Complete the attached forms in black ink.
Scan your completed forms and save as a single PDF file.
For cases involving the Department Of Child Support Services, e-mail
SelfHelpChildSupport@occourts.org .
Self-Help Services can review your completed forms before you file them
with the Court. To request review of your completed forms:
1.
2.
3.
For all other cases, e-mail SelfHelpFamilyLaw@occourts.org .
SELF-HELP FORM PACKET
For more information: www.occourts.org/self-help
SUPERIOR COURT OF CALIFORNIA
COUNTY OF ORANGE
Self-Help Services
www.occourts.org/self-help
SHC-RFO-01 (Rev. 02/02/2021)
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ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address) STATE BAR NUMBER:
FOR COURT USE ONLY
TELEPHONE NO.: FAX NO. (Optional):
EMAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE
STREET ADDRESS:
341 The City Drive South
MAILING ADDRESS: P.O. Box 14169
CITY AND ZIP CODE: Orange, Ca. 92863-1569
BRANCH NAME Lamoreaux Justice Center
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
FAMILY LAW COVERSHEET FOR ASSIGNMENT TO
ORANGE COUNTY JUSTICE CENTER
CASE NUMBER:
This form is REQUIRED for any Family Law case NOT already assigned to a judge or commissioner and MUST be
submitted with a form requesting an initial Court hearing. Do not use this form if the hearing is for Special Immigrant
Juvenile Findings, Department of Child Support Services, Adoption, or Domestic Violence requests.
1.
Select one of the following cities where the Filing Party resides. The party who files the first document requesting
a Court hearing is the “Filing Party.
a.
North Justice Center:
Brea
Buena Park
Fullerton
La Habra
La Palma
Placentia
Yorba Linda
b.
Harbor Justice Center:
Dana Point
Ladera Ranch
Laguna Beach
Laguna Niguel
Laguna Woods
Lake Forest
Newport Beach
Rancho Santa Margarita
San Clemente
c.
West Justice Center:
Costa Mesa
Cypress
Fountain Valley
Garden Grove
Huntington Beach
Los Alamitos
Midway City
Rossmoor
Seal Beach
Stanton
Westminster
d.
None of the above cities:
2.
Filing Party’s address (if address is confidential, provide mailing address):
3.
Does any party require an interpreter?:
Petitioner
Language:
Respondent
Language:
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)
Form Approved for Mandatory Use
L-0560 [Rev. 02/01/21]
FAMILY LAW
COVERSHEET FOR ASSIGNMENT TO ORANGE COUNTY
JUSTICE CENTER
Page 1 of 1
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 ONLY
FOR COURT USE ONLY
TELEPHONE NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
FAX NO.:
STATE: ZIP CODE:CITY:
STREET ADDRESS:
FIRM NAME:
NAME:
STATE BAR NO.:
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):
ORANGE
LAMOREAUX JUSTICE CENTER
ORANGE, CA 92868
341 THE CITY DRIVE SOUTH
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:
Adopted for Optional Use
L-1400 [New 02/17] DECLARATION IN SUPPORT OF MODIFICATION OF CHILD SUPPORT Page 1 of 3
PARTY WITHOUT ATTORNEY OR ATTORNEY (Name and Address):
TEL
EPHONE NO.: FAX NO. (Optional):
E-
MAIL ADDRESS (Optional):
ATTORNEY FOR (Name): BAR NO.:
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE
JUSTICE CENTER:
Central 700 Civic Center Drive West, Santa Ana, CA 92701-4045
Lamoreaux 341 The City Drive South, Orange, CA 92868-3205
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
DECLARATION IN SUPPORT OF MODIFICATION OF CHILD
SUPPORT
CASE NUMBER:
I am
requesting a modification of child support based upon the following change of circumstance since the last order for
child support was entered:
1. Job loss and current unemployment
I lost my job on: __________. I was: laid off terminated Other: ___________________________.
I have been looking for work since I lost my job. A list of my job contacts is attached or will be provided at the
hearing.
I am receiving unemployment benefits and ask that the court base my child support on my unemployment
benefits.
I am not eligible for unemployment benefits and I ask that the court reduce my child support to zero until I
find employment.
2. Change of employment and decrease in earnings
a. I am no longer working for the same employer as I was when the last order was made. I have not worked there
since __________. The reason I am not working there is because ______________________________________.
I currently work at ______________________________________. My occupation is _______________________.
