Superior Court of California, County of Sacramento
Family Law & Probate
Judgment by Declaration-Dissolution Page 1 of 1
Cover Sheet:
Judgment of Dissolution or Legal Separation by Declaration
Effective Date:
July 15, 2021
Last Revision Date:
July 27, 2021
Purpose:
These forms are used to complete a Judgment of Dissolution, Legal
Separation of Annulment without attending a court hearing. Use this
packet after or with the Request to Enter Default packet.
Assistance:
If you are unable to complete the forms on your own, you may wish
to hire a private attorney. If you need help finding an attorney,
please contact the State Bar of California at www.calbar.ca.gov or
the Sacramento County Bar Association at www.sacbar.org.
Required Forms:
All forms are Judicial Council forms, unless otherwise indicated:
Declaration for Default or Uncontested Dissolution or Legal
Separation, FL-170
Judgment, FL-180
Notice of Entry of Judgment, FL-190
Optional Forms:
These forms are needed if you have minor children with your spouse:
Child Custody and Visitation Order Attachment, FL-341
Child Support Information and Order Attachment, FL-342
Child Support Case Registry, FL-191
Notice of Rights and Responsibilities, FL-192
Filing Fee:
None
Copies:
Make 3 copies of the Judgment and 2 copies of the other completed
forms. If the Judge approves your Judgment, the Court will file and
keep the original and one copy of the Judgment and will endorse
and mail one copy of the Notice of Entry of Judgment to the other
party and will return the other copies to you.
Before You File:
Address a stamped envelope to each party and submit the
envelopes with your forms.
Filing:
All forms must be typewritten or printed in blue or black ink. (See
California Rules of Court, Rules 2.100-2.119)
Mail or place completed forms in the court drop-box located at the
Family Court at 3341 Power Inn Road, Sacramento, CA 95826.
Drop box hours are 8:00 am to 5:00 pm Monday through Friday,
excluding Court holidays.
Next Steps:
Please allow six weeks for the judgment packet to be processed.
FL-170
FOR COURT USE ONLY
PETITIONER:
RESPONDENT:
CASE NUMBER:
DECLARATION FOR DEFAULT OR UNCONTESTED
DISSOLUTION LEGAL SEPARATION
(NOTE: Items 1 through 12 apply to both dissolution and legal separation proceedings.)
I declare that if I appeared in court and were sworn, I would testify to the truth of the facts in this declaration.
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.
Petition Response
is true and correct.
All the information in the
Default without agreement
No response has been filed and there is no written agreement or stipulated judgment between the parties;
a.
No response has been filed and the parties have agreed that the matter may proceed as a default matter without
notice; and
(2)
Default with agreement
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.
The following statement is true
(check one):
Page 1 of 3
DECLARATION FOR DEFAULT OR UNCONTESTED
DISSOLUTION OR LEGAL SEPARATION
(Family Law)
Form Adopted for Mandatory Use
Judicial Council of California
FL-170 [Rev. July 1, 2012]
Family Code, § 2336
www.courts.ca.gov
1.
2.
3.
b.
ATTORNEY OR PARTY WITHOUT ATTORNEY
(Name, State Bar number, and address):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
TELEPHONE NO.:
ATTORNEY FOR
(Name):
FAX NO.
(Optional):
E-MAIL ADDRESS
(Optional):
The default of the respondent was entered or is being requested, and I am not seeking any relief not requested in the
petition; and
Type of case
(check a, b, or c):
4.
(1)
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
(B)
division of the property and debts, or if there is a negative estate, the debts are assigned fairly and equitably.
There are no assets or debts to be disposed of by the court.
(3)
(A)
(2)
(1)
Both parties have appeared in the case; and
Uncontested
c.
(2)
(1)
Declaration of disclosure
(check a, b, or c):
Both the petitioner and respondent have filed, or are filing concurrently, a
Declaration Regarding Service of Declaration
a.
of Disclosure
(form FL-141) and an
Income and Expense Declaration
(form FL-150).
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
b.
FL-140) from the respondent.
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
another, separate stipulation.
c.
5.
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.
amended
Sacramento
3341 Power Inn Road
Sacramento, CA 95826
William R. Ridgeway Family Relations Courthouse
PETITIONER:
CASE NUMBER:
RESPONDENT:
Child support
should be ordered as set forth in the proposed
Judgment
(form FL-180).
7.
b.
am receiving am not receiving intend to apply for public assistance for the child or children
To the best of my knowledge, the other party is is not receiving public assistance.
The 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.
If there are minor children, check and complete item (1) if applicable and item (2) or (3):
a.
petitioner’s respondent’s earning ability. The facts in support I request that this order be based on the
(3)
of my estimate of earning ability are
(specify):
Continued on Attachment 7a(3).
