Fillable REQUEST FOR ORDER HOW TO GET OR CHANGE (California)

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REQUEST FOR ORDER HOW TO GET OR CHANGE (California)

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HOW TO GET OR CHANGE ORDERS FOR CHILD SUPPORT,
SPOUSAL SUPPORT, CUSTODY, VISITATION
REQUEST FOR ORDER
YOU MUST FIRST HAVE AN EXISTING CASE – A DISSOLUTION,
LEGAL SEPARATION, NULLITY, PARENTAGE OR A
CHILD SUPPORT CASE WITH THE DEPARTMENT OF
CHILD SUPPORT SERVICES
1. COMPLETE THE FORMS
(Type or print in black ink)
IN ALL CASES
Request for Order
IF CHILD SUPPORT, SPOUSAL SUPPORT, OR ATTORNEY FEES,
add
Income & Expense Declaration
or
Financial Statement- Simplified
IF EMERGENCY ORDERS ARE REQUESTED,
add
Temporary Orders
Declaration re Ex Parte Notice
2. MAKE COPIES
You will need to make two more copies of each form, front and
back. If the Department of Child Support Services is involved,
you need three copies, not two.
3. FILE THE PAPERS
Take the originals and copies to the Clerk’s Office, in Ventura,
Room 208. You will have to pay a filing fee. If you are the
Respondent or Claimant and this is the first paper you have filed,
you will also have to pay the original filing fee. The Fee Schedule
may be obtained from the Clerk. If you cannot afford the fee,
you may be able to have that fee “waived”. You will need to
complete the FEE WAIVER PACKET. The clerk will keep the
originals and return the copies to you, stamped to show that they
have been “filed”. The filed document will also include your
court date. One copy is for you. The others must be “served” on
the other party or parties.
07/12
4. “SERVE’ THE PAPERS
“Service” means that someone other than you, over the age of
18, must
personally
deliver or mail a copy of the filed papers to
the other party or parties. Remember that the Department of
Child Support Services is considered a party.
Personal
Service
must be completed at least 16
court days
prior to the hearing
date. If
serving by mail
, add 5 additional days prior to the
hearing. You must also have served on the other party a package
of blank forms so that they can file their Response. Those blank
forms are at the back of the Forms packet.
5. FILE THE PROOF OF SERVICE
The person who “serves” the papers must complete and sign a
“Proof of Service” for each party who had been served. Each
“Proof of Service” must then be filed with the court.
IF YOU ARE ASKING FOR CUSTODY OR VISITATION
ORDERS IN AN EXISTING DEPARTMENT OF CHILD
SUPPORT SERVICES CASE YOU MAY NEED TO TAKE
ADDITIONAL STEPS TO “JOIN” THE OTHER PARENT IN
THE CASE. YOU CAN SEE IF THIS IS NECESSARY AT
ANY OF THE FAMILY LAW SELF-HELP CENTERS.
G:\COMMON\Admin\Family Law\Packet Instructions & Forms\HOW TO GET OR CHANGE ORDERS FOR CHILD
SUPPORT.doc
07/12
G:\Common\Admin\!Projects\Local Forms\Packet Inserts\PI.10.doc Revised 02/25/16
HOW TO GET EMERGENCY ORDERS
You may ask for emergency orders if you feel you are in danger (restraining orders) or if
you need emergency custody orders to protect the minor children. See Local Rules on
reverse of this form.
Follow these steps to request emergency orders:
1. COMPLETE THE FORMS: You may obtain the forms from the Clerk’s Office, Family
Law Facilitator, the Court Website at www.ventura.courts.ca.gov or the Judicial Council
Website at www.courtinfo.gov.
2. PICK A DATE AND TIME FOR YOUR HEARING: See the schedule on reverse.
3. GIVE NOTICE TO THE OTHER PARTY:
You must tell the other party that you are
filing for this Emergency Hearing by 10 a.m. the court day before the hearing. In some
cases, you may not have to give notice – ask the Family Law Facilitator or an attorney if you
believe you would be in danger if you told the other party about this request.
NOTICE: If there is a restraining order issued against you in this case, you may not give
notice. Someone else must give notice.
4. FILE YOUR PAPERS: Be sure to file your papers with Clerk’s office no later than
2 hours before your hearing but, if possible, the day before the hearing to allow the judge
time to read your papers. If the papers are not filed on time, your case will not be heard.
5. ATTEND THE HEARING: If the judge grants your request, you will file the signed
temporary order and have the other party served with the filed papers and the order. These
emergency orders are made for only a short period of time. You will need to come back to
court in about 3 weeks or your orders may expire.
6. SERVE THE PAPERS AND ORDER ON THE OTHER PARTY:
Someone other than you
must give these papers and the order to the other party. Whoever does this must sign a
paper called a Proof of Service verifying that the papers were given to the other party
personally. You may ask the Sheriff’s Department to serve the papers. There may be a cost
to do this.
7. FILE THE PROOF OF SERVICE WITH THE COURT:
If you have not served the other
party or do not have proof that the other party was served, the judge will not hear your case.
Your case will be continued so that the papers can be served.
8. ATTEND THE SECOND HEARING: You should have an order prepared for the judge
to sign.
If you are low income or receive public assistance benefits, you may ask for a fee waiver
so you do not have to pay any filing fees. (For Domestic Violence cases there is no fee)
G:\Common\Admin\!Projects\Local Forms\Packet Inserts\PI.10.doc Revised 02/25/16
→ → → IMPORTANT!!! PLEASE READ THESE LOCAL RULES
Local Rule 9.04 Family Law Ex Parte Matters
A. EMERGENCY ORDER APPLICATIONS DISFAVORED
Emergency Orders applications are strongly disfavored. Whenever possible, in lieu of an
emergency order, the court will issue orders shortening time and set the matter for full hearing at
the regular family law and motion calendar. However, orders shortening time are also disfavored,
and must be supported by a substantial showing of need.
B. DETERMINATION BASED ON PLEADINGS
It is the court's policy to determine emergency orders based on the pleadings submitted. Thus,
requests for emergency orders normally will be determined without giving either party an
opportunity for oral argument or discussion with the court.
California Rule of Court 5.151 (d) (5) Contents of Application and Declaration
D. APPLICATIONS REGARDING CHILD CUSTODY OR VISITATION (PARENTING TIME)
Applications for emergency orders granting or modifying child custody or visitation (parenting time)
under Family Code section 3064 must: (A) Provide a full, detailed description of the most recent
incidents showing i) Immediate harm to the child as defined in Family Code Section 3064(b) or ii)
Immediate risk that the child will be removed from the State of California, (B) Specify the date of
each incident described in (A), (C) Advise the court of the existing custody and visitation
arrangements and how they would be changed by this emergency request, (D) Include a copy of
the current custody orders, if they are available. If no orders exist, explain where and with whom
the child is currently living and (E) include a completed UCCJEA (FL-105) if one has not been
previously filed or if information has changed since previously filed.
HOW TO GET A DATE FOR YOUR HEARING:
Emergency requests are heard Monday through Friday at 11:30 a.m. for cases assigned to
Courtrooms 31, 32, 33 and 35. You must call the secretary to make an appointment:
If your case is assigned to Courtroom 31, 32 or 35 call 289-8762
If your case is assigned to Courtroom 33 call 289-8772
For Domestic Violence, Harassment, Workplace Violence and Gun Violence restraining orders, or
if your case is assigned to Courtroom 34, you do not need to make an appointment. Your case will
be heard Monday through Friday at 1:30 p.m. in Courtroom 34. Exception: A Domestic Violence
request filed in an existing Family Law case will be assigned to and heard in the courtroom of the
Judicial Officer assigned to hear the existing case.
For Elder/Dependant Adult Abuse restraining orders you do not need to make an appointment.
Your case will be heard Monday through Friday at 11:30 a.m. in Courtroom 33.
WARNING to the person served with the Request for Order: The court may make the requested orders without you if you do
not file a Responsive Declaration to Request for Order (form FL-320), serve a copy on the other parties at least nine court days
before the hearing (unless the court has ordered a shorter period of time), and appear at the hearing. (See form FL-320-INFO for
more information.)
Form Adopted for Mandatory Use
Judicial Council of California
FL-300 [Rev. July 1, 2016]
7.
JUDICIAL OFFICER
COURT ORDER
(FOR COURT USE ONLY)
6.