I earn $ _______ per hour and usually work ____ hours per week. My average gross monthly income is $_______.
This is a decrease in my gross monthly earnings of $ __________ from the time of the last order.
I tried to find
work at my previous rate of pay but was unable to.
b. I am still employed at the same place I was when the last order was made, but my earnings have decreased. I
now earn $ __________ per hour and usually work _____ hours per week. This is a decrease in my gross monthly
earnings of $ _____________. My earnings decreased because ________________________________________
___________________________________________________________________________________________.
3. Change in child custody and/or timeshare with children in this case
a. I now have primary custody substantial increased timeshare with the children in this case. The children
are now with me as follows: _____________________________________________________________________
___________________________________________________________________________________________.
Timeshare is estimated to be: _____% to me and _____% to the other parent. Timeshare was calculated by
Family Court Services the court me.
b. My child, ______________________________, is now emancipated as a result of attaining the age 18 and
not in high school
attaining the age 19 married in the military judicial decree. I request that support
for that child be terminated.
X
Adopted for Optional Use
L-1400 [New 02/17] DECLARATION IN SUPPORT OF MODIFICATION OF CHILD SUPPORT Page 2 of 3
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT:
CASE NUMBER:
4. Disability and decrease in earnings and/or loss of income
I am currently disabled. My disability began on _______________ and consists of the following medical/psychological
problems: ___________________________________________________________________________________.
I will be disabled until ________________ . I have attached a Verification of Disability from my treating doctor.
(Select one)
a. I do not receive disability benefits at this time but I have applied for benefits. I expect to receive disability
benefits from the
state government federal government private insurance Other: ______________.
I expect to start receiving benefits on or about _______________ in the amount of $ __________ monthly. Until I
start to receive these benefits, I ask the court to reduce my child support to zero.
b. I do not expect to receive disability benefits in the future because: ___________________________________
___________________________________________________________________________________________.
I ask the court to reduce my child support to zero.
c. I receive disability benefits from state government federal government private policy. The amount I
receive monthly is $ __________.
From this disability income the sum of $ __________ is deducted for child
support every month. I ask that child support be suspended and/or reduced during the period of my disability.
I
request any derivative benefits due my children from Social Security as a result of my disability be offset against my
child support order entered, pursuant to Family Code section 4504.
d. I receive SSI/SSP benefits and have received SSI/SSP benefits since _______________. Thus, child support
should be set at zero for so long as I continue to receive these benefits.
5. Change in income or ability to earn of the other parent
Since the last order for child support was made, the other parent:
a. has become employed, earning $ __________ per hour, working __________ hours per week.
b. has received an increase in earnings and now earns $ __________ per month.
c. now has the ability to obtain employment and earn at least $ __________ per month.
6. Financial hardship
Since the last order was made, I have sustained the following financial hardship(s):
a. Statutory hardship
1. Expenses of natural or adopted children in the home (FC § 4071(a)(2)). I provide support for the following
natural or adopted minor children who reside in my home: __________________________________________.
2. Extraordinary health expenses and uninsured catastrophic losses (FC § 4071(a)(1)):
________________________________________________________________________________________.
b. Low income adjustment - I request that the court order a low income adjustment in this case because I net
less than $1,500 per month, taking into consideration all allowable deductions and hardships.
c. Court discretion - I request that the court use its discretion and deviate from the guideline amount because
application of the guideline formula would be unjust or inappropriate due to the special circumstances in my case.
The facts supporting the special circumstances in my case are: _________________________________________
___________________________________________________________________________________________.
Adopted for Optional Use
L-1400 [New 02/17] DECLARATION IN SUPPORT OF MODIFICATION OF CHILD SUPPORT Page 3 of 3
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT:
CASE NUMBER:
7. Recent release from incarceration and decrease in earnings and/or current unemployment
I was released from incarceration on __________. I was incarcerated from __________ to __________. I am
currently unemployed as a result of my incarceration and am actively looking for work. A list of my job contacts is
attached or will be provided at the hearing. I have no current income. I am asking the court to reduce my child support
to zero until I find employment. I am willing to return to court for review hearings as necessary.
I am in a recovery
program called _____________________________________ and have been there since __________. The program
requirements are ________________________________________________________________________. I am not
allowed to work for the first ________ weeks/months. Thereafter I can work as follows: ________________________
______________________________________________________________________________________________.
I have attached verification of my enrollment and participation in this program. I am asking the court to reduce my
child support to zero until I find employment. I am willing to return to court for review hearings as necessary.
