g under item 6 below.

6. If you are the mother in this case, list your full name in this space.

a. List your date of birth.

b. Write your social security number.

c. List the street address, city, state, and zip code where you live.

d. List the street address, city, state, and zip code where you want your mail sent, if different from the address where you live.

e. Write your driver's license number and the state where it was issued.

f. List the telephone number where you live.

g. Indicate whether you are employed, not employed, self-employed, or by checking the appropriate box. If you are employed, write
the name, street address, city, state, zip code, and telephone number where you work.

7. If there is a restraining order, protective order, or nondisclosure order, check this box.

a. Check the box beside each person who is protected by the restraining order. b. Check the box beside the parent who is restrained. c. Write the date the restraining order expires. See the restraining order, protective order, or nondisclosure order for this date.

If you are in fear of domestic violence, you may want to ask the court for a restraining order, protective order, or nondisclosure order.

You must type or print your name, fill in the date, and sign the Child Support Case Registry Form under penalty of perjury. When you sign under penalty of perjury, you are stating that the information you have provided is true and correct.

FL-191 [Rev. July 1, 2005] CHILD SUPPORT CASE REGISTRY FORM Page 4 of 4

1 Name, Address & Telephone Number 2 3 4 5 In Propria Persona 6 7 8 STANISLAUS COUNTY SUPERIOR COURT, STATE OF CALIFORNIA 9 10 In re the Matter of: DCSS NO. ______________________ 11 _______________________________________: Petitioner, Case No. _______________________ and 12 NOTICE TO DEPARTMENT OF CHILD ____________________________________: Respondent. SUPPORT SERVICES OF INTENT TO 13 FILE JUDGMENT 14 TO: DEPARTMENT OF CHILD SUPPORT SERVICES, COUNTY OF ______________________________ 15 PLEASE TAKE NOTICE that, 1. On ___________________________________, which is the first business day 10 days after16 today, 17 2. Petitioner or Respondent will submit to the Court a JUDGMENT. 18 3. A true copy of said JUDGMENT is attached hereto as Exhibit “A”. 19 4. A completed Proof of Service by Mail is attached. 20 5. Petitioner or Respondent is receiving some form of public assistance, 21 or public benefits, or is receiving enforcement services from the Department of 22 Child Support Services. 23 DATE: _______________________________________________ Petitioner or Respondent24 25

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: P.O. 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:
PROOF OF SERVICE BY MAIL HEARING TIME:
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 www.courts.ca.gov 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 www.courts.ca.gov