A COURT HEARING WILL BE HELD AS FOLLOWS:
Time:Date:
Address of court
(specify):
Page 1 of 4
REQUEST FOR ORDER
Family Code, §§ 2045, 2107, 6224,
6226, 6320–6326, 6380–6383;
Government Code, § 26826
Cal. Rules of Court, rule 5.92
www.courts.ca.gov
8.
2.
(date):
(date):
TEMPORARY EMERGENCY ORDERS
REQUEST FOR ORDER
CHANGE
Domestic Violence OrderChild Support
Child Custody
Attorney's Fees and Costs
Visitation (Parenting Time) Spousal or Partner Support
Property Control
Other (specify):
FOR COURT USE ONLYFOR COURT USE ONLY
TELEPHONE NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
FAX NO.:
STATE: ZIP CODE:CITY:
STREET ADDRESS:
FIRM NAME:
NAME:
STATE BAR NUMBER:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
CASE NUMBER:
FL-300
1.
a.
b. same as noted above
Dept.: Room.:
other
4.
A Responsive Declaration to Request for Order (form FL-320) must be served on or before
Time for service until the hearing is shortened. Service must be on or before
The parties must attend an appointment for child custody mediation or child custody recommending counseling as follows
(specify date, time, and location):
2WKHUVSHFLI\
Date:
It is ordered that:
The orders in Temporary Emergency (Ex Parte) Orders (form FL-305) apply to this proceeding and must be personally
served with all documents filed with this Request for Order.
(Forms FL-300-INFO and DV-400-INFO provide information about completing this form.)
NOTICE OF HEARING
3.
5.
Other Parent/PartyRespondentPetitioner
TO (name(s)):
PARTY WITHOUT ATTORNEY OR ATTORNEY
Other (specify):
The visitation (parenting time) order was filed on
The order for legal or physical custody was filed on
(date):
(2)
.
The court ordered (specify):
. The court ordered (specify):
(1)
(date):
Attachment 2d.
visitation (parenting time).child custodyThis is a change from the current order for
The orders that I request are in the best interest of the children because (specify):
Attachment 2a.
a.
Form FL-311 Form FL-312
Form FL-341(D)
Form FL-341(C)
Form FL-341(E)
Form FL-305
(specify):
Other
(2)
As follows (specify):
Specified in the attached forms:
(1)
Attachment 2b.
visitation (parenting time) are:child custodyThe orders I request forb.
Child's Name
Date of Birth
Legal Custody to (person who
decides: health, education, etc):
Physical Custody to (person
with whom child lives):
I request that the court make orders about the following children (specify):
c.
Attachment 2c.
d.
REQUEST FOR ORDER
FL-300
Page 2 of 4
FL-300 [Rev. July 1, 2016]
REQUEST FOR ORDER
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
2.
CHILD CUSTODY
VISITATION (PARENTING TIME)
I request temporary emergency orders
The orders are from the following court or courts (specify county and state):
(specify):
(specify):
(specify):
(specify):
Case No. (if known):
Case No. (if known):
Case No. (if known):
Case No. (if known):
Petitioner
Respondent
Other Parent/Party (Attach a copy of the orders if you have one.)
a.
b.
c.
d.
Criminal: County/state
Family: County/state
Juvenile: County/state
Other: County/state
One or more domestic violence restraining/protective orders are now in effect between (specify):
1.
Note:
Place a mark in front of the box that applies to your case or to your request. If you need more space, mark the box for
“Attachment.” For example, mark “Attachment 2a” to indicate that the list of children's names and birth dates continues on a paper
attached to this form. Then, on a sheet of paper, list each attachment number followed by your request. At the top of the paper, write
your name, case number, and “FL-300” as a title. (You may use Attached Declaration (form MC-031
) for this purpose.)
X
RESTRAINING ORDER INFORMATION
FL-300 [Rev. July 1, 2016]
Page 3 of 4
REQUEST FOR ORDER
4.
a. $
Amount requested (monthly):
The court should should make, change, or end the support orders because (specify):
I have completed and filed a current Income and Expense Declaration (form FL-150
) in support of my request.
d.
e.
(date):
end the current support order filed onchangeb.
I want the court to
Attachment 4e.
The court ordered $
c.
This request is to modify (change) spousal or partner support after entry of a judgment.
I have completed and attached Spousal or Partner Support Declaration Attachment (form FL-157) or a declaration
that addresses the same factors covered in form FL-157.
(Note: An Earnings Assignment Order For Spousal or Partner Support (form FL-435
) may be issued.)
per month for support.
I have completed and filed with this Request for Order a current Income and Expense Declaration (form FL-150
) or I filed
a current Financial Statement (Simplified) (form FL-155
) because I meet the requirements to file form FL-155.
c.
(date):
I want to change a current court order for child support filed on
b.
d.
The court should make or change the support orders because (specify):
Attachment 3d.
The court ordered child support as follows (specify):
Monthly amount ($) requested
(if not by guideline)
Child's name and age
a.
I request support for each child
based on the child support guideline.
Attachment 3a.
I request that the court order child support as follows:
(Note: An earnings assignment may be issued. See Income Withholding for Support (form FL-195
)
FL-300
SPOUSAL OR DOMESTIC PARTNER SUPPORT
3.
CHILD SUPPORT
a.
control of the following property that we
The petitioner respondent other parent/party be given exclusive temporary use, possession, and
b.
and liens coming due while the order is in effect:
The petitioner respondent other parent/party be ordered to make the following payments on debts
own or are buying
lease or rent (specify):
c. This is a change from the current order for property control filed on
(date):
Specify in Attachment 5d
the reasons why the court should make or change the property control orders. d.
For:Pay to: Amount: $ Due date:
Pay to: For: Amount: $ Due date:
Pay to: For: Amount: $ Due date:
Pay to: For: Amount: $ Due date:
5.
PROPERTY CONTROL
I request temporary emergency orders
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
I want the court to change or end the orders because (specify):
The Restraining Order After Hearing (form DV-130) was filed on (date):
a.
endchange
I request that the court the personal conduct, stay-away, move-out orders, or other
protective orders made in Restraining Order After Hearing (form DV-130). (If you want to change the orders, complete 7c.)
b.
Attachment 7c.
I request that the court make the following changes to the restraining orders (specify):
c.
Attachment 7d.
d.
10.
I declare under penalty of perjury under the laws of the State of California that the information provided in this form and all attachments
is true and correct.
Page 4 of 4
FL-300 [Rev. July 1, 2016]
REQUEST FOR ORDER
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
). (Civ. Code, § 54.8.)
FACTS TO SUPPORT the orders I request are listed below. The facts that I write in support and attach to this request
cannot be longer than 10 pages, unless the court gives me permission.
The hearing date and service of the the Request for Order to be sooner.
I need the order because (specify):
b.
(number):
court days before the hearing.
To serve the Request for Order no less than
a.
c.
Attachment 9c.
Date:
(TYPE OR PRINT NAME)
(SIGNATURE OF APPLICANT)
OTHER ORDERS REQUESTED (specify):
8.
FL-300
7.
DOMESTIC VIOLENCE ORDER
Attachment 8.
6.
A current Income and Expense Declaration (form FL-150
).
b.
A Supporting Declaration for Attorney's Fees and Costs Attachment (form FL-158
) or a declaration that addresses the
factors covered in that form.
c.
A Request for Attorney's Fees and Costs Attachment (form FL-319
) or a declaration that addresses the factors covered
in that form.
a.
I request attorney's fees and costs, which total (specify amount):
$ . I filed the following to support my request:
ATTORNEY'S FEES AND COSTS
Do not use this form to ask for domestic violence restraining orders! Read form DV-505-INFO, How Do I Ask for a
Temporary Restraining Order, for forms and information you need to ask for domestic violence restraining orders.
Read form DV-400-INFO, How to Change or End a Domestic Violence Restraining Order for more information.
TIME FOR SERVICE / TIME UNTIL HEARING
9.
I urgently need:
•
•
Attachment 10.
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
Form Approved for Optional Use
Judicial Council of California
MC-031 [Rev. July 1, 2005]
ATTACHED DECLARATION
PLAINTIFF/PETITIONER:
CASE NUMBER:
DEFENDANT/RESPONDENT:
MC-031
(This form must be attached to another form or court paper before it can be filed in court.)
