FL-300
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
TELEPHONE NO.:
FOR COURT USE ONLY
To keep other people from
seeing what you entered
on your form, please press
the Clear This Form button
at the end of the form
when finished.
FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
Self-Represented
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
San Bernardino
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
REQUEST FOR ORDER
Child Custody
✔ Child Support
Attorney Fees and Costs
✔
MODIFICATION
Visitation
Spousal Support
Temporary Emergency
Court Order
Other (specify):
CASE NUMBER:
1. TO (name):
2. A hearing on this Request for Order will be held as follows: If child custody or visitation is an issue in this proceeding, Family
Code section 3170 requires mediation before or at the same time as the hearing (see item 7.)
Time:
a. Date:
b. Address of court
✔
same as noted above
Dept.:
Room.:
other (specify):
3. Attachments to be served with this Request for Order:
a. A blank Responsive Declaration (form FL-320)
b. ✔ Completed Income and Expense Declaration (form
FL-150) and a blank Income and Expense
Declaration
c.
d.
e.
Completed Financial Statement (Simplified) (form
FL-155) and a blank Financial Statement (Simplified)
Points and authorities
Other (specify):
Date:
(TYPE OR PRINT NAME)
(SIGNATURE)
COURT ORDER
4.
YOU ARE ORDERED TO APPEAR IN COURT AT THE DATE AND TIME LISTED IN ITEM 2 TO GIVE ANY LEGAL
REASON WHY THE ORDERS REQUESTED SHOULD NOT BE GRANTED.
5.
service
Time for
hearing
is shortened. Service must be on or before (date):
6. Any responsive declaration must be served on or before (date):
7. The parties are ordered to attend mandatory custody services as follows:
8.
You are ordered to comply with the Temporary Emergency Court Orders (form FL-305) attached.
9.
Other (specify):
Date:
JUDICIAL OFFICER
To the person who received this Request for Order: If you wish to respond to this Request for Order, you must file a
Responsive Declaration to Request for Order (form FL-320) and serve a copy on the other parties at least nine court days
before the hearing date unless the court has ordered a shorter period of time. You do not have to pay a filing fee to file the
Responsive Declaration to Request for Order (form FL-320) or any other declaration including an Income and Expense
Declaration (form FL-150) or Financial Statement (Simplified) (form FL-155).
Page 1 of 4
Form Adopted for Mandatory Use
Judicial Council of California
FL-300 [Rev. July 1, 2012]
REQUEST FOR ORDER
Family Code, §§ 2045, 2107, 6224,
6226, 6320–6326, 6380–6383
Government Code, § 26826
www.courts.ca.gov
FL-300
CASE NUMBER:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
REQUEST FOR ORDER AND SUPPORTING DECLARATION
Petitioner
1.
Respondent
Other Parent/Party
To be ordered pending the hearing
b. Legal custody to (name of person who
makes decisions about health, education, etc.)
CHILD CUSTODY
a. Child's name and age
d.
As requested in form
e.
Modify existing order
(1) filed on (date):
(2) ordering (specify):
Attachment 2a (2)
a. As requested in: (1)
(3)
Other (specify):
b.
Modify existing order
(1) filed on (date):
(2) ordering (specify):
c.
(2)
✔
Criminal: County/state:
Case No. (if known):
Family: County/state:
Case No. (if known):
Child Custody and Visitation Application Attachment (form FL-311)
(3)
(4)
Juvenile: County/state:
Case No. (if known):
Other: County/state:
Case No. (if known):
CHILD SUPPORT (An earnings assignment order may be issued.)
a. Child's name and age
d.
To be ordered pending the hearing
One or more domestic violence restraining/protective orders are now in effect. (Attach a copy of the orders if you
have one.) The orders are from the following court or courts (specify county and state):
(1)
3.
c. Physical custody to (name of
person with whom child will live)
Child Custody and Visitation Application Attachment (form FL-311)
Request for Child Abduction Prevention Orders (form FL-312)
Children's Holiday Schedule Attachment (form FL-341(C))
Additional Provisions—Physical Custody Attachment (form FL-341(D))
Joint Legal Custody Attachment (form FL-341(E))
Other (Attachment 1d)
CHILD VISITATION (PARENTING TIME)
2.
requests the following orders:
✔
b.
I request support based on the
child support guidelines
c. Monthly amount requested (if not by guideline)
$
Modify existing order
(1) filed on (date):
(2) ordering (specify):
Notice: The court is required to order child support based on the income of both parents. It normally continues until the
child is 18. You must supply the court with information about your finances by filing an Income and Expense Declaration
(form FL-150) or a Financial Statement (Simplified) (form FL-155). Otherwise, the child support order will be based on
information about your income that the court receives from other sources, including the other parent.
FL-300 [Rev. July 1, 2012]
REQUEST FOR ORDER
Page 2 of 4
FL-300
CASE NUMBER:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
4.
SPOUSAL OR PARTNER SUPPORT (An earnings assignment order may be issued.)
You will not need to
c.
a.
Modify existing order
Amount requested (monthly): $
complete any items on this
b.
(1) filed on (date):
Terminate existing order
page. Proceed to the next
(2) ordering (specify):
(1) filed on (date):
page.
(2) ordering (specify):
d.
The Spousal or Partner Support Declaration Attachment (form FL-157) is attached (for modification of spousal or
partner support after judgment only)
e. An Income and Expense Declaration (form FL-150) must be attached
5.
ATTORNEY FEES AND COSTS are requested on Request for Attorney Fees and Costs Order Attachment (form FL-319) or a
declaration that addresses the factors covered in that form. An Income and Expense Declaration (form FL-150) must be
attached. A Supporting Declaration for Attorney Fees and Costs Order Attachment (form FL-158) or a declaration that
addresses the factors covered in that form must also be attached.
6.