FL-170 [Rev. July 1, 2012]
DECLARATION FOR DEFAULT OR UNCONTESTED
DISSOLUTION OR LEGAL SEPARATION
(Family Law)
I
listed in the proposed order.
Page 2 of 3
FL-170
6.
Child custody and visitation (parenting time)
should be ordered as set forth in the proposed
Judgment
(form FL-180).
d.
Facts in support of requested judgment (
In a default case, state your reasons below):
Contained on Attachment 6d.
The information in the child support calculation attached to the proposed judgment is correct based on my
personal knowledge.
(2)
a.
The information in
Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act
(UCCJEA) (form FL-105)
has not changed since it was last filed with the court.
(If changed, attach updated form.)
has
Complete items (1) and (2) regarding public assistance.
(2)
(1)
c.
Spousal, Partner, and Family Support
(If a support order or attomey 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
(name):
I ask the court to terminate forever spousal or partner support for:
c.
d.
8.
Family support should be ordered as set forth in the proposed
Judgment
(form FL-180).
e.
b.
There is an existing court order for custody/parenting time in another case in
(county)
:
The case number is
(specify):
Child support is being enforced in another case in
(county):
The case number is
(specify):
(1)
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:
petitioner respondent.
Other
(specify):
f.
c.
The current custody and visitation (parenting time) previously ordered in this case, or current schedule is
(specify):
Spousal or Partner Support Declaration Attachment
(form FL-157)
written agreement
attached declaration
(Attachment 8d.)
Contained on Attachment 6c.
THIS STATEMENT APPLIES ONLY TO LEGAL SEPARATIONS
I ask that the court grant the request for 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.
Other
(specify):
19.
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)
18.
PETITIONER:
CASE NUMBER:
RESPONDENT:
FL-170
FL-170 [Rev. July 1, 2012]
DECLARATION FOR DEFAULT OR UNCONTESTED
DISSOLUTION OR LEGAL SEPARATION
(Family Law)
Page 3 of 3
STATEMENTS IN THIS BOX APPLY ONLY TO DISSOLUTIONS
If this is a dissolution of marriage or of a domestic partnership created in another state, the petitioner and/or the respondent
have been residents 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.
I ask that the court grant the request for a judgment for 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.
This declaration is for the termination of
marital or domestic partner status only.
I ask the court to reserve jurisdiction
over all issues whose determination is not requested in this declaration.
15.
16.
There are irreconcilable differences that 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.
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.
13.
14.
12. respondent requests restoration of his or her former name as set forth in the proposed
Judgment
(form FL-180).
The petitioner
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).
10.
Attorney fees
should be ordered as set forth in the proposed
Judgment
(form FL-180)
a.
A Voluntary Declaration of Paternity is attached.
11. The judgment should be entered nunc pro tunc for the following reasons
(specify)
:
b. Parentage was previously established by the court in
(county):
The case number is
(specify):
facts in support in form FL-319
other
(specify facts below)
:
Written agreement of the parties attached here or to the
Judgment
(form FL-180).
Form Adopted for Mandatory Use
Judicial Council of California
FL-180 [Rev. July 1, 2012]
CASE NUMBER:
JUDGMENT
NULLITYLEGAL SEPARATIONDISSOLUTION
Status only
Reserving jurisdiction over termination of marital or domestic
partnership status
Date marital or domestic partnership status ends:
Default or uncontested By declaration under Family Code section 2336This proceeding was heard as follows:
Contested
Room:Dept.:Date:
Temporary judge
Judicial officer
(name):
Attorney present in court
(name):
Claimant present in court
(name):
c.
d.
Attorney present in court
(name):
e.
The court acquired jurisdiction of the respondent on
(date):
The respondent appeared.
The respondent was served with process.
THE COURT ORDERS, GOOD CAUSE APPEARING
Judgment of dissolution is entered. Marital or domestic partnership status is terminated and the parties are restored to the
status of single persons
a.
on
(specify date):
(1)
(2)
Judgment of nullity is entered. The parties are declared to be single persons on the ground of
(specify):
b.
c.
petitioner's
e.
f.
d.
JUDGMENT
(Family Law)
Family Code, §§ 2024, 2340,
2343, 2346
www.courts.ca.gov
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER:
FL-180
TELEPHONE NO.:
ATTORNEY OR PARTY WITHOUT ATTORNEY
(Name, State Bar number, and address):
ATTORNEY FOR
(Name):
FAX NO.
(Optional):
RESPONDENT:
1.
2.
3.
4.
a.
b.
Petitioner present in court
Respondent present in court Attorney present in court
(name):
on a date to be determined on noticed motion of either party or on stipulation.
Judgment of legal separation is entered.
This judgment will be entered nunc pro tunc as of
(date):
Jurisdiction is reserved over all other issues, and all present orders remain in effect except as provided below.
