FL-460 ATTORNEY OR PARTY WITHOUT ATTORNEY OR GOVERNMENTAL AGENCY (under Fam. Code, §§ 17400, 17406) (Name, state bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: ATTORNEY FOR (Name): FAX NO.: SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT: QUALIFIED DOMESTIC RELATIONS ORDER FOR SUPPORT (EARNINGS ASSIGNMENT ORDER FOR SUPPORT) Modification Child Support Spousal or Family Support CASE NUMBER: TO THE PAYOR/PLAN: This is an earnings assignment order for support governed by Chapter 8 of the Family Code and is intended to be a qualified domestic relations order (QDRO) under applicable federal law. This order applies to the following named plan: Name: Address: This order requires you to withhold a portion of the benefits payable under the Plan with respect to (specify Obligor/Participant's full legal name and, if known, mailing address, date of birth, and employee identification number): Name: DOB: ID#: Address: and pay as directed below. Note: A separate Attachment to Qualified Domestic Relations Order for Support (form FL-461) that sets forth the social security number of any participant named above must be completed and served on the Plan with a copy of this order. The Plan will require this information for tax reporting purposes. Do not file a copy of form FL-461 with the court. THE COURT ORDERS THE FOLLOWING: 1. WITHHOLDING OF PERIODIC BENEFIT PAYMENTS a. If Participant has commenced receiving benefits under the Plan in the form of monthly or other periodic payments or has applied to receive monthly or other periodic payments (if benefits are not in pay status and have not been applied for, see item 5; if benefits are payable in a lump sum, see item 3), withhold the following amounts from the monthly benefits otherwise payable to the Participant: (4) (1) $ $ per month current child support per month child support arrearages (2) (5) per month spousal support arrearages per month current spousal support $ $ (3) (6) per month family support arrearages per month current family support $ $ b. Total monthly support obligation of (sum of item 1a(1) through (6)): $ c. If the total monthly support obligation exceeds 50 percent of Participant's periodic benefits, withhold the greater of 50 percent or the percentage, if any, set forth in item 12. d. If Participant's benefits are payable on a periodic basis other than monthly (e.g., quarterly, semiannually, or annually), multiply each of the amounts in items 1a and 1b by the number of months included in the payment period, and withhold the adjusted amounts (subject to the limitations in item 1c, taking into account the adjustment of the amount in item 1b) from each benefit payment. e. If the amount withheld is less than the total monthly support obligation, prorate the amount first to current child support, then to current family support, and then to current spousal support. Apply any remainder in the same order of priority to support arrearages. Page 1 of 4 Form Approved for Optional Use Judicial Council of California FL-460 [Rev. January 1, 2003] Family Code, § 5208; Code of Civil Procedure, § 706.052; 26 U.S.C. § 414(p); 29 U.S.C. § 1056(d) www.courtinfo.ca.gov QUALIFIED DOMESTIC RELATIONS ORDER FOR SUPPORT (EARNINGS ASSIGNMENT ORDER FOR SUPPORT) 2002 © American LegalNet, Inc. PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT: CASE NUMBER: 2. ARREARAGES: For purposes of this order, the total arrearages are set as follows (interest that has not been calculated or included is not waived): Amount As of (date) a. $ Child support: Spousal support: $ b. $ c. Family support: 3. WITHHOLDING FROM LUMP SUM DISTRIBUTIONS: Withhold from any lump sum distributions currently payable to Participant under the Plan as follows: a. An amount equal to the total of the support arrearages, if any, set forth in item 2. b. To the extent the amounts withheld under item 3a are for child support arrearages, withhold from the lump sum distribution and pay over to the appropriate taxing authorities an additional amount sufficient to satisfy the Plan's mandatory federal and state income tax withholding obligations with respect to those arrearages and with respect to all additional amounts withheld under this item 3b. Any amounts withheld under this item 3b may not be applied to reduce the amount of the child support arrearages. c. To the extent the amounts withheld under item 3a are for support arrearages other than child support, withhold from those amounts and pay over to the appropriate taxing authorities an additional amount sufficient to satisfy the Plan's mandatory federal and state income tax withholding obligations with respect to those arrearages. Any amounts withheld under this item 3c must be applied proportionally to reduce the amount of the family support arrearages and spousal support arrearages. d. If the amounts withheld under item 3a are less than the total of the support arrearages, if any, set forth in item 2, prorate the amounts first to child support arrearages, then to family support arrearages, and then to spousal support arrearages. e. If the amounts to be withheld under items 3a and 3b would exceed the total amount of the lump sum distribution currently payable, withhold the entire amount of the lump sum distribution, allocate from it an amount sufficient to satisfy the Plan's mandatory federal and state income tax withholding obligations with respect to the amount of such distribution, and allocate the balance to satisfaction of the child support arrearages. Any income tax withheld under this item 3e may not be applied to reduce the amount of the child support arrearages. f. The limitations on withholding set forth in items 1 and 12 do not apply to the withholding provisions of this item 3. 4. DISTRIBUTE AMOUNTS WITHHELD OR ALLOCATED AS FOLLOWS: a. Child Support: All amounts withheld or payable for child support under this order are for the benefit of (specify name of each Alternate Payee, with date of birth, if available): Name of each child Date of birth of each child b. Amounts withheld for child support must be paid to (specify name, capacity, and mailing address of agent to receive payments-- hereinafter "Agent"): Name: Capacity: Address: c. Spousal or Family Support (1) All amounts withheld or payable for spousal/family support under this order are for the benefit of (specify name of Spousal or Family Alte