PROPERTY RESTRAINT
To be ordered pending the hearing
a. The
petitioner
claimant
is restrained from transferring, encumbering, hypothecating,
respondent
concealing, or in any way disposing of any property, real or personal, whether community, quasi-community, or
separate, except in the usual course of business or for the necessities of life.
The applicant will be notified at least five business days before any proposed extraordinary expenditures,
and an accounting of such will be made to the court.
7.
b.
Both parties are restrained and enjoined from cashing, borrowing against, canceling, transferring, disposing of, or
changing the beneficiaries of any insurance or other coverage, including life, health, automobile, and disability,
held for the benefit of the parties or their minor children.
c.
Neither party may incur any debts or liabilities for which the other may be held responsible, other than in the
ordinary course of business or for the necessities of life.
To be ordered pending the hearing
PROPERTY CONTROL
The petitioner
respondent
is given the exclusive temporary use, possession, and control of the following
a.
property that we own or are buying (specify):
b.
8.
The petitioner
respondent
is ordered to make the following payments on liens and encumbrances coming
due while the order is in effect:
Amount of payment
Debt
Pay to
OTHER RELIEF (specify):
NOTE: To obtain domestic violence restraining orders, you must use the forms Request for Order
(Domestic Violence Prevention) (form DV-100), Temporary Restraining Order (Domestic Violence) (form
DV-110), and Notice of Court Hearing (Domestic Violence) (form DV-109).
FL-300 [Rev. July 1, 2012]
REQUEST FOR ORDER
Page 3 of 4
FL-300
CASE NUMBER:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
I request that time for service of the Request for Order and accompanying papers be shortened so that these documents may
days before the time set for the hearing. I need to have this
be served no less than (specify number):
order shortening time because of the facts specified in item 10 or the attached declaration.
9.
10.
✔
FACTS IN SUPPORT of orders requested and change of circumstances for any modification are (specify):
✔ Contained in the attached declaration. (You may use Attached Declaration (form MC-031) for this purpose.
The attached declaration must not exceed 10 pages in length unless permission to file a longer declaration has been
obtained from the court.)
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 APPLICANT)
Requests for Accommodations
Assistive listening systems, computer-assisted real-time captioning, or sign language interpreter services are available if
you ask at least five days before the proceeding. Contact the clerk’s office or go to www.courts.ca.gov/forms for
Request for Accommodations by Persons With Disabilities and Response (form MC-410). (Civil Code, § 54.8.)
FL-300 [Rev. July 1, 2012]
Page 4 of 4
REQUEST FOR ORDER
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button after you have printed the form.
Save This Form
Print This Form
Clear This Form
1
2
3
4
Name: ____________________________
Street: ____________________________
City, State: ________________________
_________________________________
5
6
7
8
SUPERIOR COURT OF CALIFORNIA
9
COUNTY OF SAN BERNARDINO
10
Case No.: _______________________
11
In re Matter of:
12
__________________________,
Declaration in Support of Request
Petitioner,
13
for Child Support
✔
14
and
15
__________________________,
Modification
Respondent.
16
, other party
17
18
19
20
21
22
23
24
25
26
27
28
I ______________________________, do hereby declare as follows:
I am the
PETITIONER
requesting that the court
RESPONDENT
ESTABLISH
RAISE
OTHER PARENT in this case. I am
LOWER my child support based on
the following material circumstances/ change of circumstances:
My gross monthly income is $ ____________._____.
My income has changed since the last child support order. Following are the facts
regarding this change: __________________________________________________________
____________________________________________________________________________
I have a permanent disability and I do not have the present ability to pay child support.
Following are the facts regarding this circumstance: __________________________________
____________________________________________________________________________
Declaration of _________________
Page 1 of 2
1
I am/was incarcerated and I do not have a job that would enable me to pay child support.
2
Following are the facts regarding this circumstance: __________________________________
3
____________________________________________________________________________
4
The income of the other parent has changed substantially. The facts supporting this
5
statement are set forth as follows: ________________________________________________
6
____________________________________________________________________________
7
The following custody/visitation schedule of the minor children is presently in effect
8
for the named minor child(ren): (Write the names and date of birth for the child(ren) of this
9
case): _____________________________
____________________________________
10
__________________________________
____________________________________
11
The custody/visitation arrangements are as follows: __________________________________
12
____________________________________________________________________________
13
There are child care cost and expenses for the minor child(ren) in the amount of:
14
$________. These costs are presently paid as follows: _______________________________
15
____________________________________________________________________________
16
Extreme hardship / additional child support orders exist. The facts supporting these
17
hardships are set forth as follows: _________________________________________________
18
____________________________________________________________________________
19
Father
20
This amount was not included in the last child support calculation.
21
Other circumstances exist that I am requesting the court to take into consideration in
Mother is presently paying a health insurance premium of $ _________.
22
calculating child support. These circumstances are: __________________________________
23
____________________________________________________________________________
24
____________________________________________________________________________
25
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
26
Dated ______________
Signature: _________________________________
27
28
Print Name: ________________________________
Declaration of _________________
Page 2 of 2
FL-150
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
FOR COURT USE ONLY
To keep other people from
seeing what you entered on
your form, please press the
Clear This Form button at the
end of the form when finished.
TELEPHONE NO.:
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
Self-Represented
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
San Bernardino
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/CLAIMANT:
CASE NUMBER:
INCOME AND EXPENSE DECLARATION
1. Employment (Give information on your current job or, if you're unemployed, your most recent job.)
a. Employer:
Attach copies
b. Employer's address:
of your pay
c. Employer's phone number:
stubs for last
d. Occupation:
two months
(black out
e. Date job started:
social
f. If unemployed, date job ended:
security
hours per week.
g. I work about
numbers).
gross (before taxes)
per month
per week
h. I get paid $
per hour.
(If you have more than one job, attach an 8½-by-11-inch sheet of paper and list the same information as above for your other
jobs. Write "Question 1—Other Jobs" at the top.)