This judgment
The restraining orders are contained on page(s) of the attachment. They expire on
(date):
MARRIAGE OR PARTNERSHIP OF
former name is restored to
(specify):
respondent's
Judgment on reserved issues
f. Other
(specify name):
g.
Judgment on reserved issues.
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
contains personal conduct restraining orders
modifies existing restraining orders.
a.
b.
E-MAIL ADDRESS
(Optional):
The
Agreement in court
Sacramento
3341 Power Inn Road
Sacramento, CA 95826
William R. Ridgeway Family Relations Courthouse
FL-180 [Rev. July 1, 2012]
JUDICIAL OFFICER
Date:
Number of pages attached:
Parentage is established for children of this relationship born prior to the marriage or domestic partnership
CASE NAME
(Last name, first name of each party):
CASE NUMBER:
k.
Child support is ordered as set forth in the attached
Previously established in another case. Case number: Court:
j.
l.
Child custody and visitation (parenting time) are ordered as set forth in the attached
Spousal, domestic partner, or family support is ordered:
As set forth in the attached
Spousal, Partner, or Family Support Order Attachment
(form FL-343).
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.
5.
JUDGMENT
(Family Law)
Page 2 of 2
4.
Stipulation to Establish or Modify Child Support and Order
(form FL-350).
SIGNATURE FOLLOWS LAST ATTACHMENT
Stipulation and Order for Custody and/or Visitation of Children
(form FL-355).
Reserved for future determination as relates to petitioner respondent
Other
(specify):
o.
(2)
(3)
(2)
(3)
(4)
(1)
(3)
(4)
Property division is ordered as set forth in the attached
m.
Settlement agreement, stipulation for judgment, or other written agreement.
Other
(specify):
Property Order Attachment to Judgment
(form FL-345).
(1)
(2)
(3)
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.
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.
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.
NOTICE
FL-180
i.
Name Birthdate
The children of this marriage or domestic partnership are:
(2)
(1)
Attorney fees and costs are ordered as set forth in the attached
n.
Attorney Fees and Costs Order
(form FL-346).
Other
(specify):
(2)
(3)
Other
(specify):
As set forth in the attached settlement agreement, stipulation for judgment, or other written agreement.
(5)
Jurisdiction terminated to order spousal or partner support to petitioner respondent
(2)
Settlement agreement, stipulation for judgment, or other written agreement which contains the information
required by Family Code section 3048(a).
(1)
Settlement agreement, stipulation for judgment, or other written agreement which contains the declarations
required by Family Code section 4065(a).
(1)
Child Custody and Visitation Order Attachment
(form FL-341).
Child Support Information and Order Attachment
(form FL-342).
Previously established in another case. Case number: Court:
(4)
Settlement agreement, stipulation for judgment, or other written agreement.
(1)
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.
1.
—NOTICE TO ATTORNEY OF RECORD OR PARTY WITHOUT ATTORNEY—
Form Adopted for Mandatory Use
Judicial Council of California
FL-190 [Rev. January 1, 2005]
NOTICE OF ENTRY OF JUDGMENT
(Family Law—Uniform Parentage—Custody and Support)
Family Code, §§ 2338, 7636,7637
www.courtinfo.ca.gov
Page 1 of 1
You are notified that the following judgment was entered on (date):
FL-190
ATTORNEY FOR (Name):
E-MAIL ADDRESS (Optional):
FAX NO. (Optional):
TELEPHONE NO.:
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
BRANCH NAME:
CITY AND ZIP CODE:
PETITIONER:
RESPONDENT:
NOTICE OF ENTRY OF JUDGMENT
FOR COURT USE ONLY
CASE NUMBER:
(specify):
Dissolution
Dissolution—status only
Dissolution—reserving jurisdiction over termination of marital status or domestic partnership
2.
3.
4.
Legal separation
Nullity
Parent-child relationship
5.
6.
Judgment on reserved issues
Other
7.
8.
Date:
, Deputy
Clerk, by
________________________________
STATEMENT IN THIS BOX APPLIES ONLY TO JUDGMENT OF DISSOLUTION
Effective date of termination of marital or domestic partnership status
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.
(specify):
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
CLERK’S CERTIFICATE OF MAILING
at (place):
, California,
on (date):
, Deputy
Clerk, by ________________________________
Date:
Name and address of respondent or respondent's attorney
Name and address of petitioner or petitioner's attorney
Sacramento
3341 Power Inn Road
3341 Power Inn Road
William R. Ridgeway Family Relations Courthouse
Sacramento, CA 95826
d.
a.
(name):
will be as follows:
The parties will go to child custody mediation or child custody recommending counseling at (specify date, time, and
No Visitation (Parenting Time)
Visitation (Parenting Time) for the
petitioner
respondent other
location):
-page document See the attached
b.
c.
e.
