Fillable FL-676 SUPERIOR COURT OF CALIFORNIA, COUNTY OF (California)

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FL-676 SUPERIOR COURT OF CALIFORNIA, COUNTY OF (California)

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FL-676
FOR COURT USE ONLY
REQUEST FOR DETERMINATION OF SUPPORT ARREARS
NOTICE OF HEARING
b. The address of the court is
2. The local child support agency is providing support enforcement services in this case.
a. The local child support agency states that past due support payments (arrears) are owed, as shown in the attached document.
b.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
(SIGNATURE)
1. A hearing on this application will be held as follows (see instructions on how to get a hearing date):
Form Adopted for Mandatory Use
Judicial Council of California
FL-676 [Rev. January 1, 2020]
Family Code, § 17526
www.courts.ca.gov
Page 1 of 2
REQUEST FOR DETERMINATION OF SUPPORT ARREARS
(Governmental)
PARTY WITHOUT ATTORNEY OR ATTORNEY (name, state bar number, and address):
NAME: STATE BAR NO.:
FIRM NAME:
STREET ADDRESS:
CITY: STATE: ZIP CODE:
TELEPHONE NO.: FAX NO.:
ATTORNEY FOR (name):
E-MAIL ADDRESS:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT
:
OTHER PARENT:
CASE NUMBER:
Date:
(TYPE OR PRINT NAME)
a. Date: Time: Div:Dept: Room:
4.
3. DETERMINATION OF SUPPORT ARREARS
I disagree with the local child support agency's statement, and I request the court to make a determination of arrears.
I am attaching my statement of the arrears, which includes a monthly breakdown of amounts ordered and amounts paid.
Other (specify):
This case may be referred to a court commissioner for hearing. By law, court commissioners do not have the authority to issue final
orders and judgments in contested cases unless they are acting as temporary judges. The court commissioner in your case will act as
a temporary judge unless, before the hearing, you or any other party objects to the commissioner’s acting as a temporary judge. If you
or the other party objects, the court commissioner may still hear your case to make findings and a recommended order to a judge. If
you do not like the recommended order, you must object to it within 10 court days in writing (use Notice of Objection (Governmental)
( )); otherwise, the recommended order will become a final order of the court. If you object to the recommended order, a
judge will make a temporary order and set a new hearing.
Number of pages attached:
Other (specify):
same as noted above
form FL-666
FL-676
FL-676 [Rev. January 1, 2020]
Page 2 of 2
REQUEST FOR DETERMINATION OF SUPPORT ARREARS
(Governmental)
An adult other than you must complete the Proof of Service below.
PROOF OF SERVICE
At the time of service I was at least 18 years of age and not a party to the legal action.
I served a copy of the foregoing Request for Determination of Support Arrears (form FL-676) and all attachments as follows
(check either a, b, or c for each party served):
b.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
1.
2.
3.
a.
(1)
(2)
(1)
(2)
I served this motion/request, which included an address verification declaration (Declaration Regarding Address
Verification—Postjudgment Request to Modify a Child Custody, Visitation, or Child Support Order ( ) may
be used for this purpose).
(3)
Date delivered:
Date delivered:
Time delivered:
Time delivered:
Date mailed:
Date mailed:
(a)
(a)
(b)
(b)
(c)
(c)
(a)
(a)
(b)
(b)
(c) (c)
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
CASE NUMBER:
(SIGNATURE OF PERSON WHO SERVED REQUEST)
Date:
(TYPE OR PRINT NAME)
Address where delivered: Address where delivered:
Address:
Address:
Place of mailing (city and state): Place of mailing (city and state):
Name of party or attorney served:
Name of party or attorney served:
Name of local child support agency served:
Name of local child support agency served:
My residence of business address is (specify):
Mail. I am a resident of or employed in the county where the mailing occurred. I deposited this request with the U.S.
Postal Service in a sealed envelope with postage fully prepaid. I used first-class mail. The envelope was addressed and
mailed as follows:
Personal delivery. I personally delivered a copy and all attachments as follows:
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FL-676 SUPERIOR COURT OF CALIFORNIA, COUNTY OF (California)

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Completed 23 September 2021

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