2. Age and education
a. My age is (specify):
b. I have completed high school or the equivalent:
Yes
c. Number of years of college completed (specify):
d. Number of years of graduate school completed (specify):
professional/occupational license(s) (specify):
e. I have:
vocational training (specify):
If no, highest grade completed (specify):
No
Degree(s) obtained (specify):
Degree(s) obtained (specify):
3. Tax information
a.
I last filed taxes for tax year (specify year):
single
head of household
married, filing separately
b. My tax filing status is
married, filing jointly with (specify name):
c. I file state tax returns in
California
other (specify state):
d. I claim the following number of exemptions (including myself) on my taxes (specify):
4. Other party's income. I estimate the gross monthly income (before taxes) of the other party in this case at (specify): $
This estimate is based on (explain):
(If you need more space to answer any questions on this form, attach an 8½-by-11-inch sheet of paper and write the
question number before your answer.) Number of pages attached:
I declare under penalty of perjury under the laws of the State of California that the information contained on all pages of this form and
any attachments is true and correct.
Date:
(TYPE OR PRINT NAME)
Form Adopted for Mandatory Use
Judicial Council of California
FL-150 [Rev. January 1, 2007]
(SIGNATURE OF DECLARANT)
INCOME AND EXPENSE DECLARATION
Page 1 of 4
Family Code, §§ 2030–2032,
2100–2113, 3552, 3620–3634,
4050–4076, 4300–4339
www.courtinfo.ca.gov
American LegalNet, Inc.
www.FormsWorkflow.com
FL-150
PETITIONER/PLAINTIFF:
CASE NUMBER:
RESPONDENT/DEFENDANT:
OTHER PARENT/CLAIMANT:
Attach copies of your pay stubs for the last two months and proof of any other income. Take a copy of your latest federal
tax return to the court hearing. (Black out your social security number on the pay stub and tax return.)
5.
Income (For average monthly, add up all the income you received in each category in the last 12 months
and divide the total by 12.)
Average
Last month monthly
a. Salary or wages (gross, before taxes). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
b. Overtime (gross, before taxes) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
c. Commissions or bonuses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
d. Public assistance (for example: TANF, SSI, GA/GR)
e. Spousal support
currently receiving . . . . . . . . . . . . . . . . . $
from this marriage
from a different marriage . . . . . . . . . . . . . . . . . . $
f. Partner support
from this domestic partnership
from a different domestic partnership $
g. Pension/retirement fund payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
h. Social security retirement (not SSI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
i.
Disability:
j.
Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Social security (not SSI)
State disability (SDI)
Private insurance . $
k. Workers' compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
l. Other (military BAQ, royalty payments, etc.) (specify): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
6.
Investment income (Attach a schedule showing gross receipts less cash expenses for each piece of property.)
a. Dividends/interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
b. Rental property income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
c. Trust income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
d. Other (specify): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
7.
Income from self-employment, after business expenses for all businesses. . . . . . . . . . . . . . . . . . . . . $
I am the
owner/sole proprietor
business partner
other (specify):
Number of years in this business (specify):
Name of business (specify):
Type of business (specify):
Attach a profit and loss statement for the last two years or a Schedule C from your last federal tax return. Black out your
social security number. If you have more than one business, provide the information above for each of your businesses.
8.
Additional income. I received one-time money (lottery winnings, inheritance, etc.) in the last 12 months (specify source and
amount):
9.
Change in income. My financial situation has changed significantly over the last 12 months because (specify):
10. Deductions
Last month
a. Required union dues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
b. Required retirement payments (not social security, FICA, 401(k), or IRA). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
c. Medical, hospital, dental, and other health insurance premiums (total monthly amount). . . . . . . . . . . . . . . . . . . . . . . . $
d. Child support that I pay for children from other relationships. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
e. Spousal support that I pay by court order from a different marriage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
f. Partner support that I pay by court order from a different domestic partnership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
g. Necessary job-related expenses not reimbursed by my employer (attach explanation labeled "Question 10g") . . . . . $
11. Assets
Total
a. Cash and checking accounts, savings, credit union, money market, and other deposit accounts . . . . . . . . . . . . . . . . $
b. Stocks, bonds, and other assets I could easily sell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
c. All other property,
FL-150 [Rev. January 1, 2007]
real
and
personal
(estimate fair market value minus the debts you owe) . . . .
INCOME AND EXPENSE DECLARATION
$
Page 2 of 4
FL-150
CASE NUMBER:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/CLAIMANT:
12. The following people live with me:
Name
Age
That person's gross
How the person is
related to me? (ex: son) monthly income
a.
Yes
No
b.
c.
Yes
No
Yes
No
d.
e.
Yes
No
Yes
No
13. Average monthly expenses
a. Home:
(1)
Estimated expenses
Proposed needs
Actual expenses
h.
Laundry and cleaning . . . . . . . . . . . . . . . . . $
i.
Clothes . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
If mortgage:
j.
Education . . . . . . . . . . . . . . . . . . . . . . . . . . $
(a) average principal: $
(b) average interest: $
k.
Entertainment, gifts, and vacation. . . . . . . . $
l.
Auto expenses and transportation
(insurance, gas, repairs, bus, etc.) . . . . . . . $
Rent or
mortgage. . . $
(2) Real property taxes . . . . . . . . . . . . . . $
(3) Homeowner's or renter's insurance
(if not included above) . . . . . . . . . . . . $
m. Insurance (life, accident, etc.; do not
include auto, home, or health insurance). . . $
(4) Maintenance and repair . . . . . . . . . . . $
n.
o.
b. Health-care costs not paid by insurance. . . $
p.
c. Child care . . . . . . . .. . . . . . . . . . . . . . . . . . $
d. Groceries and household supplies. . . . . . . $
e. Eating out. . . . . . . . . . . . . . . . . . . . . . . . . . $
f.
Pays some of the
household expenses?
q.
r.
Utilities (gas, electric, water, trash) . . . . . . $
g. Telephone, cell phone, and e-mail . . . . . . . $
s.