Reasonable right of visitation to the party without physical custody (not appropriate in cases involving domestic
violence)
(1)
at
(day of week) (time)
from
1st 2nd 3rd 4th 5th weekend of the month
p.m./ if applicable, specify:a.m.
at
(day of week) (time)
to
a.m.
p.m./ if applicable, specify:
after school
start of school
after school
start of school
(Note: The first weekend of the month is the first weekend with a Saturday.)
(date):
Weekends starting
(b)
(a)
having the initial fifth weekend, which starts (date):
The parties will alternate the fifth weekends, with the
other parent/party
respondent
petitioner
even numbered months.odd
The other parent/party respondentpetitioner will have the
CHILD CUSTODY AND VISITATION (PARENTING TIME)
ORDER ATTACHMENT
Family Code, §§ 3020, 3022, 3025,
3040–3043, 3048, 3100, 6340, 7604
www.courts.ca.gov
Form Approved for Optional Use
Judicial Council of California
FL-341 [Rev. July 1, 2016]
5.
7.
Page 1 of 3
Penalties for violating this order. If you violate this order, you may be subject to civil or criminal penalties, or both.
4.
6.
THIS IS A COURT ORDER.
CHILD CUSTODY AND VISITATION (PARENTING TIME) ORDER ATTACHMENT
TO
Stipulation and Order fo Custody and/or Visitation of Children (form FL-355)
Findings and Order After Hearing (form FL-340) Judgment (form FL-180) Judgment (form FL-250)
Other (specify):
1.
2.
Jurisdiction. This court has jurisdiction to make child custody orders in this case under the Uniform Child Custody Jurisdiction and
Enforcement Act (Fam. Code, §§ 3400–3465).
Notice and opportunity to be heard. The responding party was given notice and an opportunity to be heard, as provided by the
laws of the State of California.
3. Country of habitual residence. The country of habitual residence of the child or children in this case is
(specify):
Other
the United States
Child Custody. Custody of the minor children of the parties is awarded as follows:
Child abduction prevention. There is a risk that one of the parties will take the children out of California without the other
party's permission. (Child Abduction Prevention Orders Attachment (form FL-341(B)) must be attached and must be obeyed.)
Visitation (Parenting Time)
Child's Name
Legal custody to: (person who makes
decisions about health, education, etc.)
Birth Date
Physical custody to:
(person with whom child lives)
FL-341
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
fifth weekend in
10.
a.
c.
b.
(specify):
the state of California.
the following counties
other places
(specify):
9.
b.
c.
d.
a.
(address):
(specify):
Transportation to begin the visits will be provided by the
Transportation from the visits will be provided by the
The exchange point at the beginning of the visit will be at
The exchange point at the end of the visit will be at
During the exchanges, the party driving the children will wait in the car and the other party will wait in his or her
home (or exchange location) while the children go between the car and the home (or exchange location).
Other (specify):
other
respondent petitioner
(address):
(specify):
other
respondent petitioner
The children must be driven only by a licensed and insured driver. The car or truck must have legal child restraint
devices.
f.
g.
e.
8.
(specify):
FL-341 [Rev. July 1, 2016]
(You must attach Supervised Visitation Order (form FL-341(A).)
must have written permission from the other parent or a court order to take the children out of
The
(name):
will have supervised visitation (parenting time) with the minor children according to the schedule set forth on page 1.
(2)
Alternate weekends starting
(date):
at
(day of week) (time)
from
a.m.
p.m./ if applicable, specify:
at
(day of week)
to a.m.
p.m./ if applicable, specify:
after school
start of school
after school
start of school
after school
start of school
after school
start of school
(time)
(3)
(date):
Weekdays starting
at
(day of week) (time)
from
at
(day of week) (time)
to
(4)
Other visitation (parenting time) days and restrictions are:
listed in Attachment 7e(4) (form
as follows:
MC-025 may be used for this purpose)
p.m./ if applicable, specify:
a.m.
a.m.
p.m./ if applicable, specify:
e.
Visitation (Parenting Time) (continued)
Supervised visitation (parenting time). Until
Transportation for visitation (parenting time)
further order of the court other
other
respondent petitioner
Travel with children. The
petitioner respondent other parent/party
(name):
CHILD CUSTODY AND VISITATION (PARENTING TIME)
ORDER ATTACHMENT
Page 2 of 3
THIS IS A COURT ORDER.
FL-341
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
7.
12.
13.
15.
attached schedule. (Additional Provisions—Physical Custody Attachment (form FL-341(D)) may be used for this purpose.)
(Joint Legal Custody Attachment (form FL-341(E)) may be used for this purpose.)
11. The children will spend holiday time as listed
Holiday Schedule Attachment (form FL-341(C)) may be used for this purpose.)
Other (specify):
FL-341 [Rev. July 1, 2016]
CHILD CUSTODY AND VISITATION (PARENTING TIME)
ORDER ATTACHMENT
Page 3 of 3
THIS IS A COURT ORDER.
