FL-411 PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT: CASE NUMBER: AFFIDAVIT OF FACTS CONSTITUTING CONTEMPT Financial and Injunctive Orders Attachment to Order to Show Cause and Affidavit for Contempt (form FL-410) 1. a. Orders for child support, spousal support, family support, attorney fees, and court and litigation costs (separately itemize each default on installment payments): DATE DUE TYPE OF ORDER AND DATE FILED PAYABLE TO AMOUNT ORDERED AMOUNT PAID AMOUNT DUE Continued on Attachment 1a. TOTAL AMOUNT ORDERED TOTAL AMOUNT PAID TOTAL AMOUNT DUE Summary of contempt counts alleged (including all attachments): Child support: Spousal support: Family support: Attorney fees: Court and other costs: Total b. $ $ $ Other orders (specify which order was violated, how the order was violated, and when the violation occurred): Continued on Attachment 1b. c. Other material facts (specify): Continued on Attachment 1c. 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) Form Adopted for Mandatory Use Judicial Council of California FL-411 [Rev. January 1, 2003] (SIGNATURE) Page 1 of 1 Family Code, § 292; Code of Civil Procedure, §§ 1209, 1211, 1211.5, 2015.5 www.courtinfo.ca.gov 2003 © American LegalNet, Inc. AFFIDAVIT OF FACTS CONSTITUTING CONTEMPT Financial and Injunctive Orders