Savings and investments. . . . . . . . . . . . . . . $
Charitable contributions. . . . . . . . . . . . . . . . $
Monthly payments listed in item 14
(itemize below in 14 and insert total here). . $
Other (specify): . . . . . . . . . . . . . . . . . . . . . . $
TOTAL EXPENSES (a–q) (do not add in
the amounts in a(1)(a) and (b))
$
Amount of expenses paid by others
$
14. Installment payments and debts not listed above
Paid to
For
Amount
Balance
$
$
$
$
$
$
$
$
$
$
$
$
Date of last payment
15. Attorney fees (This is required if either party is requesting attorney fees.):
a.
b.
c.
d.
To date, I have paid my attorney this amount for fees and costs (specify): $
The source of this money was (specify):
I still owe the following fees and costs to my attorney (specify total owed): $
My attorney's hourly rate is (specify): $
I confirm this fee arrangement.
Date:
(TYPE OR PRINT NAME OF ATTORNEY)
FL-150 [Rev. January 1, 2007]
(SIGNATURE OF ATTORNEY)
INCOME AND EXPENSE DECLARATION
Page 3 of 4
FL-150
CASE NUMBER:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/CLAIMANT:
CHILD SUPPORT INFORMATION
(NOTE: Fill out this page only if your case involves child support.)
16. Number of children
a. I have (specify number):
children under the age of 18 with the other parent in this case.
b. The children spend
percent of their time with me and
percent of their time with the other parent.
(If you're not sure about percentage or it has not been agreed on, please describe your parenting schedule here.)
17. Children's health-care expenses
I do not
have health insurance available to me for the children through my job.
I do
a.
b. Name of insurance company:
c. Address of insurance company:
d. The monthly cost for the children's health insurance is or would be (specify): $
(Do not include the amount your employer pays.)
18. Additional expenses for the children in this case
Amount per month
a. Child care so I can work or get job training. . . . . . . . . . . . . . . . . . . . . . . . .
$
b. Children's health care not covered by insurance . . . . . . . . . . . . . . . . . . . .
$
c. Travel expenses for visitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
d. Children's educational or other special needs (specify below): . . . . . . . .
$
19. Special hardships. I ask the court to consider the following special financial circumstances
(attach documentation of any item listed here, including court orders):
Amount per month
a. Extraordinary health expenses not included in 18b. . . . . . . . . . . . . . . . . .
$
b. Major losses not covered by insurance (examples: fire, theft, other
insured loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. (1) Expenses for my minor children who are from other relationships and
are living with me . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(2) Names and ages of those children (specify):
(3) Child support I receive for those children. . . . . . . . . . . . . . . . . . . . . . .
For how many months?
$
$
$
The expenses listed in a, b, and c create an extreme financial hardship because (explain):
20. Other information I want the court to know concerning support in my case (specify):
FL-150 [Rev. January 1, 2007]
Print This Form
INCOME AND EXPENSE DECLARATION
For your protection and privacy, please press the Clear This Form
button after you have printed the form.
Page 4 of 4
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
COURT
COUNTY
OF
......................................................
:
:
FAX NO. (Optional):
TELEPHONE NO.:
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
Self-Represented
Plaintiff(s)
SUPERIOR COURT OF CALIFORNIA, -againstCOUNTY OF
FL-335
To keep other people from
seeing what you entered on
your form, please press the
Index No.
Clear This Form button at the
end of the form when finished.
Calendar No.
FOR COURT USE ONLY
San Bernardino
:
JUDICIAL SUBPOENA
:
STREET ADDRESS:
:
MAILING ADDRESS:
CITY AND ZIP CODE:
:
BRANCH NAME:
Defendant(s)
:
......................................................
CASE NUMBER:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
(If applicable, provide):
HEARING DATE:
OTHER PARENT/PARTY:
THE PEOPLE PROOF
OF THE OF
STATE
OF NEW
SERVICE
BY YORK
MAIL
HEARING TIME:
DEPT.:
TO
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.
GREETINGS:
2. My residence or business address is:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
located at
County of
a copy
(specify):
3. I served in
roomof the following
, ondocuments
the
day
of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned
date,
testify child
and give
evidenceIncome
as a witness
in Expense
this action on
the part of theBlank Responsive
Request
for Order
to to
modify
support;
and
Declaration;
Declaration to Request for Order; Income and Expense Declaration; Proof of Service by Mail.
to AND
comply with this subpoena is punishable as a contempt of court and will make you liable to
by enclosing them Your
in an failure
envelope
the
party onthe
whose
behalf
this subpoena
was issued
a maximum
penalty
of $50fully
andprepaid.
all damages sustained as a
a.
depositing
sealed
envelope
with the United
States for
Postal
Service with
the postage
result
of the
yourenvelope
failure to
b.
placing
forcomply.
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 isofdeposited
in the
course of
Witness,
Honorable
, one
the Justices
of ordinary
the
business with the United States Postal Service in a sealed envelope with postage fully prepaid.
Court in
County,
day of
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.
, 20
(Attorney must sign above and type name below)
Attorney(s) for
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.)
Office
and P.O. is
Address
the foregoing
true and correct.
6. I declare under penalty of perjury under the laws of the State of California that
Date:
(TYPE OR PRINT NAME)
Form Approved for Optional Use
Judicial Council of California
FL-335 [Rev. January 1, 2012]
Telephone No.:
(SIGNATURE OF PERSON COMPLETING THIS FORM)
Facsimile
No.:
Page 1 of 1
E-Mail Address:
Code of Civil Procedure, §§ 1013, 1013a
PROOF OF SERVICE BY MAIL
www.courts.ca.gov
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
FL-334
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
FOR COURT USE ONLY
To keep other people from
seeing what you entered on
your form, please press the
Clear This Form button at the
end of the form when finished.