DECLARATION
Date:
(SIGNATURE OF DECLARANT)
(TYPE OR PRINT NAME)
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Plaintiff
Other (Specify):
Defendant
Attorney for
Petitioner
Respondent
Page 1 of 1
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.
Print This Form
Clear This Form
For your protection and privacy, please press the Clear
This Form button after you have printed the form.
JUDICIAL SUBPOENA
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
Courtat thethe Honorable
located at
County of
o'clock in theday of noon, and at any recessedin room , on the , 20 , at
or adjourned date, to testify and give evidence as a witness in this action on the part of the
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
result of your failure to comply.
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
I
Calendar No.
THE PEOPLE OF THE STATE OF NEW YORK
TO
Index No.
,
American LegalNet, Inc.
www.USCourtForms.com
Court in
Witness, Honorable , one of the Justices of the
day of , 20County,
COURT
COUNTY OF
Plaintiff(s)
-against-
Defendant(s)
:
:
:
:
:
:
:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mobile Tel. No.:
FAMILY COURT SERVICES INTAKE QUESTIONNAIRE
1. Previous Mediation YES NO
Have the parents previously participated in child custody mediation?
2. Interpreters Required
Is either parent non-English speaking or limited in speaking English?
3. Parent Change of Residence
Has either parent recently moved or is planning to move out of the United States,
State of California, or County of Ventura?
4. Domestic Violence Concerns*
(a) Is there a Restraining or Protective order against either parent?
(b) Have there been any allegations of violence, abuse, or stalking committed
by either parent against the other or the child?
5. Children or Adult Protective Services Involvement
Has either parent been contacted by a Children’s or Adult Services Agency
concerning an abuse/neglect investigation?
6. Child Custody Evaluation
Have the parents participated or been ordered to participate in a child custody evaluation?
When?: ______________________________
7. Party in Jail or Prison
Identify any parent who is expected to be in jail or prison at the time of the Mediation:
___________________________________ ______________________________
Name of parent incarcerated Facility
8. Dependency Petitions
Have any dependency petitions been filed in Juvenile Court related to the parties
children?
_____________________________________________ ______________________
Signature of Petitioner or Attorney for Petitioner Date
_____________________________________________ ______________________
Signature of Respondent or Attorney for Respondent
Date
*Family
Code Section 3181(b) states; “If any party alleging domestic violence in a written declaration under penalty of perjury
or a party protected by a protective order so requests, the mediator will meet with the parties separately and at separate times.”
THIS FORM TO REMAIN CONFIDENTIAL (Family Code §3177)
Mandatory Form
VN163 -
Rev.7/09
FAMILY COURT SERVICES INTAKE QUESTIONNAIRE
IN THE MATTER OF: ________________________________________
CASE NUMBER: ____________________________________________
FOR COURT USE ONLY
VN163
(If you need more space to answer any questions on this form, attach an 8 1/2-by-11-inch sheet of paper and write the
question number before your answer.)
1.
Employment (Give information on your current job or, if you're unemployed, your most recent job.)
Form Adopted for Mandatory Use
Judicial Council of California
FL-150 [Rev. January 1, 2019]
INCOME AND EXPENSE DECLARATION
Family Code, §§ 2030–2032, 2100–2113,
3552, 3620–3634, 4050–4076, 4300–4339
www.courts.ca.gov
Page 1 of 4
Employer:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
FOR COURT USE ONLY
CASE NUMBER:
INCOME AND EXPENSE DECLARATION
PARTY WITHOUT ATTORNEY OR ATTORNEY
STATE: ZIP CODE:CITY:
STREET ADDRESS:
FIRM NAME:
NAME:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
STATE BAR NUMBER:
FL-150
Attach copies
of your pay
stubs for last
two months
(black out
Social
Security
numbers).
a.
Employer's address:
b.
Employer's phone number:
c.
Occupation:
d.
Date job started:
e.
If unemployed, date job ended:
f.
g. I work about hours per week.
h. I get paid $ gross (before taxes)
(If you have more than one job, attach an 8 1/2-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
My age is (specify):
a.
b.
I have completed high school or the equivalent:
Yes
No
If no, highest grade completed (specify):
Number of years of college completed (specify):
c.
Degree(s) obtained
(specify):
Number of years of graduate school completed (specify):
d.
Degree(s) obtained
(specify):
e. I have: professional/occupational license(s)
(specify):
vocational training
(specify):
3.
Tax information
a.
I last filed taxes for tax year
(specify year):
b.
My tax filing status is
single
head of household married, filing separately
married, filing jointly with
(specify name):
c.
I file state tax returns in
California other
(specify state):
I claim the following number of exemptions (including myself) on my taxes (specify):
d.
Other party's income. I estimate the gross monthly income (before taxes) of the other party in this case at (specify): $
4.
This estimate is based on (explain):
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.
(SIGNATURE OF DECLARANT)
Date:
(TYPE OR PRINT NAME)
per month per week
per hour.
Spousal support
Spousal support that I pay by court order from a different marriage ..........................
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.)
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.)
FL-150 [Rev. January 1, 2019] Page 2 of 4
INCOME AND EXPENSE DECLARATION
All other property, (estimate fair market value minus the debts you owe).....
c. real and
personal
* Check the box if the spousal support order or judgment was executed by the parties and the court before January 1, 2019, or if a court-ordered change
maintains the spousal support payments as taxable income to the recipient and tax deductible to the payor.
$
FL-150
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
5.
Salary or wages (gross, before taxes).....................................................................................................a.
Overtime (gross, before taxes)................................................................................................................b.
Commissions or bonuses.........................................................................................................................c.
Public assistance (for example: TANF, SSI, GA/GR) ..................................d.
e.
Partner supportf.
currently receiving
f
rom this marriage
from a different marriage
from this domestic partnership from a different domestic partnership
Pension/retirement fund payments..........................................................................................................g.
Social Security retirement (not SSI).........................................................................................................h.
Disability:i. Social Security (not SSI)
State disability (SDI) Private insurance
Unemployment compensation.................................................................................................................j.
Workers' compensation............................................................................................................................k.
l.
Other (military allowances, royalty payments) (specify):
Investment income (Attach a schedule showing gross receipts less cash expenses for each piece of property.)
6.
Dividends/interest....................................................................................................................................a.
Rental property income...........................................................................................................................b.
Trust income............................................................................................................................................c.
d.
Other (specify):
Income from self-employment, after business expenses for all businesses.........................................7.
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.
Additional income. I received one-time money (lottery winnings, inheritance, etc.) in the last 12 months (specify source and
amount):
8.
Change in income. My financial situation has changed significantly over the last 12 months because (specify):
9.
10.
Deductions
Required union dues....................................................................................................................................................a.
Required retirement payments (not Social Security, FICA, 401(k), or IRA)..................................................................b.
Medical, hospital, dental, and other health insurance premiums (total monthly amount).............................................
c.
Child support that I pay for children from other relationships.......................................................................................d.
e.
Partner support that I pay by court order from a different domestic partnership..........................................................f.
Necessary job-related expenses not reimbursed by my employer (attach explanation labeled "Question 10g").........
g.
11.
Assets
Cash and checking accounts, savings, credit union, money market, and other deposit accounts...............................a.
Stocks, bonds, and other assets I could easily sell.......................................................................................................b.
$
$
$
$
$
$
$
$
$
$
$
$
Last month
Average
monthly
$
$
$
$
$
Last month
Total
federally taxable*
federally tax deductible*
$
$
$
$
$
$
$
$
$
The following people live with me:
FL-150 [Rev. January 1, 2019] Page 3 of 4
INCOME AND EXPENSE DECLARATION
FL-150
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
12.
Attorney fees (This information is required if either party is requesting attorney fees):
15.
a.
b.
c.
d.
My attorney's hourly rate is (specify):
I confirm this fee arrangement.
Average monthly expenses13. Estimated expenses
Actual expenses Proposed needs
Installment payments and debts not listed above14.
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): $
(SIGNATURE OF DECLARANT)
Date:
(TYPE OR PRINT NAME)
Name
Age
How the person is
related to me (ex: son)
That person's gross
monthly income
Pays some of the
household expenses?
a.
b.
c.
d.
e.
Yes
No
Yes No
Yes No
Yes No
Yes No
a.
Home:
(1) Rent or
mortgage..........
