FL-485 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/PARTY: CASE NUMBER: NOTICE OF DELINQUENCY 1. NOTICE TO PERSON ORDERED TO PAY CHILD SUPPORT (OBLIGOR) Obligor's name: The child support payments listed on this form are more than 30 days in arrears on the date of filing this notice. If they are not paid within 30 days of the date of service of this notice on you, a penalty of 6% per month may be charged on the unpaid balance. The penalty may accumulate to a maximum of 72% of the original amount of the unpaid support. California law provides: "Within a timely fashion after service of the Notice of Delinquency the [obligor may file] and serve a motion to determine arrearages" and show the court why the 6% penalty should not be imposed. Forms (FL-490 and FL-300) for filing the motion (also known as a "request for order") for a court hearing to establish your possible exemption were served on you with this Notice of Delinquency. You should file the Request for Order (form FL-300) as soon as possible, before the person to whom child support is paid (support obligee) obtains a court order or writ of execution. 2. The court ordered payment of child support on (date): The payments listed below are more than 30 days in arrears on the date of filing this notice: TOTAL CHILD SUPPORT ORDERED PAID ACTUALLY PAID ON ACCRUED INTEREST ON ORDER BALANCE DUE ON ACCRUED INTEREST CHECK BOX IF AMOUNT LISTED ON PREVIOUS NOTICE OF DELINQUENCY DATE DUE AMOUNT DATE PAID ON ORDER continued on attached page. Total due on order: Form Adopted for Mandatory Use Judicial Council of California FL-485 [Rev. July 1, 2013] Total due on interest: Page 1 of 2 Family Code, §§ 4720-4733 www.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com NOTICE OF DELINQUENCY PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT/PARTY: CASE NUMBER: 3. Address of chiIdren (complete a or b): There is a protective order that prohibits the support obligor from knowing the location of the child or children for whom a. support is payable or that excuses completion of part b. --OR-- b. The name, current address, and telephone number of children for whom support is due are as follows: Phone No. Name: Address: 4. a. b. Court papers should be served at the address shown at the top of page 1 of this form. The address at which court papers should be served on the support obligee is (address): 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 OF SUPPORT OBLIGEE) (SIGNATURE OF SUPPORT OBLIGEE) To Support Obligee: Have a completed copy of the Notice of Delinquency and a blank Application to Determine Arrearages (form FL-490) as well as a blank Request for Order (form FL-300) served on the support obligor by someone at least age 18 other than yourself. The person serving must complete the proof of service below. The proof of service must be filed with the court before you can collect the penalty. PROOF OF SERVICE OF NOTICE OF DELINQUENCY 1. At the time of service I was at least 18 years of age and not a party to this action. I served the completed Notice of Delinquency, blank Application to Determine Arrearages (form FL-490), and blank Request for Order (form FL-300) on (name): By personal delivery to the person served (1) Date served: (2) Time served: b. By mailing by certified mail (1) Date mailed: (Attach signed return receipt) (2) Place mailed: a. (3) Address: c. By mailing (by first-class mail or airmail) copies to the person served, together with two copies of the Notice and Acknowledgment of Receipt (form 982(a)(4)) and a return envelope, postage prepaid, addressed to the sender. (Attach completed Acknowledgment of Receipt) Other (specify code section): Additional page is attached. d. 2. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: (SIGNATURE OF PERSON SERVING NOTICE) Name and address of person serving notice: FL-485 [Rev. July 1, 2013] NOTICE OF DELINQUENCY Page 2 of 2