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 IMPERIAL 939 W. Main Street El Centro, CA 92243 PETITIONER: RESPONDENT: ORDER ON REGISTRATION OF OUT-OF-STATE SUPPORT ORDER INCOME WITHHOLDING ORDER CASE NUMBER: 1. Notice of Registration of Out of State Support Order-Judicial Council Form (FL-570). A copy of the registration statement with a copy of the out of state order was sent by the Clerk of the Court to ___________________________ by first class mail on (date):_____________. 2. A Request for Hearing Regarding Registration of Support Order and/or Income Withholding Order-Judicial Council Form (FL-575) was NOT filed and this proceeding was heard by default. OR A Request for Hearing Regarding Registration of Support Order and/or Income Withholding Order-Judicial Council Form (FL-575) was filed on (date): ______________________ and this proceeding was heard as follows: This proceeding was heard as a contested matter: On (date):__________________at (time)_________________in Dept.______ Temporary Judge by Judge (name): _________________________ Petitioner present Attorney present (name): Respondent present Attorney present (name): Other present Attorney present (name): THE COURT ORDERS: 3. 4. 5. 6. 7. Out of State Support Order is confirmed Out of State Support Order is not confirmed Out of State Income Withholding Order is confirmed Out of State Income Withholding Order is not confirmed Other: ___________________________________ Judge of the Superior Court Date:__________________________ Approved for Optional Use FL-17 (Adopted 01/01/11, Revised 01/01/13) ORDER ON REGISTRATION OF OUT-OF-STATE SUPPORT ORDER/INCOME WITHHOLDING ORDER American LegalNet, Inc. www.FormsWorkFlow.com