Holiday schedule.
below
in the attached schedule (Children's
The parties will follow the additional custody provisions listed
Additional custody provisions.
below in the
The parties will share joint legal custody as listed Joint legal custody.
in the attached schedule. below
14. Access to children's records. Both the custodial and noncustodial parent have the right to access records and information
about their minor children (including medical, dental, and school records) and consult with professionals who are providing services
to the children.
FL-341
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
FL-342
CHILD SUPPORT INFORMATION AND ORDER ATTACHMENT
TO
THE COURT USED THE FOLLOWING INFORMATION IN DETERMINING THE AMOUNT OF CHILD SUPPORT:
1.
2.
Gross monthly
income
Net monthly
income
Receiving
TANF/CaIWORKS
Each parent’s monthly income is as follows:
Imputation of income. The court finds that the
and has based the support order upon this imputed income.
3.
%
%
4.
Hardships for the following have been allowed in calculating child support:
Petitioner/
plaintiff
Respondent/
defendant
Approximate ending time
for the hardship
a.
b.
c.
THE COURT ORDERS
5.
6.
a.
Base child support
(date): and continuing until further order of the court, or until the child marries, dies, is emancipated, reaches
age 19, or reaches age 18 and is not a full-time high school student, whichever occurs first, as follows:
Payable to (name):
Date of birth Monthly amount
one-half on the 1st and one-half on the 15th of the monthPayable
THIS IS A COURT ORDER.
Page 1 of 3
CHILD SUPPORT INFORMATION AND ORDER ATTACHMENT
Form Adopted for Mandatory Use
Judicial Council of California
FL-342 [Rev. January 1, 2017]
Family Code, §§ 4055–4069
www.courts.ca.gov
Child’s name
%
must pay child support beginning
has the capacity to earn:
a.
b.
Other parent/
party
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
CASE NUMBER:
a.
b.
Petitioner/plaintiff: $
Respondent/defendant: $
Other parent/party: $
$
$
$
$
$
$
$
$
$
$
$
$
Number of children who are the subjects of the support order (specify):
Approximate percentage of time spent with petitioner/plaintiff:
Respondent/defendant:
Other parent/party:
The low-income adjustment applies.
Other minor children:
Extraordinary medical expenses:
Catastrophic losses:
Child support
Petitioner/plaintiff
Respondent/defendant Other parent/party
Petitioner/plaintiff
Respondent/defendant
Other parent/party
Hardships
Children of this relationship
Income
Low-income adjustment
Findings and Order After Hearing (form FL-340)
Restraining Order After Hearing (CLETS-OAH) (form DV-130)
Judgment (form FL-180)
$
per
(specify):
on the 1st of the month
Other
a.
b.
other (specify):
The low-income adjustment does not apply because (specify reasons):
A printout of a computer calculation and findings is attached and incorporated in this order for all required items not filled out
below.
This order does not meet the child support guideline set forth in Family Code section 4055. Non-Guideline Child Support
Findings Attachment (form FL-342(A)) is attached.
(1)
(2)
their respective places of employment or self-employment. Both parties are ordered to cooperate in the presentation, collection,
and reimbursement of any health-care claims. The parent ordered to provide health insurance must seek continuation of
coverage for the child after the child attains the age when the child is no longer considered eligible for coverage as a dependent
under the insurance contract, if the child is incapable of self-sustaining employment because of a physically or mentally
disabling injury, illness, or condition and is chiefly dependent upon the parent providing health insurance for support and
maintenance.
THIS IS A COURT ORDER.
Page 2 of 3
CHILD SUPPORT INFORMATION AND ORDER ATTACHMENT
FL-342 [Rev. January 1, 2017]
d.
7.
Health-care expenses
Health insurance coverage for the minor children of the parties must be maintained by the
a.
per month.
per month.
per month.
per month.
per month.
per month.
if available at no or reasonable cost through
FL-342
(2)
Reasonable uninsured health-care costs for the children
per month.
per month.
per month.
c.
Mandatory additional child support
THE COURT FURTHER ORDERS
per month child-care costs.
(d)
(c)
6. b.
(1)
Child-care costs related to employment or reasonably necessary job training
per month
per month
child-care costs.
child-care costs.
(a)
(b)
e.
Child Support Order Suspension
f.
When a person who has been ordered to pay child support is in jail or prison or is involuntarily institutionalized for any period
of more than 90 days in a row, the child support order is temporarily stopped. However, the child support order will not be
stopped if the person who owes support has the financial ability to pay that support while in jail, prison, or an institution. It will
also not be stopped if the reason the person is in jail, prison, or an institution is because the person didn't pay court ordered
child support or committed domestic violence against the supported person or child. The child support order starts again on
the first day of the month after the person is released from jail, prison, or an institution.