$
$
$
$
$
$
If mortgage:
(a) average principal:
$
(b) average interest:
$
(2) Real property taxes..................................
(3)
Homeowner's or renter's insurance
(if not included above)..............................
(4) Maintenance and repair...........................
b.
Health-care costs not paid by insurance........
c.
Child care.......................................................
$
d.
Groceries and household supplies.................
$
e.
Eating out.......................................................
$
f.
Utilities (gas, electric, water, trash)................
$
g.
Telephone, cell phone, and e-mail.................
$
$
h.
Laundry and cleaning.....................................
i.
Clothes...........................................................
$
j.
Education.......................................................
$
k.
Entertainment, gifts, and vacation..................
$
l.
Auto expenses and transportation
(insurance, gas, repairs, bus, etc.).................
$
m.
Insurance (life, accident, etc.; do not include
auto, home, or health insurance)...................
$
$
$
$
$
n.
Savings and investments...............................
o.
Charitable contributions..................................
p.
Monthly payments listed in item 14
(itemize below in 14 and insert total here).....
q.
Other (specify):
r.
TOTAL EXPENSES (a–q) (do not add in
the amounts in a(1)(a) and (b))
$
s.
Amount of expenses paid by others
Paid to For Amount Balance Date of last payment
$
$
$
$
$
$
$
$
$
$
$
$
CHILD SUPPORT INFORMATION
(NOTE: Fill out this page only if your case involves child support.)
FL-150 [Rev. January 1, 2019]
Page 4 of 4
INCOME AND EXPENSE DECLARATION
FL-150
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
a.
b.
d.
(Do not include the amount your employer pays.)
Number of children16.
I do
I do not
I have (specify number): children under the age of 18 with the other parent in this case.
a.
Name of insurance company:
The monthly cost for the children's health insurance is or would be (specify): $
The children spend percent of their time with me and percent of their time with the other parent.
b.
Children's health-care expenses17.
have health insurance available to me for the children through my job.
c.
Additional expense for the children in this case18.
Childcare so I can work or get job training....................................................................a.
Children's health care not covered by insurance...........................................................b.
Travel expenses for visitation........................................................................................c.
Special hardships. I ask the court to consider the following special financial circumstances19.
Extraordinary health expenses not included in 18b...................................a.
Major losses not covered by insurance (examples: fire, theft, other
insured loss)...............................................................................................
b.
Expenses for my minor children who are from other relationships and
are living with me..................................................................................
c.
d.
Children's educational or other special needs (specify below):.....................................
(attach documentation of any item listed here, including court orders):
(1)
Names and ages of those children (specify):
(2)
Child support I receive for those children...............................................(3)
20.
(If you're not sure about percentage or it has not been agreed on, please describe your parenting schedule here.)
Address of insurance company:
Amount per month
Other information I want the court to know concerning support in my case (specify):
The expenses listed in a, b, and c create an extreme financial hardship because (explain):
Amount per month
For how many months?
$
$
$
$
$
$
$
$
FOR COURT USE ONLY
TELEPHONE NO.:
Your name and address or attorney's name and address:
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
CASE NUMBER:
FINANCIAL STATEMENT (SIMPLIFIED)
NOTICE: Read page 2 to find out if you qualify to use this form and how to use it.
My only source of income is TANF, SSI, or GA/GR.
I have applied for TANF, SSI, or GA/GR.
1.
b.
I am the parent of the following number of natural or adopted children from this relationship
The children from this relationship are with me this amount of time
%
The children from this relationship are with the other parent this amount of time
%
Our arrangement for custody and visitation is (specify, using extra sheet if necessary):
head of household married filing separately.married filing jointly
single
My tax filing status is:
My current gross income (before taxes) per month is
This income comes from the following:
Salary/wages: Amount before taxes per month
$
Retirement: Amount before taxes per month
Unemployment compensation: Amount per month
Workers' compensation: Amount per month
Other Amount per month SSISocial security:
Disability: Amount per month
I have no income other than as stated in this paragraph.
Day care or preschool to allow me to work or go to school
a.
Health care not paid for by insurance
b.
School, education, tuition, or other special needs of the child
c.
Travel expenses for visitation
d.
7.
other minor children of mine living with me. Their monthly expensesThere are (specify number)
that I pay are
I spend the following average monthly amounts (please attach proof):
Job-related expenses that are not paid by my employer (specify reasons for expenses on separate sheet)
a.
Required union dues
b.
Required retirement payments (not social security, FICA, 401k or IRA)
c.
Health insurance costs
d.
e.
f.
Spousal support I am paying because of a court order for another relationship
rent or
mortgage Monthly housing costs:
g.
my current employment
my most recent employment:Information concerning
Employer:
Address:
Telephone number:
My occupation:
Date work started:
FINANCIAL STATEMENT (SIMPLIFIED)
Form Approved for Optional Use
Judicial Council of California
FL-155 [Rev. January 1, 2004]
Family Code, § 4068(b)
www.courtinfo.ca.gov
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Child support I am paying for other minor children of mine who are not living with me
. . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . .. . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . .
I pay the following monthly expenses for the children in this case:
FL-155
Page 1 of 2
OTHER PARENT:
Date work stopped (if applicable): What was your gross income (before taxes) before work stopped?:
Interest income ( from bank accounts or other): Amount per month
$
. . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
a.
2.
3.
a.
b.
c.
4.
5.
6.
8.
9.
. .. . . . . . . . . . . . . . . .
Attach 1
copy of pay
stubs for
last 2
months here
(cross out
social
security
numbers)
If mortgage: interest payments $____________ real property taxes $____________
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.
JUDICIAL SUBPOENA
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
Courtat thethe Honorable
located at
County of
o'clock in theday of noon, and at any recessedin room , on the , 20 , at
or adjourned date, to testify and give evidence as a witness in this action on the part of the
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
result of your failure to comply.
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
I
Calendar No.
THE PEOPLE OF THE STATE OF NEW YORK
TO
Index No.
,
American LegalNet, Inc.
www.USCourtForms.com
Court in
Witness, Honorable , one of the Justices of the
day of , 20County,
COURT
COUNTY OF
Plaintiff(s)
-against-
Defendant(s)
:
:
:
:
:
:
:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mobile Tel. No.:
CASE NUMBER:
PETITIONER/PLAINTIFF:
10. My estimate of the other party's gross monthly income (before taxes) is
12. Other information I want the court to know concerning child support in my case (attach extra sheet with the information).
Date:
(SIGNATURE OF DECLARANT)
(TYPE OR PRINT NAME)
PETITIONER/PLAINTIFF
RESPONDENT/DEFENDANT
INSTRUCTIONS
Step 1: Are you eligible to use this form? If your answer is YES to any of the following questions, you may NOT
use this form:
• Are you self-employed?
Step 2: Make 2 copies of each of your pay stubs for the last two months. If you received money from other
than wages or salary, include copies of the pay stub received with that money.
Privacy notice: If you wish, you may cross out your social security number if it appears on the pay stub, other
payment notice or your tax return
Step 4: Complete this form with the required information. Type the form if possible or complete it neatly and
clearly in black ink. If you need additional room, please use plain or lined paper, 8½-by-11", and staple to this form.
Step 6: Serve a copy on the other party. Have someone other than yourself mail to the attorney for the other
party, the other party, and the local child support agency, if they are handling the case, 1 copy of this form, 1 copy
of each of your stubs for the last two months, and 1 copy of your most recent federal income tax return.
Step 7: File the original with the court. Staple this form with 1 copy of each of your pay stubs for the last two
months. Take this document and give it to the clerk of the court. Check with your local court about how to submit
your return.
Step 9: Take the copy of your latest federal income tax return to the court hearing.
It is very important that you attend the hearings scheduled for this case. If you do not attend a hearing, the
court may make an order without considering the information you want the court to consider.
FINANCIAL STATEMENT (SIMPLIFIED)
Page 2 of 2
FL-155 [Rev. January 1, 2004]
. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . .
$
• Is your spouse or former spouse asking for spousal support (alimony) or a change in spousal support?
• Are you asking for spousal support (alimony) or a change in spousal support?
• Are you asking the other party to pay your attorney fees?
• Is the other party asking you to pay his or her attorney fees?
• Do you receive money (income) from any source other than the following?
