Santa Clara — FM-1083*

Source: https://santaclara.courts.ca.gov/system/files/forms/fm-1083_rem.pdf

ATTACHMENT FM-1083 ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME AND ADDRESS) TELEPHONE NUMBER: FOR COURT USE ONLY

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ATTORNEY FOR (Name): Reset Form button at the end SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA of the form when finished. STREET ADDRESS: 201 North First Street, San José, CA 95113 MAILING ADDRESS: 191 North First Street CITY AND ZIP CODE: San José, California 95113 BRANCH NAME: Family Justice Center

PETITIONER:

RESPONDENT:

OTHER PARENT/CLAIMANT: STIPULATION AND ORDER CASE NUMBER: Modification DEPARTMENT:

1. Not based on a hearing

   Today’s Hearing (date)

2. Judge: Temporary

3. The parties agree that the Court will make orders about the following items:

   Custody/Visitation Arrears
   Child Support Attorney’s Fees and Costs

   Spousal or Family Support Other: All other issues are reserved until further Court order

4. Parties/Attorneys:

   Petitioner present in court Petitioner’s attorney present:

   Respondent present in court Respondent’s attorney present:

   Claimant present in court Claimant’s attorney present:

   Child’s Attorney/Other (specify): present:

5. Continued Hearing: This hearing is continued to (dept) on (date) at (time)
   about the following issues:

6. Number of attached pages:

   Do not use this form for domestic violence restraining orders.

   Those orders must be made on a Restraining Order after Hearing (CLETS), form DV-130.

We have read this entire Stipulation and Order, including all Attachments. We understand it fully and ask that the Court make our stipulation into court orders.

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PETITIONER: CASE NUMBER:

RESPONDENT:

Date: Petitioner

Date: Attorney for Petitioner

Date: Respondent

Date: Attorney for Respondent

Date: Child’s Attorney

Date: Other:

Date: Other:

Interpreter Witness Declaration

Interpreter: The Petitioner Respondent is unable to read or understand this Stipulation and Order
and its attachments because:

a. his/her primary language is (specify):
b. other (specify):

I certify under penalty of perjury under the laws of the State of California that I have, to the best of my ability, read or translated for the Petitioner Respondent this Stipulation and Order including all attachments. He or she said they understood this Stipulation and Order and its attachments before signing them.

Date Interpreter’s printed name Interpreter’s signature

ORDER

The Court approves the terms stipulated and agreed to in this document by the parties and makes them court orders. All previous orders that are not inconsistent with these orders remain in full force and effect.

Date: Judicial Officer of the Superior Court

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