FAX NO. (Optional):
TELEPHONE NO.:
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
Self-Represented
SUPERIOR COURT OF CALIFORNIA, COUNTY OF San Bernardino
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
DECLARATION REGARDING ADDRESS VERIFICATION—
POSTJUDGMENT REQUEST TO MODIFY A CHILD CUSTODY,
VISITATION, OR CHILD SUPPORT ORDER
1. I am the
petitioner
respondent
other parent
other party
in this matter.
The request is to modify a judgment or permanent order only for child support and a local child support agency is
providing services in the case. Service of the request solely to modify child support will be made on other party by serving
the local child support agency at least 30 days prior to the hearing as provided in Family Code sections 17404(e)(3) and
17406(f).
2.
3.
attorney for
CASE NUMBER:
✔
The request is to modify a judgment or permanent orders for child custody, visitation, or child support.
Note: If you cannot verify the other party’s current residence or office address, mail service may not be used. The other party
must be personally served. Proof of Personal Service (form FL-330) may be used for this purpose.
a. Before the request was served on the other party by mail, I verified in the previous 30 days that the other party’s current
current residence or office address is (specify):
b. I can confirm that the above address is the other party’s current residence or office address because (specify):
(1)
(2)
I contacted the other party directly within the past 30 days and he or she gave me the above address.
I have been at that address in connection with a custody and visitation or other matter within the past 30 days.
(3)
It is the new address that the other party provided on Notice of Change of Address (form MC-040) or other
pleading and filed with the court on (specify date):
(4)
It is the office address that he or she last gave on a document filed with the court in this case which was also
served on me as a party in the case.
(5)
I sent the other party a letter by mail to the address in (2) with return receipt requested and the other party signed
and accepted the letter at that address within the past 30 days.
I confirmed by another method (specify):
(6)
Continued in Attachment 3b(6).
I declare under penalty of perjury under the laws of the State of California that the foregoing and all attachments are true and correct.
Date:
(TYPE OR PRINT NAME)
Form Approved for Optional Use
Judicial Council of California
FL-334 [New January 1, 2012]
(SIGNATURE OF PERSON COMPLETING THIS FORM)
DECLARATION REGARDING ADDRESS VERIFICATION—
POSTJUDGMENT REQUEST TO MODIFY A CHILD CUSTODY,
VISITATION, OR CHILD SUPPORT ORDER
Page 1 of 2
Code of Civil Procedure, §§ 1013, 1013a;
Family Code, §§ 215, 17404, 17406
www.courts.ca.gov
FL-334
CASE NUMBER:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARTY:
NOTICE AND SERVICE INFORMATION
If you want to change a judgment or permanent order for child custody, visitation, or child support, a person at least 18
years of age or older must serve the request on the other party by (1) personal delivery or (2) first-class mail or airmail,
postage prepaid. Requests to modify a judgment or permanent order for matters other than child custody, visitation, or
child support must be served on the other party by personal service.
• If your request is to change a judgment or permanent orders only for child support and a local child support
agency is currently providing services, the other party may be served by mail at the office of the local child
support agency. Where service is made by mail on the local child support agency, the following apply:
1. The local child support agency must be served not less than 30 days before the hearing date.
2. Attach a copy of this completed form to the proof of service by mail; and
3. File this original form at the court clerk’s office.
• If your request is to change a judgment or permanent order for child custody, visitation, or child support and
you have verified the other party’s current residence or office address, you must:
1. Complete this form to provide the other party’s current residence or business address and indicate how you obtained
the other party’s current residence or office address.
2. Attach a copy of this completed form to the proof of service by mail; and
3. File this original form at the court clerk’s office.
• If you cannot verify the other party’s current residence or office address, mail service may not be used. The
other party must be personally served. Proof of Personal Service (form FL-330) may be used for this purpose.
FL-334 [New January 1, 2012]
DECLARATION REGARDING ADDRESS VERIFICATION—
POSTJUDGMENT REQUEST TO MODIFY A CHILD CUSTODY,
VISITATION, OR CHILD SUPPORT ORDER
For your protection and privacy, please press the Clear This Form
button after you have printed the form.
Save This Form
Print This Form
Page 2 of 2
Clear This Form
FL-330
FOR COURT USE ONLY
ATTORNEY OR PARTY WITHOUT ATTORNEY OR GOVERNMENTAL AGENCY (under Family Code, §§ 17400,17406
(Name, State Bar number, and address):
TELEPHONE NO.:
ATTORNEY FOR (Name):
To keep other people from
seeing what you entered
on your form, please press
the Clear This Form button
at the end of the form
when finished.
FAX NO.:
Self-Represented
SUPERIOR COURT OF CALIFORNIA, COUNTY OF San
Bernardino
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER/PLAINTIFF:
CASE NUMBER:
RESPONDENT/DEFENDANT:
(If applicable, provide):
HEARING DATE:
OTHER PARENT/PARTY:
HEARING TIME:
PROOF OF PERSONAL SERVICE
DEPT.:
1. I am at least 18 years old, not a party to this action, and not a protected person listed in any of the orders.
2. Person served (name):
3. I served copies of the following documents (specify):
Request for Order to modify child support; Income and Expense Declaration; Blank Responsive
Declaration to Request for Order; Income and Expense Declaration; Proof of Service by Mail.
4. By personally delivering copies to the person served, as follows:
a. Date:
c. Address:
5. I am
a.
b.
c.
b. Time:
not a registered California process server.
a registered California process server.
an employee or independent contractor of a
registered California process server.
d.
e.
exempt from registration under Business & Profession
Code section 22350(b).
a California sheriff or marshal.
6. My name, address, and telephone number, and, if applicable, county of registration and number (specify):
7.
8.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
I am a California sheriff or marshal and I certify that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME OF PERSON WHO SERVED THE PAPERS)
(SIGNATURE OF PERSON WHO SERVED THE PAPERS)
Page 1 of 1
Form Approved for Optional Use
Judicial Council of California
FL-330 [Rev. January 1, 2012]
Code of Civil Procedure, § 1011
www.courts.ca.gov
PROOF OF PERSONAL SERVICE
For your protection and privacy, please press the Clear This Form
button after you have printed the form.