• Welfare (such as TANF, GR, or GA)
• Salary or wages
• Disability
• Unemployment
• Workers' compensation
• Social security
• Retirement
Step 3: Make 2 copies of your most recent federal income tax form.
If you are eligible to use this form and choose to do so, you do not need to complete the Income and Expense
Declaration (form FL-150). Even if you are eligible to use this form, you may choose instead to use the Income
and Expense Declaration (form FL-150).
Step 5: Make 2 copies of each side of this completed form and any attached pages.
RESPONDENT/DEFENDANT:
• Interest
13. I am attaching a copy of page 3 of form FL-150, Income and Expense Declaration showing my expenses.
OTHER PARENT:
Step 8: Keep the remaining copies of the documents for your file.
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.
11. My current spouse's monthly income (before taxes) is
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . .
$
Print This Form
For your protection and privacy, please press the Clear
This Form button after you have printed the form.
Clear This Form
TEMPORARY EMERGENCY (EX PARTE) ORDERS
Child Custody
Other (specify):
Property Control
Visitation (Parenting Time)
FOR COURT USE ONLY
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
CASE NUMBER:
FL-305
ATTORNEY OR PARTY WITHOUT ATTORNEY
STATE: ZIP CODE:CITY:
STREET ADDRESS:
FIRM NAME:
NAME:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
STATE BAR NUMBER:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
3.
CHILD CUSTODY
Page 1 of 2
Form Adopted for Mandatory Use
Judicial Council of California
FL-305 [Rev. July 1, 2016]
Family Code, §§ 2045, 3062–3064,
Cal. Rules of Court, rules 5.151–5.169
www.courts.ca.gov
TEMPORARY EMERGENCY (EX PARTE) ORDERS
THIS IS A COURT ORDER.
A court hearing will be held on the Request for Order (form FL-300) served with this order, as follows:
Time:Date:
Address of court
(specify):
a.
b.
same as noted above
Dept.: Room:
other
Findings: Temporary emergency (ex parte) orders are needed to: (a) help prevent an immediate loss or irreparable harm to a
party or to children in the case, (b) help prevent immediate loss or damage to property subject to disposition in the
case, or (c) set or change procedures for a hearing or trial.
Child's name
a.
The temporary orders for physical custody, care, and control of the minor children in
(3) are subject to the other party's or parties' rights of visitation (parenting time) as follows (specify):
Visitation
(Parenting Time)
b.
Temporary physical custody, care, and control to:
Petitioner Respondent Other Party/Parent
Continued on Attachment 3(a)
Date of Birth
See Attachment 3(b)
2.
COURT ORDERS: The following temporary emergency orders expire on the date and time of the hearing scheduled in (1), unless
extended by court order:
1.
Respondent
Petitioner
TO (name(s)):
Other (specify):
Other Parent/Party
FL-305
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
(3)
Country of habitual residence: The country of habitual residence of the child or children is (specify):
(4) If you violate this order, you may be subject to civil or criminal penalties, or both.
The United States of America
Other (specify):
e. (1) Jurisdiction: This court has jurisdiction to make child custody orders in this case under the Uniform Child Custody
Jurisdiction and Enforcement Act (part 3 of the California Family Code, commencing with section 3400).
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.
(2)
Child abduction prevention orders are attached (see form FL-341(B)).
d.
4. PROPERTY CONTROL
a.
Petitioner
Respondent
Other Parent/Party is given exclusive temporary use, possession, and
control of the following property that the parties own or are buying
lease or rent
b. Petitioner
Respondent
Other Parent/Party is ordered to make the following payments on the liens
and encumbrances coming due while the order is in effect:
Pay to: For: Amount: $ Due date:
Pay to: For: Amount: $ Due date:
Pay to: For: Amount: $ Due date:
Pay to: For: Amount: $ Due date:
6.
OTHER ORDERS (specify):
Additional orders are listed in Attachment 6.
Date:
JUDGE OF THE SUPERIOR COURT
Page 2 of 2 FL-305 [Rev. July 1, 2016]
TEMPORARY EMERGENCY (EX PARTE) ORDERS
All other existing orders, not in conflict with these temporary emergency orders, remain in full force and effect.
5.
THIS IS A COURT ORDER.
c.
(a) from the state of California.
(b)
from the following counties (specify):
(c)
other (specify):
The party or parties with temporary physical custody, care, and control of minor children must not remove the minor
children from the state of California unless the court allows it after a noticed hearing.
(1)
Travel restrictions
Petitioner
Respondent Other Parent/Party must not remove their minor children (specify):
(2)
CHILD CUSTODY (continued)
3.
ATTORNEY OF PARTY WITHOUT ATTORNEY (Name and Address) Telephone Number
ATTORNEY FOR (Name):
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF VENTURA Limited Civil Case
800 SOUTH VICTORIA AVE. VENTURA, CA 93009
4353 VINEYARD AVE., OXNARD, CA 93036
PLAINTIFF/PETITIONER:
DEFENDANT/RESPONDENT:
DECLARATION RE EX PARTE NOTICE
Dom. Violence Restraining Order Civil Harassment Restraining order
Other Family Law / Custody Other Civil / Probate
CASE NUMBER:
Instructions: The person giving the notice must state how notice was given, where the hearing is to be held, and what
orders are requested. If notice is not being given, please advance to page two of this form.
I, , declare:
1. I informed the person listed above that an order would be sought in the Superior Court of Ventura County at
800 South Victoria Ave., Ventura 4353 Vineyard Ave., Oxnard
on: Date: Time: Courtroom:
Person informed: (Name) Date and time informed:
How Informed:
By telephone to the party attorney at (Telephone Number)
By leaving a message with (Name) relationship to party:
at (Telephone Number) In person
By leaving a message on voicemail of the party at (Telephone Number)
By personally informing: party attorney
In writing (copy must be attached).
2. I told him/her that the orders requested included, but were not limited to:
Domestic Violence Restraining Orders with move-out orders custody orders
Civil Harassment Restraining Orders
Custody / visitation orders, specifically:
Other:
and that he/she should appear at the above time and place if he/she wished to be heard by the court.
3. I do do not expect the other party to oppose my request.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Dated:
Signature of Declarant
DECLARATION RE EXPARTE NOTICE
VN028
Optional form
VN028 (Rev.01/14)
Page 1 of 2
DECLARATION RE: EXPARTE NOTICE - NO NOTICE GIVEN
Dom. Violence Restraining Order
Other Family Law / Custody
Civil Harassment Restraining order
Other Civil / Probate
Instructions: Notice must be given for all Ex Parte requests unless the person requesting the order can establish
exceptional circumstances to excuse notice.
1. I,
, am requesting Ex Parte orders as stated below. I am requesting that notice be
excused in this matter.
2. Ex Parte hearing is set at
800 South Victoria Ave., Ventura
3855-F Alamo St., Simi Valley
4353 Vineyard Ave., Oxnard
on: Date: Time: Courtroom:
3. I am requesting the following orders:
Domestic Violence Restraining Orders with move-out orders custody orders
Civil Harassment Restraining Orders
Custody / visitation orders, specifically:
Other Civil/Probate orders, specifically:
4.
Notice should be excused because (provide details as to why the other party should not be told, in advance, of your
request for emergency orders)
I do not have any way to give notice to the other party because:
If notice is given, I, or the children, will suffer immediate harm, specifically:
Giving notice would frustrate the purpose of this order because:
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Dated:
DECLARATION RE EXPARTE NOTICE
Optional form
VN028 (Rev.01/14)
Page 2 of 2
VN028
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address) Telephone Number
ATTORNEY FOR (Name):
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF VENTURA
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
SHORT TITLE OF CASE:
PROOF OF SERVICE
CASE NUMBER:
1. At the time of service, I was at least 18 years of age and not a party to this action.
2. I served the following documents:
Summons
Petition
Responsive Declaration to Requesf for Order
Income & Expense Declaration
Response Order After Hearing
Complaint Blank Response
Answer Blank Answer
UCCJEA Declaration Blank Responsive Declaration
Notice of Motion Blank Income and Expense Declaration
Request for Order OTHER _______________________________________
Temporary Restraining Order
______________________________________________
Mediation/Orientation Appointment
______________________________________________
Fact Sheet
3. Party served:
4. Address:
5. Method of service:
Personal service: By personal delivery to the person identified in paragraph 3.