Total child support per month: $
$
$
$
$
$
$
$
$
$
$
$
$
Mandatory additional child support
Additional child support
Non-Guideline Order
Petitioner/plaintiff must pay:
Respondent/defendant must pay:
Other parent/party must pay:
Costs to be paid as follows
(specify):
(d)
(c)
(a)
(b)
Petitioner/plaintiff must pay:
Respondent/defendant must pay:
Other parent/party must pay:
Costs to be paid as follows
(specify):
(d)
(c)
(a)
(b)
Petitioner/plaintiff must pay:
Respondent/defendant must pay:
Other parent/party must pay:
Costs to be paid as follows
(specify):
(d)
(c)
(a)
(b)
Petitioner/plaintiff must pay:
Respondent/defendant must pay:
Other parent/party must pay:
Costs to be paid as follows
(specify):
Costs related to the educational or other special needs of the children
Travel expenses for visitation
petitioner/plaintiff
respondent/defendant other parent/party
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
CASE NUMBER:
% of total or
% of total or
% of total or
% of total or
% of total or
% of total or
% of total or
% of total or
% of total or
% of total or
% of total or
% of total or
Notices
a.
Notice of Rights and Responsibilities (Health-Care Costs and Reimbursement Procedures) and Information Sheet on Changing
a Child Support Order (form FL-192) must be attached and is incorporated into this order.
Child Support Case Registry Form
Both parties must complete and file with the court a Child Support Case Registry Form (form FL-191) within 10 days of the date of
this order. Thereafter, the parties must notify the court of any change in the information submitted within 10 days of the change by
filing an updated form.
NOTICE: Any party required to pay child support must pay interest on overdue amounts at the legal rate, which is currently
10 percent per year.
THIS IS A COURT ORDER.
Page 3 of 3
CHILD SUPPORT INFORMATION AND ORDER ATTACHMENT
FL-342 [Rev. January 1, 2017]
FL-342
11.
12.
13.
If this form is attached to Restraining Order After Hearing (form DV-130), the support orders issued on this form (form FL-342)
remain in effect after the restraining orders issued on form DV-130 end.
b.
9.
In the event that there is a contract between a party receiving support and a private child support collector, the party ordered to pay
support must pay the fee charged by the private child support collector. This fee must not exceed 33 1/3 percent of the total
amount of past due support nor may it exceed 50 percent of any fee charged by the private child support collector. The money
judgment created by this provision is in favor of the private child support collector and the party receiving support, jointly.
is ordered to seek employment with the
10.
8.
Earnings assignment
An earnings assignment order is issued. Note: The payor of child support is responsible for the payment of support directly to the
recipient until support payments are deducted from the payor’s wages and for payment of any support not paid by the assignment.
b.
c.
at a reasonable cost at this time.
7.
following terms and conditions:
petitioner/plaintiff
respondent/defendant other parent/party
The party providing coverage must assign the right of reimbursement to the other party.
Health insurance is not available to the
Petitioner/plaintiff
Respondent/defendant Other parent/party
Employment search order (Family Code § 4505)
Other orders (specify):
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
CASE NUMBER:
FL-191
ATTORNEY OR PARTY WITHOUT ATTORNEY
(Name, State Bar number, and address):
COURT PERSONNEL:
STAMP DATE RECEIVED HERE
DO NOT FILE
CHILD SUPPORT CASE REGISTRY FORM
CASE NUMBER:
Mother First form completed
Father
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.
ModificationInitial child support or family support orderb.
Total monthly base current child or family support amount ordered for children listed below, plus any monthly amount ordered
payable on past-due support
:
(1) Current
base child
support:
(2) Additional
monthly
support:
Person required to pay child or family support
(name):
Relationship to child
(if applicable):
Person or agency to receive child or family support payments
(name):
TYPE OR PRINT IN INK
Page 1 of 4
Family Code, § 4014
Form Adopted for Mandatory Use
Judicial Council of California
FL-191 [Rev. July 1, 2005]
CHILD SUPPORT CASE REGISTRY FORM
www.courtinfo.ca.gov
Change to previous information
Relationship to child
(specify):
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 PARENT:
(5) Wage withholding was
(date):
ordered but stayed until
Support order information
(this information is on the court order you are filing or have received).
ordered
(3) Total
past-due
support:
$
$
$
Date order filed:
1.
3.
2.
a.
c.
Child Support:
Family Support:
Spousal Support:
$0 (zero) order
Reserved order
(4) Payment
on past-
due support:
$
Current
base family
support:
Additional
monthly
support:
Total
past-due
support:
$
$
$
$0 (zero) order
Reserved order
Payment
on past-
due support:
$
Current
spousal
support:
Total
past-due
support:
$
$
$0 (zero) order
Reserved order
Payment
on past-
due support:
$
Sacramento
3341 Power Inn Road
Sacramento, CA 95826
William R. Ridgeway Family Relations Courthouse
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.