Save This Form
Print This Form
Clear This Form
New Requirement:
After getting court date from clerk and then serving on the other person,
you must contact the other person to see if you can settle your issues
MEET AND CONFER
Starting January 01, 2013, California Rules of Court Rule 5.98 requires that all parties
shall meet and confer in person, or by telephone, or as ordered by the Court, before
the date of the hearing when a party filed a Request For Order (form FL-300).
During the meet and confer process, the parties must discuss and make a good faith
attempt to settle all issues. If a complete settlement is not possible, a conditional
agreement can be made. The meet and confer requirement does not apply to cases that
involve domestic violence.
Custody Mediation: If your court date involves custody and/or visitation, then
you have obeyed this requirement with your Family Court Services counseling.
DOCUMENT EXCHANGE
Before the hearing or while you are meeting, parties must exchange all evidence that
will be presented at the hearing. At the hearing, the Court may decline to consider
documents that were not given to the other party before the hearing as required under
this rule. However, the requirement for exchange of documents does not apply to
evidence that contradicts the other person’s evidence or questions the other person’s
credibility.
HOW DO I COMPLY WITH THESE RULES?
After filing your Request For Order for child support, spousal support, or anything else that does
not involve child custody or visitation, you must contact the other party or their attorney listed
on their case, to discuss the issues stated on your court forms. Your options are to set up a
meeting in person or by telephone BEFORE the court hearing. This is your “settlement”
meeting.
[If your case includes child custody or visitation and you will be attending mediation with Family
Court Services; you will talk to the other party at that time.]
During the settlement meeting, explain to the other party what the issues are, and how you
think the issues can be resolved. Also, ask the other party for their opinion. Try to reach a
compromise. If you are not able to reach an agreement on all of the issues, you can try to
reach an agreement on some of the issues.
Additionally, during your meeting or at any time before your court date, you must exchange all
of your evidence with each other. Some examples of such evidence could be declarations
written under penalty of perjury by third parties, pictures, emails, lab test results, school
records, credit card statements, mortgage documents, bank records, and medical records.
(Your Proof)
When the Judge calls your case you can inform the Judge that you met with the other party
before the hearing and whether you have an agreement, a partial agreement or no agreement.
DO NOT WRITE ON THE PAPERS BELOW!!!
THE FOLLOWING PAPERWORK IS THE BLANK PAPERWORK
THAT YOU ARE REQUIRED TO HAVE SERVED ON THE OTHER
PARTY.

Print
Print out your set of forms.

Review

File
Review all of the information that you have completed. Make sure to sign
all of the appropriate areas. (If you would like for your forms to be
reviewed, then stop by your local self-help center for more information)
Make 3 copies if DCSS is involved in your case.
When you are ready to file your paperwork you will need to make (2)
copies of the original documents and file them with the clerk’s office
within the court in your jurisdiction (the same court that is listed in your
paperwork).

Serve
Once you have filed your paperwork with the court, you will need to have
the other party served with a copy of your documents. The person who
served the other party will complete the proof of service form.
REMEMBER!
A person over the age of 18 and not a party to the action is supposed to
serve the documents to the other party…
NOT YOU!

File Proof of Service
After the other party has been served, you will need to file the Proof of
Service Form. The form will need to be filed with the clerk’s office within
the court in your jurisdiction (the same court that is listed in your
paperwork). You should file your Proof of Service form as soon as
possible.
Do not write on the papers below!!!!
FYI:
This set of papers is meant to be given to the
other party. (You don’t need to copy)
Under the law, you are required to serve these
BLANK forms on the other person.
FL-320
FOR COURT USE ONLY
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
TELEPHONE NO.:
FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARTY:
RESPONSIVE DECLARATION TO REQUEST FOR ORDER
HEARING DATE:
TIME:
DEPARTMENT OR ROOM:
1.
CHILD CUSTODY
I consent to the order requested.
a.
b.
I do not consent to the order requested, but I consent to the following order:
2.
CHILD VISITATION (PARENTING TIME)
I consent to the order requested.
a.
b.
I do not consent to the order requested, but I consent to the following order:
3.
CHILD SUPPORT
a.
I consent to the order requested.
b.
I consent to guideline support.
c.
I do not consent to the order requested, but I consent to the following order:
Guideline
(1)
Other (specify):
(2)
4.
SPOUSAL OR PARTNER SUPPORT
I consent to the order requested.
a.
b.
I do not consent to the order requested.
c.
CASE NUMBER:
I consent to the following order:
Page 1 of 2
Form Adopted for Mandatory Use
Judicial Council of California
FL-320 [Rev. July 1, 2012]
www.courts.ca.gov
RESPONSIVE DECLARATION TO REQUEST FOR ORDER
FL-320
CASE NUMBER:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARTY:
5.
ATTORNEY'S FEES AND COSTS
6.
a.
b.
I consent to the order requested.
I do not consent to the order requested.
c.
I consent to the following order:
PROPERTY RESTRAINT
a.
I consent to the order requested.
b.
I do not consent to the order requested.
c.
I consent to the following order:
PROPERTY CONTROL
a.
I consent to the order requested.
b.
I do not consent to the order requested.
7.
c.
8.
I consent to the following order:
OTHER RELIEF
I consent to the order requested.
a.
b.
I do not consent to the order requested.
c.
9.
I consent to the following order:
SUPPORTING INFORMATION
Contained in the attached declaration. (You may use Attached Declaration (form MC-031) for this purpose).
NOTE: To respond to domestic violence restraining orders requested in the Request for Order (Domestic Violence Prevention)
(form DV-100), you must use the Answer to Temporary Restraining Order (Domestic Violence Prevention) (form DV-120).
I declare under penalty of perjury under the laws of the State of California that the foregoing and all attachments are true and correct.