Date of Service:
Time of Service:
By Mail: By mailing copies to the person identified in paragraph 3, with postage fully prepaid, by
first class mail as follows:
Date of Mailing:
Place of Deposit:
With two copies of the Notice and Acknowledgment of Receipt and stamped return envelope
addressed to me. (Attach signed Notice & Acknowledgment of Receipt)
To an address outside of California with return receipt requested (Attach Returned Receipt)
PROOF OF SERVICE
VN120
Optional Form
VN120 (Rev. 07/13)
Page 1 of 2
6. Person Serving (name, address and telephone number):
7. Person serving, additional information
Fee for service
Not a registered California process server.
Exempt from registration under B & P section 22350(b)
Registered California process server:
Employee or independent contractor
Registration Number:
County of Registration:
I declare under the penalty of perjury and pursuant to the laws of the State of California that the
foregoing is true and correct. Executed on _________________ at ____________________________.
_________________________________________
Signature of Declarant
I am a California sheriff, marshall or constable, and I certify that the foregoing is true and correct.
Executed on ___________________ at ___________________________________________________.
_________________________________________
Signature
PROOF OF SERVICE
PROOF OF SERVICE
VN120
Page 2 of 2
Optional Form
VN120 (Rev. 07/13)
NOTICE
ALL OF THE FOLLOWING FORMS ARE LEFT
BLANK AND MUST BE SERVED
ON THE RESPONDENT
ALONG WITH A COPY OF THE DOCUMENTS
YOU HAVE FILED
G:\COMMON\Admin\Family Law\Packet Instructions & Forms\NOTICE.doc
HOW TO RESPOND TO
REQUEST FOR ORDER
1. COMPLETE THE FORMS
(Type or print in black ink)
Responsive Declaration to Request for Order
This is your opportunity to
respond
to the issues raised on
the Request for Order. You can only respond to those
issues already raised. If you want to raise additional
issues, you need to file your own Request for Order.
Income and Expense Declaration or Financial Declaration
(Simplified) if issues of support or attorney fees raised in the
Request for Order
2. SERVE A COPY ON THE OTHER PARTY
Make TWO copies of the above documents. One copy is to be
“served” on the other party. Service means the
copy
must be
personally delivered or mailed to the other party by someone
over the age of 18 other than you. You cannot “serve” it
yourself. Service must be completed no later than 9 court days
before the court hearing. Whoever serves the papers must
complete the Proof of Service. You will file the Proof of Service
with the Original Responsive Declaration.
3. FILE THE PAPERS
Take the original and two copies along with the Proof of Service
to the Clerk’s Office, in Ventura, Room 208. The clerk will keep
the original and return the copies to you, stamped to show that it
has been “filed”. One of the two copies is to be “served” on the
other party. The other copy is for your records.
G:\COMMON\Admin\Family Law\Packet Instructions & Forms\HOW TO RESPOND TO.doc
2.
CHILD CUSTODY
I consent to the order requested for child custody (legal and physical custody).a.
b.
I do not consent to the order requested for child custody
I consent to the order requested for visitation (parenting time).
visitation (parenting time)
but I consent to the following order:
c.
d.
b. I consent to the order requested.
I consent to guideline support.
I do not consent to the order requested
but I consent to the following order:
c.
a.
I have completed and filed a current Income and Expense Declaration (form FL-150
) or, if eligible, a current Financial
Statement (Simplified) (form FL-155
) to support my responsive declaration.
3.
CHILD SUPPORT
I consent to the order requested.
I do not consent to the order requested
I have completed and filed a current Income and Expense Declaration (form FL-150
) to support my responsive
declaration.
but I consent to the following order:
b.
c.
a.
Page 1 of 2
Form Adopted for Mandatory Use
Judicial Council of California
FL-320 [Rev. July 1, 2016]
RESPONSIVE DECLARATION TO REQUEST FOR ORDER
FL-320
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
FOR COURT USE ONLY
CASE NUMBER:
RESPONSIVE DECLARATION TO REQUEST FOR ORDER
HEARING DATE:
TIME: DEPARTMENT OR ROOM:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
PARTY WITHOUT ATTORNEY OR ATTORNEY
STATE: ZIP CODE:CITY:
STREET ADDRESS:
FIRM NAME:
NAME:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
STATE BAR NUMBER:
4. SPOUSAL OR DOMESTIC PARTNER SUPPORT
Read Information Sheet: Responsive Declaration to Request for Order (form FL-320-INFO) for more information about this form.
VISITATION (PARENTING TIME)
1.
No domestic violence restraining/protective orders are now in effect between the parties in this case.
I agree that one or more domestic violence restraining/ protective orders are now in effect between the parties in
this case.
a.
b.
RESTRAINING ORDER INFORMATION
Code of Civil Procedure, § 1005
Cal. Rules of Court, rule 5.92
www.courts.ca.gov
c. I consent to the order requested.
I do not consent to the order requestedd.
but I consent to the following order:
I have completed and filed a current Income and Expense Declaration
(
form FL-150
)
to support my responsive
declaration.
I have completed and filed with this form a Supporting Declaration for Attorney's Fees and Costs Attachment
(
form
FL-158
)
or a declaration that addresses the factors covered in that form.
b.
a.
a. I consent to the order requested.
I do not consent to the order requestedb.
but I consent to the following order:
5. PROPERTY CONTROL
a. I consent to the order requested.
I do not consent to the order requested
b. but I consent to the following order:
7. DOMESTIC VIOLENCE ORDER
a.
I consent to the order requested.
I do not consent to the order requestedb.
but I consent to the following order:
8.
OTHER ORDERS REQUESTED
CASE NUMBER:
I declare under penalty of perjury under the laws of the State of California that the information provided in this form and all attachments
is true and correct.
FL-320 [Rev. July 1, 2016]
Page 2 of 2
RESPONSIVE DECLARATION TO REQUEST FOR ORDER
(SIGNATURE OF DECLARANT)
(TYPE OR PRINT NAME)
Date:
ATTORNEY'S FEES AND COSTS
6.
a. I consent to the order requested.
I do not consent to the order requestedb.
but I consent to the following order:
9. TIME FOR SERVICE / TIME UNTIL HEARING
10.
FACTS TO SUPPORT my responsive declaration are listed below. The facts that I write and attach to this form cannot be
longer than 10 pages, unless the court gives me permission.
Attachment 10.
FL-320
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
FAMILY COURT SERVICES INTAKE QUESTIONNAIRE
1. Previous Mediation YES NO
Have the parents previously participated in child custody mediation?
2. Interpreters Required
Is either parent non-English speaking or limited in speaking English?
3. Parent Change of Residence
Has either parent recently moved or is planning to move out of the United States,
State of California, or County of Ventura?
4. Domestic Violence Concerns*
(a) Is there a Restraining or Protective order against either parent?
(b) Have there been any allegations of violence, abuse, or stalking committed
by either parent against the other or the child?
5. Children or Adult Protective Services Involvement
Has either parent been contacted by a Children’s or Adult Services Agency
concerning an abuse/neglect investigation?
6. Child Custody Evaluation
Have the parents participated or been ordered to participate in a child custody evaluation?
When?: ______________________________
7. Party in Jail or Prison
Identify any parent who is expected to be in jail or prison at the time of the Mediation:
___________________________________ ______________________________
Name of parent incarcerated Facility
8. Dependency Petitions
Have any dependency petitions been filed in Juvenile Court related to the parties
children?
_____________________________________________ ______________________
Signature of Petitioner or Attorney for Petitioner Date
_____________________________________________ ______________________
Signature of Respondent or Attorney for Respondent
Date
*Family
Code Section 3181(b) states; “If any party alleging domestic violence in a written declaration under penalty of perjury
or a party protected by a protective order so requests, the mediator will meet with the parties separately and at separate times.”
THIS FORM TO REMAIN CONFIDENTIAL (Family Code §3177)
Mandatory Form
VN163 -
Rev.7/09
FAMILY COURT SERVICES INTAKE QUESTIONNAIRE
IN THE MATTER OF: ________________________________________
CASE NUMBER: ____________________________________________
FOR COURT USE ONLY
VN163
(If you need more space to answer any questions on this form, attach an 8 1/2-by-11-inch sheet of paper and write the
question number before your answer.)
1.
Employment (Give information on your current job or, if you're unemployed, your most recent job.)
