FL-430 FOR COURT USE ONLY ATTORNEY OR PARTY WITHOUT ATTORNEY OR GOVERNMENTAL AGENCY (under Fam. Code, §§ 17400, 17406) (Name, state bar number, and address): FAX NO.: TELEPHONE NO.: ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT: EX PARTE APPLICATION FOR EARNINGS ASSIGNMENT ORDER CASE NUMBER: MODIFICATION APPLICANT DECLARES 1. Child support was ordered as follows: a. Date of order: respondent petitioner b. Payable by respondent c. Payable to petitioner d. Total amount unpaid is at least: $ 2. Spousal support family support a. Date of order: b. Payable by petitioner c. Payable to petitioner d. Total amount unpaid is at least: $ 3. was ordered as follows: respondent respondent other parent other (specify): as of (date): (Complete for support ordered before July 1, 1990, only) child support spousal support is overdue in the sum of at least one month's payment. Payment of Written notice of my intent to seek an earnings assignment was a. given at least 15 days before the date of filing this application (1) by first class mail. (2) by personal service. (3) contained in the support order described in item 1 or 2. other (specify): (4) b. 4. other parent other (specify): as of (date): waived (explain): An earnings assignment order has not been issued for support ordered after July 1, 1990. 5. a. The amount of arrears stated in items 1d and 2d not included, it is not waived.) does does not include interest at the legal rate. (If interest is b. The amount of arrears stated in items 1d and 2d are not included, they are not waived.) does does not include penalties at the legal rate. (If penalties Page 1 of 2 Form Adopted for Mandatory Use Judicial Council of California FL-430 [Rev. January 1, 2003] EX PARTE APPLICATION FOR EARNINGS ASSIGNMENT ORDER Family Code, §§ 5230, 5252 www.courtinfo.ca.gov 2003 © American LegalNet, Inc. PETITIONER/PLAINTIFF: CASE NUMBER: RESPONDENT/DEFENDANT: OTHER PARENT: 6. Modification of the existing earnings assignment order is requested because a. the following children are emancipated (support is no longer required by law) as of the following dates (name each and give date): b. custody of the following children has changed (specify): c. the support arrears in this case are paid in full. d. the earnings assignment order must be conformed to the most recent support order as follows (specify): e. the local child support agency is no longer enforcing the current support obligation in this case but is required to collect and enforce any arrears owing. f. the earnings assignment order should be terminated as to spousal support because (1) the supported spouse remarried on (date): (2) the supported spouse died on (date): (3) by terms of the current order, spousal support was to terminate on (date): g. other (specify): 7. I request an earnings assignment order issue for the following monthly deductions: per month current child support. a. $ per month current spousal support. b. $ per month current family support. c. $ per month child support arrears. d. $ per month spousal support arrears. e. $ f. per month family support arrears. $ g. Total deductions per month: $ I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: (SIGNATURE OF APPLICANT) (TYPE OR PRINT NAME) FL-430 [Rev. January 1, 2003] EX PARTE APPLICATION FOR EARNINGS ASSIGNMENT ORDER Page 2 of 2 2003 © American LegalNet, Inc.