8. Other change of circumstance: ________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
9. I r
equest child support be modified and set at zero for any full calendar months in which the parent ordered to
pay support is incarcerated or receiving SSI, and has no other assets or income. For all other periods, I
request current support remain in effect until modified by court order.
10. Oth
er information I want the court to know concerning child support in my case that supports my request as
set forth above: ________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
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)
(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 ORANGE
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.
341 The City Drive
Orange, CA 92868
Lamoreaux Justice Center
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?
$
$
$
$
$
$
$
$
FL-321
Request for Order (FL-300)
Respondent Petitioner
Family Code, § 217(c);
Cal.Rules of Court, rule 5.113
www.courts.ca.gov
WITNESS LIST
Attachment to Responsive Declaration (FL-320)
hearing or
trial scheduled on (date):
Other (specify):
Form Approved for Optional Use
Judicial Council of California
FL-321 [New July 1, 2012]
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER/PLAINTIFF:
OTHER PARENT/PARTY:
CASE NUMBER(S):
WITNESS LIST
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
TELEPHONE NO.: FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
RESPONDENT/DEFENDANT:
Name Subject and Brief Description of Testimony
intends to call the following witnesses to testify Other
at the time of
ORANGE
341 THE CITY DRIVE SOUTH
ORANGE, CA 92868
LAMOREAUX JUSTICE CENTER
FL-330
ATTORNEY OR PARTY WITHOUT ATTORNEY OR GOVERNMENTAL AGENCY (under Family Code, §§ 17400,17406
(Name, State Bar number, and address):
PROOF OF PERSONAL SERVICE
I am at least 18 years old, not a party to this action, and not a protected person listed in any of the orders.
Person served (name):
I served copies of the following documents (specify):
By personally delivering copies to the person served, as follows:
Date: b. Time:
Address:
I am
registered California process server.
exempt from registration under Business & Profession a.
d.
a California sheriff or marshal.e.
My name, address, and telephone number, and, if applicable, county of registration and number (specify):
7. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
8.
Date:
(TYPE OR PRINT NAME OF PERSON WHO SERVED THE PAPERS) (SIGNATURE OF PERSON WHO SERVED THE PAPERS)
Page 1 of 1
Code of Civil Procedure, § 1011
www.courts.ca.gov
Form Approved for Optional Use
Judicial Council of California
FL-330 [Rev. January 1, 2012]
PROOF OF PERSONAL SERVICE
FOR COURT USE ONLY
CASE NUMBER:
1.
2.
3.
4.
a.
c.
5.
not a registered California process server.
a registered California process server.
an employee or independent contractor of a
b.
c.
Code section 22350(b).
6.
I am a California sheriff or marshal and I certify that the foregoing is true and correct.
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
TELEPHONE NO.:
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
FAX NO.:
HEARING DATE:
DEPT.:
HEARING TIME:
(If applicable, provide):
ORANGE
341 THE CITY DRIVE SOUTH
ORANGE, CA 92868
LAMOREAUX JUSTICE CENTER
Request for Order (form FL-300), Declaration in Support of Modification of Child Support (form L-1400),
Witness List (form FL-321), completed and blank Income and Expense Declaration (form FL-150),
Blank Responsive Declaration (form FL-320)
INFORMATION SHEET FOR PROOF OF PERSONAL SERVICE
Use these instructions to complete the Proof of Personal Service (form FL-330).
A person at least 18 years of age or older must serve the documents. There are two ways to serve documents:
(1) personal delivery and
(2) by mail. See the Proof of Service by Mail (form FL-335) if the documents are being ser
ved by
mail. The person who s
erves the documents must complete a proof of service form for the documents being served. You
cannot serve documents if you are a party to the action.
INSTRUCTIONS FOR THE PERSON WHO SERVES THE DOCUMENTS (TYPE OR PRINT IN BLACK INK)
You must complete a proof of service for each package of documents you serve. For example, if you serve the respondent
and the other parent, you must complete two proofs of service; one for the respondent and one for the other parent.
Complete the top section of the proof of service forms as follows:
First box, left side: In this box print the name, address, and phone number of the person for whom you are serving the
documents.
Second box, left side: Print the name of the county in which the legal action is filed and the court’s address in this box.
Use the same address for the court that is on the documents you are serving.