Date:
(TYPE OR PRINT NAME)
FL-320 [Rev. July 1, 2012]
(SIGNATURE OF DECLARANT)
RESPONSIVE DECLARATION TO REQUEST FOR ORDER
Page 2 of 2
FL-150
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
FOR COURT USE ONLY
TELEPHONE NO.:
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/CLAIMANT:
CASE NUMBER:
INCOME AND EXPENSE DECLARATION
1. Employment (Give information on your current job or, if you're unemployed, your most recent job.)
a. Employer:
Attach copies
b. Employer's address:
of your pay
c. Employer's phone number:
stubs for last
d. Occupation:
two months
(black out
e. Date job started:
social
f. If unemployed, date job ended:
security
hours per week.
g. I work about
numbers).
gross (before taxes)
per month
per week
h. I get paid $
per hour.
(If you have more than one job, attach an 8½-by-11-inch sheet of paper and list the same information as above for your other
jobs. Write "Question 1—Other Jobs" at the top.)
2. Age and education
a. My age is (specify):
b. I have completed high school or the equivalent:
Yes
c. Number of years of college completed (specify):
d. Number of years of graduate school completed (specify):
professional/occupational license(s) (specify):
e. I have:
vocational training (specify):
If no, highest grade completed (specify):
No
Degree(s) obtained (specify):
Degree(s) obtained (specify):
3. Tax information
a.
I last filed taxes for tax year (specify year):
single
head of household
married, filing separately
b. My tax filing status is
married, filing jointly with (specify name):
c. I file state tax returns in
California
other (specify state):
d. I claim the following number of exemptions (including myself) on my taxes (specify):
4. Other party's income. I estimate the gross monthly income (before taxes) of the other party in this case at (specify): $
This estimate is based on (explain):
(If you need more space to answer any questions on this form, attach an 8½-by-11-inch sheet of paper and write the
question number before your answer.) Number of pages attached:
I declare under penalty of perjury under the laws of the State of California that the information contained on all pages of this form and
any attachments is true and correct.
Date:
(TYPE OR PRINT NAME)
Form Adopted for Mandatory Use
Judicial Council of California
FL-150 [Rev. January 1, 2007]
(SIGNATURE OF DECLARANT)
INCOME AND EXPENSE DECLARATION
Page 1 of 4
Family Code, §§ 2030–2032,
2100–2113, 3552, 3620–3634,
4050–4076, 4300–4339
www.courtinfo.ca.gov
American LegalNet, Inc.
www.FormsWorkflow.com
FL-150
PETITIONER/PLAINTIFF:
CASE NUMBER:
RESPONDENT/DEFENDANT:
OTHER PARENT/CLAIMANT:
Attach copies of your pay stubs for the last two months and proof of any other income. Take a copy of your latest federal
tax return to the court hearing. (Black out your social security number on the pay stub and tax return.)
5.
Income (For average monthly, add up all the income you received in each category in the last 12 months
and divide the total by 12.)
Average
Last month monthly
a. Salary or wages (gross, before taxes). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
b. Overtime (gross, before taxes) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
c. Commissions or bonuses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
d. Public assistance (for example: TANF, SSI, GA/GR)
e. Spousal support
currently receiving . . . . . . . . . . . . . . . . . $
from this marriage
from a different marriage . . . . . . . . . . . . . . . . . . $
f. Partner support
from this domestic partnership
from a different domestic partnership $
g. Pension/retirement fund payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
h. Social security retirement (not SSI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
i.
Disability:
j.
Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Social security (not SSI)
State disability (SDI)
Private insurance . $
k. Workers' compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
l. Other (military BAQ, royalty payments, etc.) (specify): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
6.
Investment income (Attach a schedule showing gross receipts less cash expenses for each piece of property.)
a. Dividends/interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
b. Rental property income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
c. Trust income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
d. Other (specify): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
7.
Income from self-employment, after business expenses for all businesses. . . . . . . . . . . . . . . . . . . . . $
I am the
owner/sole proprietor
business partner
other (specify):
Number of years in this business (specify):
Name of business (specify):
Type of business (specify):
Attach a profit and loss statement for the last two years or a Schedule C from your last federal tax return. Black out your
social security number. If you have more than one business, provide the information above for each of your businesses.
8.
Additional income. I received one-time money (lottery winnings, inheritance, etc.) in the last 12 months (specify source and
amount):
9.
Change in income. My financial situation has changed significantly over the last 12 months because (specify):
10. Deductions
Last month
a. Required union dues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
b. Required retirement payments (not social security, FICA, 401(k), or IRA). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
c. Medical, hospital, dental, and other health insurance premiums (total monthly amount). . . . . . . . . . . . . . . . . . . . . . . . $
d. Child support that I pay for children from other relationships. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
e. Spousal support that I pay by court order from a different marriage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
f. Partner support that I pay by court order from a different domestic partnership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
g. Necessary job-related expenses not reimbursed by my employer (attach explanation labeled "Question 10g") . . . . . $
11. Assets
Total
a. Cash and checking accounts, savings, credit union, money market, and other deposit accounts . . . . . . . . . . . . . . . . $
b. Stocks, bonds, and other assets I could easily sell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
c. All other property,
FL-150 [Rev. January 1, 2007]
real
and
personal
(estimate fair market value minus the debts you owe) . . . .
INCOME AND EXPENSE DECLARATION
$
Page 2 of 4
FL-150
CASE NUMBER:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/CLAIMANT:
12. The following people live with me:
Name
Age
That person's gross
How the person is
related to me? (ex: son) monthly income
a.
Yes
No
b.
c.
Yes
No
Yes
No
d.
e.
Yes
No
Yes
No
13. Average monthly expenses
a. Home:
(1)
Estimated expenses
Proposed needs
Actual expenses
h.
Laundry and cleaning . . . . . . . . . . . . . . . . . $
i.
Clothes . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
If mortgage:
j.
Education . . . . . . . . . . . . . . . . . . . . . . . . . . $
(a) average principal: $
(b) average interest: $
k.
