FL-450 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: REQUEST FOR HEARING REGARDING EARNINGS ASSIGNMENT CASE NUMBER: NOTICE: Complete and file this form with the court clerk to request a hearing only if you object to the Income Withholding for Support (form FL-195/OMB0970-0154) or Earnings Assignment Order for Spousal or Partner Support (form FL-435). This form may not be used to modify your current child support amount. (See page 2 of form FL-192, Information Sheet on Changing a Child Support Order.) Page 3 of this form is instructional only and does not need to be delivered to the court. 1. A hearing on this application will be held as follows (see instructions for getting a hearing date on page 3): a. Date: Time: Dept.: same as noted above other (specify): Div.: Room: b. The address of the court is: 2. I request that service of the Earnings Assignment Order for Spousal or Partner Support (form FL-435) or Income Withholding for Support (form FL-195/OMB0970-0154) be quashed (set aside) because a. I am not the obligor named in the earnings assignment. b. There is good cause to recall the earnings assignment because all of the following conditions exist: (1) Recalling the earnings assignment would be in the best interest of the children for whom I am ordered to pay support (state reasons): (2) I have paid court-ordered support fully and on time for the last 12 months without either an earnings assignment or another mandatory collection process. (3) I do not owe any arrearage (back support). (4) Service of the earnings assignment would cause extraordinary hardship for me, as follows (state reasons; you must prove these reasons at any hearing on this application by clear and convincing evidence): c. The other parent and I have a written agreement that allows the support order to be paid by an alternative method. A copy of the agreement is attached. (NOTE: If the support obligation is paid to the local child support agency, this agreement must be signed by a representative of that agency.) Page 1 of 3 Form Adopted for Mandatory Use Judicial Council of California FL-450 [Rev. July 1, 2008] REQUEST FOR HEARING REGARDING EARNINGS ASSIGNMENT (Family Law--Governmental--UIFSA) Family Code, § 5246 www.courtinfo.ca.gov American LegalNet, Inc. www.FormsWorkflow.com FL-450 PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT: CASE NUMBER: 3. I request that the earnings assignment be modified because a. the total amount of arrearages claimed as owing is incorrect. (Check one or more of the following reasons.) (1) I did not receive credit for all of the payments I have made. (Check (a), (b), or both.) (a) I have attached my statement of the payment history, which includes a monthly breakdown of amounts ordered and amounts paid. (b) I made the following payments that were not credited (for each payment, specify the date, the amount, and the name of the person or agency paid): (2) Child support was terminated (specify name of child, child's date of birth, date of termination, and reason support was terminated): (3) Other (specify): b. c. the monthly payment specified in the earnings assignment is more than half of my total net income each month from all sources. the monthly arrearage payment stated in the earnings assignment creates an undue hardship because (describe the hardship and state the amount you are able to pay on your arrearage): (NOTE: If you want to change the amount of money being deducted for arrearage because it creates a hardship, please attach a completed Financial Statement (Simplified) (form FL-155) or Income and Expense Declaration (form FL-150).) 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 PERSON REQUESTING HEARING) (SIGNATURE OF PERSON REQUESTING HEARING) CLERK'S CERTIFICATE OF MAILING I certify that I am not a party to this action and that a true copy of the Request for Hearing Regarding Earnings Assignment (form FL-450) was mailed, with postage fully prepaid, in a sealed envelope addressed as shown below, and that the request was mailed at (place): on (date): Date: Clerk, by , Deputy FL-450 [Rev. July 1, 2008] REQUEST FOR HEARING REGARDING EARNINGS ASSIGNMENT (Family Law--Governmental--UIFSA) Page 2 of 3 INFORMATION SHEET AND INSTRUCTIONS FOR REQUEST FOR HEARING REGARDING EARNINGS ASSIGNMENT (Do not deliver this information sheet to the court clerk.) FL-450 Please follow these instructions to complete the Request for Hearing Regarding Earnings Assignment (form FL-450) if you do not have an attorney representing you. Your attorney, if you have one, should complete this form. You must file the completed Request for Hearing form and its attachments with the court clerk within 10 days after the date your employer gave you a copy of Earnings Assignment Order for Spousal or Partner Support (form FL-435) or an Income Withholding for Support (form FL-195/OMB0970-0154). The address of the court clerk is the same as the one shown for the superior court on the earnings assignment order. You may have to pay a filing fee. If you cannot afford to pay the filing fee, the court may waive it, but you will have to fill out some forms first. For more information about the filing fee and waiver of the filing fee, contact the court clerk or the family law facilitator in your county. (TYPE OR PRINT IN INK) Front page, first box, top of form, left side: Print your name, address, and telephone number in this box if they are not already there. Item 1. a­b. You must contact the court clerk's office and ask that a hearing date be set for this motion. The court clerk will give you the information you need to complete this section. Item 2. Check this box if you want the court to stop the local child support agency or the other parent from collecting any support from your earnings. If you check this box, you must check the box for either a, b, or c beneath it. a. Check this box if you are not the person required to pay support in the earnings assignment. b. Check this box if you believe that there is "good cause" to recall the earnings assignment. Note: The court must find that all of the conditions listed i