Third box, left side: Print the names of the petitioner/plaintiff, respondent/defendant, and other parent in this box. Use
the same names listed on the documents you are serving.
First box, top of form, right side: Leave this box blank for the court’s use.
Second box, right side: Print the case number in this box. This number is also stated on the documents you are serving.
You are stating that you are over the age of 18 and that you are neither a party of this action nor a protected person
listed in any of the orders.
Print the name of the party to whom you handed the documents.
List the name of each document that you delivered to the party.
a. Wr
ite in the date that you delivered the documents to the party.
b. Write in the time of day that you delivered the documents to the party.
c. Print the address where you delivered the docum
ents.
Check the box that applies to you. If you are a private person serving the documents for a party, check box “a.”
Print your name, address, and telephone number. If applicable, include the county in which you are registered as a
process server and your registration number.
You must check this box if you are not a California sheriff or marshal. You are stating under penalty of perjury that the
information you have provided is true and correct.
Do not check this box unless you are a California sheriff or marshal.
Print your name, fill in the date, and sign the form.
If you need additional assistance with this form, contact the family law facilitator in your county.
FL-330-INFO [New January 1, 2012]
Page 1 of 1
INFORMATION SHEET FOR PROOF OF PERSONAL SERVICE
1.
2.
3.
4.
5.
6.
8.
7.
FL-330-INFO
Third box, right side: Print the hearing date, time, and department. Use the same information that is on the documents
you are serving.
Code of Civil Procedure, § 1011
www.courts.ca.gov
FL-335
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
FOR COURT USE ONLY
CASE NUMBER:
PROOF OF SERVICE BY MAIL
NOTICE: To serve temporary restraining orders you must use personal service (see form FL-330).
I am at least 18 years of age, not a party to this action, and I am a resident of or employed in the county where the mailing took
place.
My residence or business address is:
I served a copy of the following documents (specify):
by enclosing them in an envelope AND
a. depositing the sealed envelope with the United States Postal Service with the postage fully prepaid.
b.
The envelope was addressed and mailed as follows:
Name of person served:
Date mailed:
Place of mailing (city and state):
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 1 of 1
Form Approved for Optional Use
Judicial Council of California
FL-335 [Rev. January 1, 2012]
PROOF OF SERVICE BY MAIL
Code of Civil Procedure, §§ 1013, 1013a
1.
2.
3.
placing the envelope for collection and mailing on the date and at the place shown in item 4 following our ordinary
business practices. I am readily familiar with this business’s practice for collecting and processing correspondence for
mailing. On the same day that correspondence is placed for collection and mailing, it is deposited in the ordinary course of
business with the United States Postal Service in a sealed envelope with postage fully prepaid.
4.
Address:b.
a.
c.
d.
6.
www.courts.ca.gov
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
I served a request to modify a child custody, visitation, or child support judgment or permanent order which included an
5.
address verification declaration. (Declaration Regarding Address Verification—Postjudgment Request to Modify a Child
Custody, Visitation, or Child Support Order (form FL-334) may be used for this purpose.)
HEARING DATE:
DEPT.:
HEARING TIME:
FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
TELEPHONE NO.:
(If applicable, provide):
ORANGE
341 THE CITY DRIVE SOUTH
ORANGE, CA 92868
LAMOREAUX JUSTICE CENTER
Request for Order (form FL-300), Declaration in Support of Modification of Child Support (form L-1400),
Witness List (form FL-321), completed and blank Income and Expense Declaration (form FL-150),
Blank Responsive Declaration (form FL-320)
INFORMATION SHEET FOR PROOF OF SERVICE BY MAIL
Use these instructions to complete the Proof of Service by Mail (form FL-335).
A person at least 18 years of age or older must serve the documents. There are two ways to serve documents:
(1) personal delivery and
(2) by mail. See the Proof of Personal Service (form FL-330) if the documents are bei
ng
personally served. The person who serves the documents must complete a proof of service form for the documents
being served. You cannot serve documents if you are a party to the action.
INSTRUCTIONS FOR THE PERSON WHO SERVES THE DOCUMENTS (TYPE OR PRINT IN BLACK INK)
You must complete a proof of service for each package of documents you serve. For example, if you serve the respondent
and the other parent, you must complete two proofs of service; one for the respondent and one for the other parent.
Complete the top section of the proof of service forms as follows:
documents.