Father’s name:
Date of birth:
Social security number:
Street address:
City, state, zip code:
Mailing address:
Driver’s license number:
State:
Telephone number:
Self-employedEmployed Not employed
g.
Employer’s name:
Street address:
City, state, zip code:
Telephone number:
7.
A restraining order, protective order, or nondisclosure order due to domestic violence is in effect.
Father
Mother
Children
The order protects:
Father
Mother
From:
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)
Page 2 of 4
CHILD SUPPORT CASE REGISTRY FORM
FL-191 [Rev. July 1, 2005]
a.
b.
c.
5.
a.
b.
c.
d.
e.
f.
Mother’s name:
Date of birth:
Social security number:
Street address:
City, state, zip code:
Mailing address:
City, state, zip code:
Driver’s license number:
State:
Telephone number:
Self-employedEmployed Not employed
g.
Employer’s name:
Street address:
City, state, zip code:
Telephone number:
a.
b.
c.
6.
d.
e.
f.
City, state, zip code:
PETITIONER/PLAINTIFF:
CASE NUMBER:
RESPONDENT/DEFENDANT:
OTHER PARENT:
The child support order is for the following children:
Date of birth
Social security number
a.
b.
Additional children are listed on a page attached to this document.
Child’s name
4.
c.
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:
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.
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.”
Information regarding the amount and type of support ordered and wage withholding is on the court order you are filing or have
received.
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.
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.
Page 3 of 4
CHILD SUPPORT CASE REGISTRY FORM
FL-191 [Rev. July 1, 2005]
1. a.
b.
c.
(1)
(2)
Write the name of the person who is supposed to pay child or family support.
Write the name of the person or agency supposed to receive child or family support payments.
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.
If you are the father in this case, list your full name in this space. See instructions for a–g under item 6 below.
If you are the mother in this case, list your full name in this space.
List the street address, city, state, and zip code where you want your mail sent, if different from the address where you live.
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.
If there is a restraining order, protective order, or nondisclosure order, check this box.
Check the box beside the parent who is restrained.
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.
CHILD SUPPORT CASE REGISTRY FORM
FL-191 [Rev. July 1, 2005]
Page 4 of 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.
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.
(3)
(4)
2. a.
b.
3. a.
b.
4.
Write the relationship of that person to the child.
Write the relationship of that person to the child.
6.
5.
Check the box beside each person who is protected by the restraining order.
List your date of birth.
Write your social security number.
List the street address, city, state, and zip code where you live.
Write your driver's license number and the state where it was issued.
List the telephone number where you live.
7.
a.
b.
c.
d.
e.
f.
g.
a.
b.
c.
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.
(5)
FL-192
NOTICE OF RIGHTS AND RESPONSIBILITIES
Health-Care Costs and Reimbursement Procedures
IF YOU HAVE A CHILD SUPPORT ORDER THAT INCLUDES A PROVISION FOR THE
REIMBURSEMENT OF A PORTION OF THE CHILD'S OR CHILDREN'S HEALTH-CARE COSTS
AND THOSE COSTS ARE NOT PAID BY INSURANCE, THE LAW SAYS:
1. Notice. You must give the other parent an itemized
statement of the charges that have been billed for any health-
care costs not paid by insurance. You must give this
statement to the other parent within a reasonable time, but no
more than 30 days after those costs were given to you.
2. Proof of full payment. If you have already paid all of the
uninsured costs, you must (1) give the other parent proof that
you paid them and (2) ask for reimbursement for the other
parent's court-ordered share of those costs.
3. Proof of partial payment. If you have paid only your share
of the uninsured costs, you must (1) give the other parent
proof that you paid your share, (2) ask that the other parent
pay his or her share of the costs directly to the health-care
provider, and (3) give the other parent the information
necessary for that parent to be able to pay the bill.
4. Payment by notified parent. If you receive notice from a
parent that an uninsured health-care cost has been incurred,
you must pay your share of that cost within the time the court
orders; or if the court has not specified a period of time, you
must make payment (1) within 30 days from the time you were
given notice of the amount due, (2) according to any payment
schedule set by the health-care provider, (3) according to a
schedule agreed to in writing by you and the other parent, or
(4) according to a schedule adopted by the court.
5. Disputed charges. If you dispute a charge, you may file a
motion in court to resolve the dispute, but only if you pay that
charge before filing your motion. If you claim that the other
party has failed to reimburse you for a payment, or the other
party has failed to make a payment to the provider after proper
notice has been given, you may file a motion in court to resolve
the dispute. The court will presume that if uninsured costs have
been paid, those costs were reasonable. The court may award
attorney fees and costs against a party who has been
unreasonable.
6. Court-ordered insurance coverage. If a parent provides
health-care insurance as ordered by the court, that insurance
must be used at all times to the extent that it is available for
health-care costs.
a.