Entertainment, gifts, and vacation. . . . . . . . $
l.
Auto expenses and transportation
(insurance, gas, repairs, bus, etc.) . . . . . . . $
Rent or
mortgage. . . $
(2) Real property taxes . . . . . . . . . . . . . . $
(3) Homeowner's or renter's insurance
(if not included above) . . . . . . . . . . . . $
m. Insurance (life, accident, etc.; do not
include auto, home, or health insurance). . . $
(4) Maintenance and repair . . . . . . . . . . . $
n.
o.
b. Health-care costs not paid by insurance. . . $
p.
c. Child care . . . . . . . .. . . . . . . . . . . . . . . . . . $
d. Groceries and household supplies. . . . . . . $
e. Eating out. . . . . . . . . . . . . . . . . . . . . . . . . . $
f.
Pays some of the
household expenses?
q.
r.
Utilities (gas, electric, water, trash) . . . . . . $
g. Telephone, cell phone, and e-mail . . . . . . . $
s.
Savings and investments. . . . . . . . . . . . . . . $
Charitable contributions. . . . . . . . . . . . . . . . $
Monthly payments listed in item 14
(itemize below in 14 and insert total here). . $
Other (specify): . . . . . . . . . . . . . . . . . . . . . . $
TOTAL EXPENSES (a–q) (do not add in
the amounts in a(1)(a) and (b))
$
Amount of expenses paid by others
$
14. Installment payments and debts not listed above
Paid to
For
Amount
Balance
$
$
$
$
$
$
$
$
$
$
$
$
Date of last payment
15. Attorney fees (This is required if either party is requesting attorney fees.):
a.
b.
c.
d.
To date, I have paid my attorney this amount for fees and costs (specify): $
The source of this money was (specify):
I still owe the following fees and costs to my attorney (specify total owed): $
My attorney's hourly rate is (specify): $
I confirm this fee arrangement.
Date:
(TYPE OR PRINT NAME OF ATTORNEY)
FL-150 [Rev. January 1, 2007]
(SIGNATURE OF ATTORNEY)
INCOME AND EXPENSE DECLARATION
Page 3 of 4
FL-150
CASE NUMBER:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/CLAIMANT:
CHILD SUPPORT INFORMATION
(NOTE: Fill out this page only if your case involves child support.)
16. Number of children
a. I have (specify number):
children under the age of 18 with the other parent in this case.
b. The children spend
percent of their time with me and
percent of their time with the other parent.
(If you're not sure about percentage or it has not been agreed on, please describe your parenting schedule here.)
17. Children's health-care expenses
I do not
have health insurance available to me for the children through my job.
I do
a.
b. Name of insurance company:
c. Address of insurance company:
d. The monthly cost for the children's health insurance is or would be (specify): $
(Do not include the amount your employer pays.)
18. Additional expenses for the children in this case
Amount per month
a. Child care so I can work or get job training. . . . . . . . . . . . . . . . . . . . . . . . .
$
b. Children's health care not covered by insurance . . . . . . . . . . . . . . . . . . . .
$
c. Travel expenses for visitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
d. Children's educational or other special needs (specify below): . . . . . . . .
$
19. Special hardships. I ask the court to consider the following special financial circumstances
(attach documentation of any item listed here, including court orders):
Amount per month
a. Extraordinary health expenses not included in 18b. . . . . . . . . . . . . . . . . .
$
b. Major losses not covered by insurance (examples: fire, theft, other
insured loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. (1) Expenses for my minor children who are from other relationships and
are living with me . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(2) Names and ages of those children (specify):
(3) Child support I receive for those children. . . . . . . . . . . . . . . . . . . . . . .
For how many months?
$
$
$
The expenses listed in a, b, and c create an extreme financial hardship because (explain):
20. Other information I want the court to know concerning support in my case (specify):
FL-150 [Rev. January 1, 2007]
Print This Form
INCOME AND EXPENSE DECLARATION
For your protection and privacy, please
Page 4 of 4
Clear This Form
COURT
COUNTY
OF
......................................................
:
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
Plaintiff(s)
-against-FAX NO. (Optional):
TELEPHONE NO.:
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
Index No.
FL-335
FOR COURT USE ONLY
:
Calendar No.
:
JUDICIAL SUBPOENA
:
:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
:
STREET ADDRESS:
MAILING ADDRESS:
Defendant(s)
:
. . BRANCH
. . . . . NAME:
...............................................
CITY AND ZIP CODE:
CASE NUMBER:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
THE PEOPLE OF THE STATE OF NEW YORK
OTHER PARENT/PARTY:
TO
(If applicable, provide):
HEARING DATE:
HEARING TIME:
PROOF OF SERVICE BY MAIL
DEPT.:
NOTICE: To serve temporary restraining orders you must use personal service (see form FL-330).
GREETINGS:
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.
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
at the
Court
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
residence
or business address is:
2. My the
Honorable
3. I served a copy of the following documents (specify):
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
by enclosing them in an envelope AND
result of your failure to comply.
a.
b.
depositing the sealed envelope with the United States Postal Service with the postage fully prepaid.
placing the envelope for collection and mailing on the date and at the place shown in item 4 following our ordinary
Witness,
Honorable
, one
the Justices
of the
business
practices.
I am readily familiar with this business’s practice for collecting
andof
processing
correspondence
for
On the same
day that correspondence
is placed, for
Courtmailing.
in
County,
day of
20collection 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.
(Attorney must sign above and type name below)
Attorney(s) for
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.)
Office and P.O. Address
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)
Form Approved for Optional Use
Judicial Council of California
FL-335 [Rev. January 1, 2012]
Telephone No.:
Facsimile
No.: OF PERSON COMPLETING THIS FORM)
(SIGNATURE
Page 1 of 1
E-Mail Address:
Code of Civil Procedure, §§ 1013, 1013a
PROOF OF SERVICE BY
MAIL Tel. No.:
www.courts.ca.gov
Mobile
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