- FL-626 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT: STIPULATION AND ORDER WAIVING UNASSIGNED ARREARS (Governmental) CASE NUMBER: Instructions: This form is to be filled out if the party to whom support is owed wishes to give up the right to past-due support that is owed to him or her. If either party has any questions about the possible consequences of this waiver, he or she should ask an attorney. If either party has any questions about the case or the information on this form, he or she should ask the Family Law Facilitator or the local child support agency. PARTIES 1. The party waiving past support is petitioner/plaintiff respondent/defendant other parent other (specify): 2. The party ordered to pay support is petitioner/plaintiff respondent/defendant other parent other (specify): 3. The party ordered to pay support and the party waiving past support are the parties to this agreement. RIGHT TO AN ATTORNEY 4. The parties understand their right to be represented by an attorney, at their expense, in connection with these proceedings. NO TIME LIMIT FOR COLLECTION 5. The parties understand that the amounts owed for Non-Aid arrears (past-due child support ordered to be paid personally to the party waiving support) remain owed until paid. There is no time limit for the collection of past-due support. CONTINUING COLLECTION EFFORTS 6. All methods to collect or enforce the amounts past due may be used until the past due support is paid in full, including, but not limited to, wage assignments, levy on assets, tax refund interception, license suspension, property liens, and contempt. The parties understand that a waiver of support will stop all collection efforts of the support waived. RIGHT TO DETERMINATION OF DISPUTED PAST SUPPORT 7. If the amount of past-due support is unknown or uncertain, the parties understand that they have the right to have the local child support agency review and audit the amount due, including all amounts ordered, all payments, and all credits. The parties also understand that if they are not satisfied with the agency's audit, they have the right to have a court hearing to determine the amount due. Page 1 of 4 Form Approved for Optional Use Judicial Council of California FL-626 [Rev. January 1, 2009] STIPULATION AND ORDER WAIVING UNASSIGNED ARREARS (Governmental) Family Code, § 4503, 17526 www.courtinfo.ca.gov American LegalNet, Inc. www.FormsWorkflow.com FL-626 PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT: CASE NUMBER: CONSEQUENCES OF WAIVING PAST SUPPORT 8. The parties understand that once the party waiving past support gives up his or her right to past-due support, he or she can never request payment of the amount given up or ask the local child support agency or court to reinstate the amount given up, UNLESS he or she has specifically retained the right to do so as part of item 16. 9. The parties understand that the party waiving past support cannot give up the right to collect Aid arrears (past-due child support that belongs to the county in exchange for receipt of public assistance benefits), nor can he or she give up the right to future child support. The parties understand that this stipulation does not affect the current child support order. If there is a current child support order, that order still remains in full force and effect. 10. The parties have had sufficient time to read and think about this stipulation and to discuss it with any and all advisors, counselors, or attorneys of their choosing. 11. The party waiving past support has not been promised anything by the party ordered to pay support, the local child support agency, the court, or anyone else, to induce him or her to give up amounts owed to him or her, except as specifically set forth in writing in this stipulation. 12. The party waiving past support has not been threatened in any way (physically, emotionally, or otherwise) by the party ordered to pay support, the local child support agency, the court, or anyone else, to force him or her to give up support amounts. 13. The party waiving past support has thought about and decided that it is in his or her best interest and the best interest of his or her children to give up this support arrearage. AMOUNT OF PAST-DUE SUPPORT 14. As of (date calculated): a. NON-AID ARREARS (these are the amounts owed personally to the party waiving past support before this waiver becomes effective): Type (1) (2) (3) (4) Child support: Spousal/family support: Other (specify): TOTAL: See attachment 14a. AID ARREARS (these are the amounts assigned and owed to a public agency and cannot be waived by the parties): Type Principal Interest Time Period (1) (2) (3) (4) Child support: Spousal/family support: Other (specify): TOTAL: See attachment 14b. c. The parties agree that the amounts in items 14a and 14b will be considered a final determination by the court of the amount of past-due support. $ $ $ $ $ $ $ $ _____ through _________ _____ through _________ _____ through _________ Principal $ $ $ $ Interest $ $ $ $ Time Period _____ through _________ _____ through _________ _____ through _________ b. WARNING: If the box at item 14c is checked you may be prohibited from any future challenge regarding the amount of past-due support indicated at items 14a and 14b. d. The parties agree that the amounts stated above represent the amount of past-due support indicated by the local child support agency records. However, in agreeing to this waiver of Non-Aid arrears, the parties have not reached an agreement regarding the accuracy of the amount of past-due support as stated. FL-626 [Rev. January 1, 2009] STIPULATION AND ORDER WAIVING UNASSIGNED ARREARS (Governmental) Page 2 of 4 FL-626 PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT: CASE NUMBER: WAIVER OF PAST-DUE SUPPORT 15. In consideration of the payment by the party ordered to pay support of the sums set forth below, and the performance of any other condition stated below, the parties agree as follows (check and complete either a or b, but not both, and add other applicable provisions): a. to the local child support agency on Upon payment by party ordered to pay support of the sum of $ , the Non-Aid arr