Second box, left side: Print the name of the county in which the legal action is filed and the court’s address in this box.
Third box, left side: Print the names of the petitioner/plaintiff, respondent/defendant, and other parent in this box. Use
the same names listed on the documents you are serving.
First box, top of form, right side: Leave this box blank for the court’s use.
You cannot serve a temporary restraining order by mail. You must serve those documents by personal service.
You are stating that you are at least 18 years old and that you are not a party to this action. You are also stating that
you either live in or are employed in the county where the mailing took place.
Print your home or business address.
List the name of each document that you mailed (the exact names are listed on the bottoms of the forms).
Check this box if you put the documents in the regular U.S. mail.
Check this box if you put the documents in the mail at your place of employment.
Print the name you put on the envelope containing the documents.
Print the address you put on the envelope containing the documents.
Print the date that you put the envelope containing the documents in the mail.
Print the city and state you were in when you mailed the envelope containing the documents.
You are stating under penalty of perjury that the information you have provided is true and correct.
Print your name, fill in the date, and sign the form.
If you need additional assistance with this form, contact the family law facilitator in your county.
INFORMATION SHEET FOR PROOF OF SERVICE BY MAIL
FL-335-INFO [New January 1, 2012]
Page 1 of 1
First box, left side: In this box print the name, address, and phone number of the person for whom you are serving the
Second box, right side: Print the case number in this box. This number is also stated on the documents you are serving.
2.
1.
3.
a.
b.
4. a.
b.
c.
d.
6.
Check this box if you are serving an address verification form (required for service by mail of a postjudgment request to
change a child custody, visitation, or child support order).
5.
Third box, right side: Print the hearing date, time, and department. Use the same information that is on the documents
you are serving.
FL-335-INFO
Code of Civil Procedure, §§ 1013, 1013a
www.courts.ca.gov
Use the same address for the court that is on the documents you are serving.
DO NOT write on the following blank forms!
These blank forms must be served on the Other Party so that the Other Party may
respond to this action. These blank forms must accompany a conformed (stamped)
copy of all the forms that you prepared and filed today.
************************************
NO escriba en los siguientes formularios en
blanco!
Estos formularios en blanco deben ser entregadas a la Otra Parte para que la Otra
Parte podrá responder a esta acción. Estos formularios en blanco deberán
acompañar una copia conforme (sellada) de todas las formas que ha preparado y
archivado hoy.
USE Responsive Declaration to Request for Order (form FL-320)
Forms checklist
For child custody or visitation (parenting time) orders, you may need to complete some of these forms:
Ask for court orders that were not requested in the Request for Order (form FL-300). Instead, file and serve your
own Request for Order (form FL-300
) to ask for orders about other issues.
If you plan on having witnesses testify at the hearing, you need this form:
For attorney’s fees and costs, you need these forms:
For child support, you need:
For spousal or domestic partner support or orders about your finances, you need these forms:
a.
b.
FL-105, Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act
FL-311, Child Custody and Visitation (Parenting Time) Application Attachment
FL-312, Request for Child Abduction Prevention Orders
FL-341(C), Children’s Holiday Schedule Attachment
FL-341(D), Additional Provisions—Physical Custody Attachment
FL-341(E), Joint Legal Custody Attachment
c.
A current form FL-150, Income and Expense Declaration. You may use form FL-155, Financial Statement
(Simplified) instead of form FL-150 if you meet the requirements listed on page 2 of form FL-155.
d.
FL-150, Income and Expense Declaration
FL-157, Spousal or Partner Support Declaration Attachment (if the request is to change a support judgment)
e.
FL-150, Income and Expense Declaration
FL-319, Request for Attorney’s Fees and Costs Attachment (or provide the information in a declaration)
FL-158, Supporting Declaration for Attorney’s Fees and Costs (or provide the information in a declaration)
f.
FL-321, Witness List
FL-320-INFO, Page 1 of 3
Form Approved for Optional Use
Judicial Council of California
www.www.courts.ca.gov
New July 1, 2016
Information Sheet: Responsive Declaration to
Request for Order
(Family Law)
FL-320-INFO
Information Sheet: Responsive Declaration to Request for Order
Carefully read the papers you received to make sure you understand what orders are being requested.
If you received a Request for Order (form FL-300),
DO NOT USE Responsive Declaration to Request for Order (form FL-320) to:
Respond to Request for Domestic Violence Restraining Order (form DV-100
). Instead, you must use Response to
Request for Domestic Restraining Order (form DV-120
).