Burden to prove. The party claiming that the coverage is
inadequate to meet the child's needs has the burden of
proving that to the court.
b. Cost of additional coverage. If a parent purchases health-
care insurance in addition to that ordered by the court, that
parent must pay all the costs of the additional coverage. In
addition, if a parent uses alternative coverage that costs
more than the coverage provided by court order, that parent
must pay the difference.
7. Preferred health providers. If the court-ordered coverage
designates a preferred health-care provider, that provider
must be used at all times consistent with the terms of the
health insurance policy. When any party uses a health-care
provider other than the preferred provider, any health-care
costs that would have been paid by the preferred health
provider if that provider had been used must be the sole
responsibility of the party incurring those costs.
Page 1 of 2
Form Approved for Optional Use
Judicial Council of California
FL-192 [Rev. January 1, 2021]
Family Code, §§ 4062, 4063
NOTICE OF RIGHTS AND RESPONSIBILITIES
Health-Care Costs and Reimbursement Procedures
www.courts.ca.gov
FL-192
INFORMATION SHEET ON CHANGING A CHILD SUPPORT ORDER
General Information
The court has just made a child support order in your case. This order will remain the same unless a party to the action requests that
the support be changed (modified). An order for child support can be modified only by filing a motion to change child support and
serving each party involved in your case. If both parents and the local child support agency (if it is involved) agree on a new child
support amount, you can complete, have all parties sign, and file with the court a Stipulation to Establish or Modify Child Support and
Order ( ) or Stipulation and Order (Governmental) ( ).
When a Child Support Order May Be Modified
The court takes several things into account when ordering the payment of child support. First, the number of children is considered.
Next, the net incomes of both parents are determined, along with the percentage of time each parent has physical custody of the
children. The court considers both parties’ tax filing status and may consider hardships, such as a child of another relationship. An
existing order for child support may be modified when the net income of one of the parents changes significantly, the parenting
schedule changes significantly, or a new child is born.
Examples
You have been ordered to pay $500 per month in child support. You lose your job. You will continue to owe $500 per month, plus
10 percent interest on any unpaid support, unless you file a motion to modify your child support to a lower amount and the court
orders a reduction.
You are currently receiving $300 per month in child support from the other parent, whose net income has just increased
substantially. You will continue to receive $300 per month unless you file a motion to modify your child support to a higher amount
and the court orders an increase.
You are paying child support based upon having physical custody of your children 30 percent of the time. After several months it
turns out that you actually have physical custody of the children 50 percent of the time. You may file a motion to modify child
support to a lower amount.
How to Change a Child Support Order
To change a child support order, you must file papers with the court. Remember: You must follow the order you have now.
What forms do I need?
If you are asking to change a child support order, you must fill out one of these forms:
, Request for Order or
, Notice of Motion and Motion for Simplified Modification of Order for Child, Spousal, or Family Support
You must also fill out one of these forms:
, Income and Expense Declaration or
, Financial Statement (Simplified)
What if I am not sure which forms to fill out?
Talk to the family law facilitator at your court.
After you fill out the forms, file them with the court clerk and ask for a hearing date. Write the hearing date on the form.
The clerk may ask you to pay a filing fee. If you cannot afford the fee, fill out these forms, too:
, Request to Waive Court Fees
, Order on Court Fee Waiver (Superior Court)
You must serve the other parent. If the local child support agency is involved, serve it too.
This means someone 18 or over—not you—must serve the other parent copies of your filed court forms at least 16 court days before
the hearing. Add 5 calendar days if you serve by mail within California (see Code of Civil Procedure section 1005 for other situations).
Court days are weekdays when the court is open for business (Monday through Friday except court holidays). Calendar days include
all days of the month, including weekends and holidays. To find court holidays, go to .
The server must also serve blank copies of these forms:
, Responsive Declaration to Request for Order and , Income and Expense Declaration,or
, Financial Statement (Simplified)
Then the server fills out and signs a Proof of Service ( or ). Take this form to the clerk and file it.
Go to your hearing and ask the judge to change the support. Bring your tax returns from the last two years and your last two
months' pay stubs. The judge will look at your information, listen to both parents, and make an order. After the hearing, fill out:
, Findings and Order After Hearing and
, Child Support Information and Order Attachment
Need help?
Contact the in your county or call your county's bar association and ask for an experienced family lawyer.
FL-192 [Rev. January 1, 2021]
NOTICE OF RIGHTS AND RESPONSIBILITIES
Health-Care Costs and Reimbursement Procedures
Page 2 of 2
form FL-350
form FL-625
Form FL-300
Form FL-390
Form FL-150
Form FL-155
Form FW-001
Form FW-003
www.courts.ca.gov/holidays.htm
Form FL-320
form FL-150
Form FL-155
form FL-330
form FL-335
Form FL-340
Form FL-342
family law facilitator