FL-616 GOVERNMENTAL AGENCY (under Family Code §§ 17400, 17406): TELEPHONE AND FAX NOS.: FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT: DECLARATION FOR AMENDED PROPOSED JUDGMENT CASE NUMBER: 1. The local child support agency is providing enforcement services in this case. a Summons and Complaint Regarding Parental Obligations (form FL-600) was filed requesting 2. On (date): the Obligor pay child support based on the California support guideline. The amount of the support requested was based on the Obligor's gross monthly income as follows (check one): a. b. Presumed income as provided by law. Known income of: $ per month. 3. Since the service of the Summons and Complaint Regarding Parental Obligations (form FL-600) a. the local child support agency has received additional income information that would result in a different support order. According to this information, Obligor's gross monthly income is: $ Obligee's gross monthly income is: $ Obligor's income has become unknown. Other (specify): b. c. 4. An amended proposed judgment is attached. 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) (SIGNATURE OF DECLARANT) Page 1 of 2 Form Adopted for Mandatory Use Judicial Council of California FL-616 [Rev. January 1, 2003] DECLARATION FOR AMENDED PROPOSED JUDGMENT (Governmental) Family Code, § 17400, 17406 www.courtinfo.ca.gov 2002 © American LegalNet, Inc. PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT: CASE NUMBER: PROOF OF SERVICE 5. I served this declaration and the attached amended proposed judgment on the Obligor. a. Personal delivery. I personally delivered this declaration and judgment to the Obligor as follows: (1) Name: (2) Address where delivered: (3) Date of delivery: (4) Time of delivery: b. Mail. I deposited this declaration and judgment in the United States mail, in a sealed envelope with postage fully prepaid. I used first-class mail. The envelope was addressed and mailed as follows: (1) Name: (2) Address: (3) Date of mailing: (4) Place of mailing (city and state): 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) (SIGNATURE OF PERSON WHO SERVED OBLIGOR) 6. I served this declaration and the attached amended proposed judgment on the other parent. a. Personal delivery. I personally delivered this declaration and judgment to the other parent as follows: (1) Name: (2) Address where delivered: (3) Date of delivery: (4) Time of delivery. b. Mail. I deposited this declaration and judgment in the United States mail, in a sealed envelope with postage fully prepaid. I used first-class mail. The envelope was addressed and mailed as follows: (1) Name: (2) Address: (3) Date of mailing: (4) Place of mailing (city and state): 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) FL-616 [Rev. January 1, 2003] (SIGNATURE OF PERSON WHO SERVED OTHER PARENT) Page 2 of 2 DECLARATION FOR AMENDED PROPOSED JUDGMENT (Governmental) 2002 © American LegalNet, Inc.