COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): : Plaintiff(s) TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): Index No. Calendar No. FL-191 COURT PERSONNEL: STAMP DATE RECEIVED HERE : : : : JUDICIAL SUBPOENA DO NOT FILE -against- FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: Defendant(s) : .CITY .AND ZIP CODE:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ....... BRANCH NAME: PETITIONER/PLAINTIFF: THE PEOPLE OF THE RESPONDENT/DEFENDANT: TO OTHER PARENT: STATE OF NEW YORK CHILD SUPPORT CASE REGISTRY FORM Mother Father First form completed Change to previous information CASE NUMBER: GREETINGS: THIS FORM WILL NOT BE PLACED IN THE COURT FILE. IT WILL BE MAINTAINED IN A CONFIDENTIAL FILE WITH THE STATE OF CALIFORNIA. Notice: Pages 1 and 2 of this form must be completed and delivered to the court along with the court order for support. the Honorable at the Court Pages 3 and 4 are instructional only and do not need to be delivered to the court. If you did not file the court order, you must located at 10 days of the date on which you received a copy of the support order. County of complete this form and deliver it to the court within Any later change to the information on day of must be delivered ,to the courto'clock in the this form on another form within 10 days of the in room , on the , 20 at noon, and at any recessed change.adjourned date, to testify and give evidence as inwitness of any changes ofthe part of the and telephone number. It is important that you keep the court informed a writing in this action on your address or 1. Support order information (this information is on the court order you are filing or have received). a. Date order filed: b. Initial child support or family support order Modification WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , Your failure to child or with this subpoena ordered for children listed below, court and will amount ordered c. Total monthly base current complyfamily support amount is punishable as a contempt ofplus any monthly make you liable to the party on whose support: this subpoena was issued for a maximum penalty of $50 and all damages sustained as a payable on past-due behalf resultSupport: failure to comply. Family Support: Child of your Spousal Support: (1) Current $ Witness, base child Honorable Reserved order support: County, day $0 (zero) order of Additional monthly support: Total past-due support: $ Current $ base family support: , 20 Additional $ monthly support: Total past-due support: $ Current Reserved order $0 (zero) order support: $ $0 (zero) order , one of the Justices of theReserved order spousal Court in (2) (3) $ (Attorney must sign above and type name below) Total $ past-due support: (4) Payment $ on pastdue support: (5) Wage withholding was ordered Payment $ Attorney(s) for on pastdue support: ordered but stayed until (date): Payment $ on pastdue support: 2. Person required to pay child or family support (name): Relationship to child (specify): 3. Person or agency to receive child or family support payments (name): Relationship to child (if applicable): Office and P.O. Address Form Adopted for Mandatory Use Judicial Council of California FL-191 [Rev. July 1, 2005] Telephone No.: Facsimile No.: TYPE OR PRINT IN INK E-Mail Address: Mobile Tel. No.: CHILD SUPPORT CASE REGISTRY FORM Page 1 of 4 Family Code, § 4014 www.courtinfo.ca.gov American LegalNet, Inc. www.USCourtForms.com PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT: CASE NUMBER: 4. The child support order is for the following children: Child's name a. b. c. Additional children are listed on a page attached to this document. Date of birth Social security number You are required to complete the following information about yourself. You are not required to provide information about the other person, but you are encouraged to provide as much as you can. This form is confidential and will not be filed in the court file. It will be maintained in a confidential file with the State of California. 5. Father's name: a. Date of birth: b. Social security number: c. Street address: 6. Mother's name: a. Date of birth: b. Social security number: c. Street address: City, state, zip code: d. Mailing address: City, state, zip code: d. Mailing address: City, state, zip code: e. Driver's license number: State: f. Telephone number: g. Employed Employer's name: Not employed Self-employed City, state, zip code: e. Driver's license number: State: f. Telephone number: g. Employed Employer's name: Not employed Self-employed Street address: City, state, zip code: Telephone number: 7. Street address: City, state, zip code: Telephone number: A restraining order, protective order, or nondisclosure order due to domestic violence is in effect. a. The order protects: Father Mother Children b. From: Father Mother c. The restraining order expires on (date): I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: (TYPE OR PRINT NAME) FL-191 [Rev. July 1, 2005] (SIGNATURE OF PERSON COMPLETING THIS FORM) CHILD SUPPORT CASE REGISTRY FORM Page 2 of 4 INFORMATION SHEET FOR CHILD SUPPORT CASE REGISTRY FORM (Do NOT deliver this Information Sheet to the court clerk.) Please follow these instructions to complete the Child Support Case Registry Form (form FL-191) if you do not have an attorney to represent you. Your attorney, if you have one, should complete this form. Both parents must complete a Child Support Case Registry Form. The information on this form will be included in a national database that, among other things, is used to locate absent parents. When you file a court order, you must deliver a completed form to the court clerk along with your court order. If you did not file a court order, you must deliver a completed form to the court clerk WITHIN 10 DAYS of the date you received a copy of your court order. If any of the information you provide on this form changes, you must complete a new form and deliver it to the court clerk within 10 days of the change. The address of the court clerk is the same as the one shown for the superior court on your order. This form is confidential and will not be filed in the court file. It will