Form FL-320
, Responsive Declaration to Request for Order is the basic form you need. Depending on the
requests made in the Request for Order (form FL-300), you may need other forms.
Notice: The court will order child support based on the income of the parents.
Child support normally continues until the child is 18 years and has graduated from high school.
You must give the court information about your finances. If you do not, the child support order
will be based on information about your income that the court receives from other sources.
Use form FL-320 to let the court and the other party know that you agree or disagree with each of the requests
made in the Request for Order (form FL-300).
If you disagree, use form FL-320 to describe the orders you would like the court to make.
If you do not file and serve form FL-320, the court can still make orders without your input.
2
3
4
1
Note the date, time, and location of the court hearing.
Check to see if the court ordered a specific date for filing and serving your Responsive Declaration to Request
for Order (form FL-320).
If you need more time before the hearing to prepare a responsive declaration or talk with a lawyer, you may ask
the court to continue the hearing date. For more information, consult with a lawyer or contact the the Family Law
Facilitator or Self-Help Center in your court (see item ).
16
To respond to a Request for Order, you must:
Complete caption of the form
Next steps: file or serve your paperwork
You must file your paperwork with the court clerk
at least 9 court days before the hearing. If the court
orders a shorter time to file your papers, file them
by the date specified in the order.
Pay filing fees
Generally, you do not have to pay a fee to file the
Responsive Declaration. However, if you have
never filed any papers in the case, you may have to
pay a “first appearance fee,” which, in general,
everyone has to pay when filing court papers in a
case for the first time.
Specify a response to orders requested
Sign and date: Print your name, sign, and write
the date you signed form FL-320.
Items 1–9: Each item on the form matches the
item numbers on the Request for Order (form
FL-300). Complete item 1. Next, mark the same
box that is marked on form FL-300. Then, specify
if you consent (agree) or do not consent to
(disagree with) the orders requested. If you
disagree, describe the order you would like the
court to make. Note: you may file one form
FL-150 to respond to items 3, 4, and 6.
Complete the top portion including your name,
address, and telephone number, the court address,
the name of all the parties in the case, and the case
number. Also, print or type the same hearing date,
time, and department that appears on the Request
for Order (form FL-300).
If you cannot afford to pay the filing fee, you can
ask the court to waive the fees. To do so, complete
and file form FW-001
, Request to Waive Court
Fees and form FW-003, Order on Court Fee
Waiver.
Item 10: Use the space to explain your responses
to items 1–9. Include the reasons why you do not
agree with the orders requested by the other party
and why the court should make the orders you
described. If you need more space, write your
responses on a separate sheet of paper and attach it
to the form (Attached Declaration (form MC-031)
may be used for this purpose).
7
8
5
6
9
Serve your papers on the other party
“Service” is the act of giving your legal papers to
all persons named as parties in the case so that they
know what orders you want the court to make.
Note: If a party has a lawyer in the
case, the papers should be served on that party’s
lawyer.
Make 2 copies of your original paperwork. Then,
do one of the following before the filing deadline:
Take your paperwork and copies to the court
clerk to process (or e-file them, if available in
your county). The clerk will keep the original and
give you back copies with a court stamp on them.
Have a stamped copy served; or
Have an unstamped copy of your paperwork
served before you take (or e-file) the
originals and copies to the court clerk to file.
Be sure the original documents are not served.
FL-320-INFO
Information Sheet: Responsive Declaration to Request for Order
FL-320-INFO, Page 2 of 3
New July 1, 2016
Information Sheet: Responsive Declaration to
Request for Order
(Family Law)
Personal service or service by mail on the other
party must be completed at least 9 court days before
the court hearing. If the court has ordered a shorter
time to serve your responsive papers, be sure to
have them served by the date specified in the court
order.
Deadline for service
Server. You cannot serve the papers. Have
someone else (who is at least 18 years old) do it.
The “server” can be a friend, a relative who is not
involved in your case, a county sheriff, or a
professional process server.
Personal service.
Your papers may be
served by “personal
service.” “Personal
service” means that
Service by mail.
“Service by mail”
means that your
“server” places copies
of all the documents
in a sealed envelope
and mails them to the
address of each party
File the Proof of Service before your
hearing date
The Proof of Service shows the judge that the
person received a copy of your Responsive
Declaration to Request for Order. Make three
copies of the completed Proof of Service. Take the
original and copies to the court clerk as soon as
possible before your hearing.