Form Adopted for Mandatory Use
Judicial Council of California
FL-150 [Rev. January 1, 2019]
INCOME AND EXPENSE DECLARATION
Family Code, §§ 2030–2032, 2100–2113,
3552, 3620–3634, 4050–4076, 4300–4339
www.courts.ca.gov
Page 1 of 4
Employer:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
FOR COURT USE ONLY
CASE NUMBER:
INCOME AND EXPENSE DECLARATION
PARTY WITHOUT ATTORNEY OR ATTORNEY
STATE: ZIP CODE:CITY:
STREET ADDRESS:
FIRM NAME:
NAME:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
STATE BAR NUMBER:
FL-150
Attach copies
of your pay
stubs for last
two months
(black out
Social
Security
numbers).
a.
Employer's address:
b.
Employer's phone number:
c.
Occupation:
d.
Date job started:
e.
If unemployed, date job ended:
f.
g. I work about hours per week.
h. I get paid $ gross (before taxes)
(If you have more than one job, attach an 8 1/2-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
My age is (specify):
a.
b.
I have completed high school or the equivalent:
Yes
No
If no, highest grade completed (specify):
Number of years of college completed (specify):
c.
Degree(s) obtained
(specify):
Number of years of graduate school completed (specify):
d.
Degree(s) obtained
(specify):
e. I have: professional/occupational license(s)
(specify):
vocational training
(specify):
3.
Tax information
a.
I last filed taxes for tax year
(specify year):
b.
My tax filing status is
single
head of household married, filing separately
married, filing jointly with
(specify name):
c.
I file state tax returns in
California other
(specify state):
I claim the following number of exemptions (including myself) on my taxes (specify):
d.
Other party's income. I estimate the gross monthly income (before taxes) of the other party in this case at (specify): $
4.
This estimate is based on (explain):
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.
(SIGNATURE OF DECLARANT)
Date:
(TYPE OR PRINT NAME)
per month per week
per hour.
Spousal support
Spousal support that I pay by court order from a different marriage ..........................
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.)
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.)
FL-150 [Rev. January 1, 2019] Page 2 of 4
INCOME AND EXPENSE DECLARATION
All other property, (estimate fair market value minus the debts you owe).....
c. real and
personal
* Check the box if the spousal support order or judgment was executed by the parties and the court before January 1, 2019, or if a court-ordered change
maintains the spousal support payments as taxable income to the recipient and tax deductible to the payor.
$
FL-150
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
5.
Salary or wages (gross, before taxes).....................................................................................................a.
Overtime (gross, before taxes)................................................................................................................b.
Commissions or bonuses.........................................................................................................................c.
Public assistance (for example: TANF, SSI, GA/GR) ..................................d.
e.
Partner supportf.
currently receiving
f
rom this marriage
from a different marriage
from this domestic partnership from a different domestic partnership
Pension/retirement fund payments..........................................................................................................g.
Social Security retirement (not SSI).........................................................................................................h.
Disability:i. Social Security (not SSI)
State disability (SDI) Private insurance
Unemployment compensation.................................................................................................................j.
Workers' compensation............................................................................................................................k.
l.
Other (military allowances, royalty payments) (specify):
Investment income (Attach a schedule showing gross receipts less cash expenses for each piece of property.)
6.
Dividends/interest....................................................................................................................................a.
Rental property income...........................................................................................................................b.
Trust income............................................................................................................................................c.
d.
Other (specify):
Income from self-employment, after business expenses for all businesses.........................................7.
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.
Additional income. I received one-time money (lottery winnings, inheritance, etc.) in the last 12 months (specify source and
amount):
8.
Change in income. My financial situation has changed significantly over the last 12 months because (specify):
9.
10.
Deductions
Required union dues....................................................................................................................................................a.
Required retirement payments (not Social Security, FICA, 401(k), or IRA)..................................................................b.
Medical, hospital, dental, and other health insurance premiums (total monthly amount).............................................
c.
Child support that I pay for children from other relationships.......................................................................................d.
e.
Partner support that I pay by court order from a different domestic partnership..........................................................f.
Necessary job-related expenses not reimbursed by my employer (attach explanation labeled "Question 10g").........
g.
11.
Assets
Cash and checking accounts, savings, credit union, money market, and other deposit accounts...............................a.
Stocks, bonds, and other assets I could easily sell.......................................................................................................b.
$
$
$
$
$
$
$
$
$
$
$
$
Last month
Average
monthly
$
$
$
$
$
Last month
Total
federally taxable*
federally tax deductible*
$
$
$
$
$
$
$
$
$
The following people live with me:
FL-150 [Rev. January 1, 2019] Page 3 of 4
INCOME AND EXPENSE DECLARATION
FL-150
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
12.
Attorney fees (This information is required if either party is requesting attorney fees):
15.
a.
b.
c.
d.
My attorney's hourly rate is (specify):
I confirm this fee arrangement.
Average monthly expenses13. Estimated expenses
Actual expenses Proposed needs
Installment payments and debts not listed above14.
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): $
(SIGNATURE OF DECLARANT)
Date:
(TYPE OR PRINT NAME)
Name
Age
How the person is
related to me (ex: son)
That person's gross
monthly income
Pays some of the
household expenses?
a.
b.
c.
d.
e.
Yes
No
Yes No
Yes No
Yes No
Yes No
a.
Home:
(1) Rent or
mortgage..........
$
$
$
$
$
$
If mortgage:
(a) average principal:
$
(b) average interest:
$
(2) Real property taxes..................................
(3)
Homeowner's or renter's insurance
(if not included above)..............................
(4) Maintenance and repair...........................
b.
Health-care costs not paid by insurance........
c.
Child care.......................................................
$
d.
Groceries and household supplies.................
$
e.
Eating out.......................................................
$
f.
Utilities (gas, electric, water, trash)................
$
g.
Telephone, cell phone, and e-mail.................
$
$
h.
Laundry and cleaning.....................................
i.
Clothes...........................................................
$
j.
Education.......................................................
$
k.
Entertainment, gifts, and vacation..................
$
l.
Auto expenses and transportation
(insurance, gas, repairs, bus, etc.).................
$
m.
Insurance (life, accident, etc.; do not include
auto, home, or health insurance)...................
$
$
$
$
$
n.
Savings and investments...............................
o.
Charitable contributions..................................
p.
Monthly payments listed in item 14
(itemize below in 14 and insert total here).....
q.
Other (specify):
r.
TOTAL EXPENSES (a–q) (do not add in
the amounts in a(1)(a) and (b))
$
s.
Amount of expenses paid by others
Paid to For Amount Balance Date of last payment
$
$
$
$
$
$
$
$
$
$
$
$
CHILD SUPPORT INFORMATION
(NOTE: Fill out this page only if your case involves child support.)
FL-150 [Rev. January 1, 2019]
Page 4 of 4
INCOME AND EXPENSE DECLARATION
FL-150
CASE NUMBER:
PETITIONER:
RESPONDENT:
OTHER PARTY/PARENT/CLAIMANT:
a.
b.
d.
(Do not include the amount your employer pays.)
Number of children16.
I do
I do not
I have (specify number): children under the age of 18 with the other parent in this case.
a.
Name of insurance company:
The monthly cost for the children's health insurance is or would be (specify): $
The children spend percent of their time with me and percent of their time with the other parent.
b.
Children's health-care expenses17.
have health insurance available to me for the children through my job.
c.
Additional expense for the children in this case18.
Childcare so I can work or get job training....................................................................a.
Children's health care not covered by insurance...........................................................b.
Travel expenses for visitation........................................................................................c.
Special hardships. I ask the court to consider the following special financial circumstances19.
Extraordinary health expenses not included in 18b...................................a.
Major losses not covered by insurance (examples: fire, theft, other
insured loss)...............................................................................................
b.
Expenses for my minor children who are from other relationships and
are living with me..................................................................................
c.
d.
Children's educational or other special needs (specify below):.....................................
(attach documentation of any item listed here, including court orders):
(1)
Names and ages of those children (specify):
(2)
Child support I receive for those children...............................................(3)
20.
(If you're not sure about percentage or it has not been agreed on, please describe your parenting schedule here.)
Address of insurance company:
Amount per month
Other information I want the court to know concerning support in my case (specify):
The expenses listed in a, b, and c create an extreme financial hardship because (explain):
Amount per month
For how many months?