Server must complete a Proof of Service
After personal service, the server should complete a
form FL-330, Proof of Personal Service.
Form
FL-330-INFO
, Information Sheet for Proof of
Personal Service has instructions to help the person
complete the form.
After service by mail, the server should complete
form FL-335, Proof of Service by Mail.
Form
FL-335-INFO, Information Sheet for Proof of
Service by Mail has instructions to help the person
complete the form.
Still have questions or need help?
Contact the Family Law Facilitator or Self-Help
Center for information, local rules, and referrals
to local legal services providers. Go to
http://
www.courts.ca.gov/1083.htm/.
Talk to a lawyer if you want legal advice,
someone to go to court with you, or other legal
help. Find an attorney through your local bar
association, the State Bar of California at
calbar.
ca.gov, or the Lawyer Referral Service at
1-866-442-2529.
For free and low-cost legal help (if you qualify),
go to lawhelpcalifornia.org
.
Find more information about preparing for the
hearing at
www.courts.ca.gov/1094.htm.
Get ready for your hearing
How to “serve”
The clerk will keep the original and give you back
the copies stamped “Filed.” Bring a copy stamped
“Filed” to your hearing. (If unstamped copies of
your paperwork were served, you can file the
completed Proof of Service when you file the
original Responsive Declaration.)
Take at least two copies of your documents and
filed forms to the hearing. Include a filed Proof of
Service form.
11
15
13
12
16
10
14
If the Request for Order includes a court order for
you to attend mediation or child custody
recommending counseling, the date, time, and
location is found on page 1 of the Request for
Order. For more information, read Child Custody
Information Sheet (form FL-313-INFO
or form
FL-314-INFO).
Participate in child custody mediation or
child custody recommending counseling
being served (or to the party’s lawyer, if he or she
has one.) The server must be 18 years of age or over
and must live or work in the county where the
mailing took place.
your “server” walks up to each person to be served,
makes sure he or she is the right person, and then
gives a copy of all the papers to him or her.
FL-320-INFO
Information Sheet: Responsive Declaration to Request for Order
FL-320-INFO, Page 3 of 3
New July 1, 2016
Information Sheet: Responsive Declaration to
Request for Order
(Family Law)
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
Oran
g
e
Lamoreaux Justice Center
Oran
g
e, CA 92868
341 The Cit
y
Drive South
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:
(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 ORANGE
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.
Lamoreaux Justice Center
Orange, CA 92868
341 The City Drive
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?
$
$
$
$
$
$
$
$
FL-335
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
FOR COURT USE ONLY
CASE NUMBER:
PROOF OF SERVICE BY MAIL
NOTICE: To serve temporary restraining orders you must use personal service (see form FL-330).
I am at least 18 years of age, not a party to this action, and I am a resident of or employed in the county where the mailing took
place.
My residence or business address is:
I served a copy of the following documents (specify):
by enclosing them in an envelope AND
a. depositing the sealed envelope with the United States Postal Service with the postage fully prepaid.
b.
The envelope was addressed and mailed as follows:
Name of person served:
Date mailed:
Place of mailing (city and state):
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 1 of 1
Form Approved for Optional Use
Judicial Council of California
FL-335 [Rev. January 1, 2012]
PROOF OF SERVICE BY MAIL
Code of Civil Procedure, §§ 1013, 1013a
1.
2.
3.
placing the envelope for collection and mailing on the date and at the place shown in item 4 following our ordinary
business practices. I am readily familiar with this business’s practice for collecting and processing correspondence for
mailing. On the same day that correspondence is placed for collection and mailing, it is deposited in the ordinary course of
business with the United States Postal Service in a sealed envelope with postage fully prepaid.
4.
Address:b.
a.
c.
d.
6.
www.courts.ca.gov
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
I served a request to modify a child custody, visitation, or child support judgment or permanent order which included an
5.
address verification declaration. (Declaration Regarding Address Verification—Postjudgment Request to Modify a Child
Custody, Visitation, or Child Support Order (form FL-334) may be used for this purpose.)
HEARING DATE:
DEPT.:
HEARING TIME:
FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
TELEPHONE NO.:
(If applicable, provide):
ORANGE
341 THE CITY DRIVE SOUTH
ORANGE, CA 92868
LAMOREAUX JUSTICE CENTER