$
$
$
$
$
$
$
$
FOR COURT USE ONLY
TELEPHONE NO.:
Your name and address or attorney's name and address:
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
CASE NUMBER:
FINANCIAL STATEMENT (SIMPLIFIED)
NOTICE: Read page 2 to find out if you qualify to use this form and how to use it.
My only source of income is TANF, SSI, or GA/GR.
I have applied for TANF, SSI, or GA/GR.
1.
b.
I am the parent of the following number of natural or adopted children from this relationship
The children from this relationship are with me this amount of time
%
The children from this relationship are with the other parent this amount of time
%
Our arrangement for custody and visitation is (specify, using extra sheet if necessary):
head of household married filing separately.married filing jointly
single
My tax filing status is:
My current gross income (before taxes) per month is
This income comes from the following:
Salary/wages: Amount before taxes per month
$
Retirement: Amount before taxes per month
Unemployment compensation: Amount per month
Workers' compensation: Amount per month
Other Amount per month SSISocial security:
Disability: Amount per month
I have no income other than as stated in this paragraph.
Day care or preschool to allow me to work or go to school
a.
Health care not paid for by insurance
b.
School, education, tuition, or other special needs of the child
c.
Travel expenses for visitation
d.
7.
other minor children of mine living with me. Their monthly expensesThere are (specify number)
that I pay are
I spend the following average monthly amounts (please attach proof):
Job-related expenses that are not paid by my employer (specify reasons for expenses on separate sheet)
a.
Required union dues
b.
Required retirement payments (not social security, FICA, 401k or IRA)
c.
Health insurance costs
d.
e.
f.
Spousal support I am paying because of a court order for another relationship
rent or
mortgage Monthly housing costs:
g.
my current employment
my most recent employment:Information concerning
Employer:
Address:
Telephone number:
My occupation:
Date work started:
FINANCIAL STATEMENT (SIMPLIFIED)
Form Approved for Optional Use
Judicial Council of California
FL-155 [Rev. January 1, 2004]
Family Code, § 4068(b)
www.courtinfo.ca.gov
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Child support I am paying for other minor children of mine who are not living with me
. . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . .. . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . .
I pay the following monthly expenses for the children in this case:
FL-155
Page 1 of 2
OTHER PARENT:
Date work stopped (if applicable): What was your gross income (before taxes) before work stopped?:
Interest income ( from bank accounts or other): Amount per month
$
. . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
a.
2.
3.
a.
b.
c.
4.
5.
6.
8.
9.
. .. . . . . . . . . . . . . . . .
Attach 1
copy of pay
stubs for
last 2
months here
(cross out
social
security
numbers)
If mortgage: interest payments $____________ real property taxes $____________
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.
JUDICIAL SUBPOENA
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
Courtat thethe Honorable
located at
County of
o'clock in theday of noon, and at any recessedin room , on the , 20 , at
or adjourned date, to testify and give evidence as a witness in this action on the part of the
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
result of your failure to comply.
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
I
Calendar No.
THE PEOPLE OF THE STATE OF NEW YORK
TO
Index No.
,
American LegalNet, Inc.
www.USCourtForms.com
Court in
Witness, Honorable , one of the Justices of the
day of , 20County,
COURT
COUNTY OF
Plaintiff(s)
-against-
Defendant(s)
:
:
:
:
:
:
:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mobile Tel. No.:
CASE NUMBER:
PETITIONER/PLAINTIFF:
10. My estimate of the other party's gross monthly income (before taxes) is
12. Other information I want the court to know concerning child support in my case (attach extra sheet with the information).
Date:
(SIGNATURE OF DECLARANT)
(TYPE OR PRINT NAME)
PETITIONER/PLAINTIFF
RESPONDENT/DEFENDANT
INSTRUCTIONS
Step 1: Are you eligible to use this form? If your answer is YES to any of the following questions, you may NOT
use this form:
• Are you self-employed?
Step 2: Make 2 copies of each of your pay stubs for the last two months. If you received money from other
than wages or salary, include copies of the pay stub received with that money.
Privacy notice: If you wish, you may cross out your social security number if it appears on the pay stub, other
payment notice or your tax return
Step 4: Complete this form with the required information. Type the form if possible or complete it neatly and
clearly in black ink. If you need additional room, please use plain or lined paper, 8½-by-11", and staple to this form.
Step 6: Serve a copy on the other party. Have someone other than yourself mail to the attorney for the other
party, the other party, and the local child support agency, if they are handling the case, 1 copy of this form, 1 copy
of each of your stubs for the last two months, and 1 copy of your most recent federal income tax return.
Step 7: File the original with the court. Staple this form with 1 copy of each of your pay stubs for the last two
months. Take this document and give it to the clerk of the court. Check with your local court about how to submit
your return.
Step 9: Take the copy of your latest federal income tax return to the court hearing.
It is very important that you attend the hearings scheduled for this case. If you do not attend a hearing, the
court may make an order without considering the information you want the court to consider.
FINANCIAL STATEMENT (SIMPLIFIED)
Page 2 of 2
FL-155 [Rev. January 1, 2004]
. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . .
$
• Is your spouse or former spouse asking for spousal support (alimony) or a change in spousal support?
• Are you asking for spousal support (alimony) or a change in spousal support?
• Are you asking the other party to pay your attorney fees?
• Is the other party asking you to pay his or her attorney fees?
• Do you receive money (income) from any source other than the following?
• Welfare (such as TANF, GR, or GA)
• Salary or wages
• Disability
• Unemployment
• Workers' compensation
• Social security
• Retirement
Step 3: Make 2 copies of your most recent federal income tax form.
If you are eligible to use this form and choose to do so, you do not need to complete the Income and Expense
Declaration (form FL-150). Even if you are eligible to use this form, you may choose instead to use the Income
and Expense Declaration (form FL-150).
Step 5: Make 2 copies of each side of this completed form and any attached pages.
RESPONDENT/DEFENDANT:
• Interest
13. I am attaching a copy of page 3 of form FL-150, Income and Expense Declaration showing my expenses.
OTHER PARENT:
Step 8: Keep the remaining copies of the documents for your file.
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.
11. My current spouse's monthly income (before taxes) is
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . .
$
Print This Form
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Clear This Form
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address) Telephone Number
ATTORNEY FOR (Name):
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF VENTURA
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
SHORT TITLE OF CASE:
PROOF OF SERVICE
CASE NUMBER:
1. At the time of service, I was at least 18 years of age and not a party to this action.
2. I served the following documents:
Summons
Petition
Responsive Declaration to Requesf for Order
Income & Expense Declaration
Response Order After Hearing
Complaint Blank Response
Answer Blank Answer
UCCJEA Declaration Blank Responsive Declaration
Notice of Motion Blank Income and Expense Declaration
Request for Order OTHER _______________________________________
Temporary Restraining Order
______________________________________________
Mediation/Orientation Appointment
______________________________________________
Fact Sheet
3. Party served:
4. Address:
5. Method of service:
Personal service: By personal delivery to the person identified in paragraph 3.
Date of Service:
Time of Service:
By Mail: By mailing copies to the person identified in paragraph 3, with postage fully prepaid, by
first class mail as follows:
Date of Mailing:
Place of Deposit:
With two copies of the Notice and Acknowledgment of Receipt and stamped return envelope
addressed to me. (Attach signed Notice & Acknowledgment of Receipt)
To an address outside of California with return receipt requested (Attach Returned Receipt)
PROOF OF SERVICE
VN120
Optional Form
VN120 (Rev. 07/13)
Page 1 of 2
6. Person Serving (name, address and telephone number):
7. Person serving, additional information
Fee for service
Not a registered California process server.
Exempt from registration under B & P section 22350(b)
Registered California process server:
Employee or independent contractor
Registration Number:
County of Registration:
I declare under the penalty of perjury and pursuant to the laws of the State of California that the
foregoing is true and correct. Executed on _________________ at ____________________________.
_________________________________________
Signature of Declarant
I am a California sheriff, marshall or constable, and I certify that the foregoing is true and correct.
Executed on ___________________ at ___________________________________________________.
_________________________________________
Signature
PROOF OF SERVICE
PROOF OF SERVICE
VN120
Page 2 of 2
Optional Form
VN120 (Rev. 07/13)
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REQUEST FOR ORDER HOW TO GET OR CHANGE (California)

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Completed 10 November 2020

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