FL-665 FOR COURT USE ONLY ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FAX NO. (Optional): TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT: CASE NUMBER: FINDINGS AND RECOMMENDATION OF COMMISSIONER 1. Name (specify): hearing this matter as a temporary judge. objected to Commissioner (name): 2. THIS MATTER PROCEEDED AS FOLLOWS a. By court hearing, appearances as follows: (1) Date: Dept.: Judicial officer: Petitioner/plaintiff present Attorney present (name): (2) Respondent/defendant present (3) Attorney present (name): Other parent present (4) Attorney present (name): (5) Local child support agency attorney (Family Code, §§ 17400, 17406) by (name): (6) Other (specify): The parent ordered to pay support is the petitioner/plaintiff respondent/defendant b. 3. 4. other parent. Attached is a computer printout showing the parents’ income and percentage of time each parent spends with the child(ren). The printout, which shows the calculation of child support payable, will become the court’s findings. This recommended order is based on the attached documents (specify): 5. THE COMMISSIONER RECOMMENDS THE FOLLOWING a. All orders previously made in this action remain in full force and effect except as modified below. mother father b. (Name of parent): mother father (Name of parent): are the parents of the children listed below. c. The parent ordered to pay support must pay current child support as follows: Date of birth Name of child (1) Other (specify): (2) For a total of $ beginning (date): (3) Monthly support amount The low-income adjustment applies. The low-income adjustment does not apply because (specify reasons): payable on the day of each month (4) Any support ordered will continue until further order of court, unless terminated by operation of law. NOTICE: Any party required to pay child support must pay interest on overdue amounts at the legal rate, which is currently 10 percent per year. Page 1 of 3 Form Adopted for Alternative Mandatory Use instead of Form FL-692 Judicial Council of California FL-665 [Rev. January 1, 2010] FINDINGS AND RECOMMENDATION OF COMMISSIONER (Governmental) Family Code, § 4251 www.courtinfo.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com FL-665 PETITIONER/PLAINTIFF: CASE NUMBER: RESPONDENT/DEFENDANT: OTHER PARENT: 5. d. The parent ordered to pay support must pay child support for the past periods and in the amounts set forth below: Date of birth Period of support Amount Name of child (1) (2) Other (specify): For a total of $ day of each month payable on the beginning (date): (3) e. Interest accrues on the entire principal balance owing and not on each installment as it becomes due. The parent ordered to pay support owes support arrears as follows, as of (date): (1) (2) (3) Child support: $ Spousal support: $ Interest is not included and is not waived. Family support: $ Payable: $ on the day of each month beginning (date): (4) Interest accrues on the entire principal balance owing and not on each installment as it becomes due. f. No provision of this judgment/order may operate to limit any right to collect the principal (total amount of unpaid support) or to charge and collect interest and penalties as allowed by law. All payments ordered are subject to modification. g. All payments must be made to (name and address of agency): h. An earnings assignment order is issued. i. In the event that there is a contract between a party receiving support and a private child support collector, the party ordered to pay support must pay the fee charged by the private child support collector. This fee must not exceed 33 1/3 percent of the total amount of past due support nor may it exceed 50 percent of any fee charged by the private child support collector. The money judgment created by this provision is in favor of the private child support collector and the party receiving support, jointly. The parent receiving support must (1) provide and maintain health insurance The parent ordered to pay support j. coverage for the children if it is available through employment or a group plan, or otherwise available at no or reasonable cost, and keep the local child support agency informed of the availability of the coverage; (2) if health insurance is not available, provide coverage when it becomes available; (3) within 20 days of the local child support agency’s request, complete and return a health insurance form; (4) provide to the local child support agency all information and forms necessary to obtain health-care services for the children; (5) present any claim to secure payment or reimbursement to the other parent or caretaker who incurs costs for health-care services for the children; and (6) assign any rights to reimbursement to the other parent or caretaker who incurs costs for health-care services for the children. The parent ordered to provide health insurance must seek continuation of coverage for the child after the child attains the age when the child is no longer considered eligible for coverage as a dependent under the insurance contract, if the child is incapable of self-sustaining employment because of a physically or mentally disabling injury, illness, or condition and is chiefly dependent upon the parent providing health insurance for support and maintenance. k. If “The parent ordered to pay support” box is checked in item 5j, a health insurance coverage assignment must issue. l. The parents must notify the local child support agency in writing within 10 days of any change in residence or employment. m. The form Notice of Rights and Responsibilities (Health-Care Costs and Reimbursement Procedures) and Information Sheet on Changing a Child Support Order (form FL-192) is attached. n. The following person (the "other parent") is added as a party to this action (name): o. The parent ordered to pay support must pay costs of (specify): p. to (specify): The court further recommends (specify): Date: COMMISSIONER Number of pages attached: FL-665 [Rev. January 1, 2010] SIGNATURE FOLLOWS LAST ATTACHMENT FINDINGS AND RECOMMENDATION OF COMMISSIONER (Governmental) Page 2 of 3 FL-665 PETITIONER/PLAINTIFF: CASE NUMBER: RESPONDENT/DEFENDANT: OTHER PARENT: CLERK’S CERTIFICATE OF MAILING OR SERVICE I certify that I am not a party to this cause and that 1. 2. Personal service. A true copy of this Findings and Recommendation of Commissioner was handed to the petitioner/plaintiff respondent/defendant other parent at the hearing of this matter before the commissioner. Mail. A true copy of this Findings and Recommendation of Commissioner was mailed first class, postage fully prepaid, in a sealed envelope addressed as shown below, and that the request was mailed California, at (place): on (date): Date: FL-665 [Rev. January 1, 2010] Clerk, by FINDINGS AND RECOMMENDATION OF COMMISSIONER (Governmental) , Deputy Page 3 of 3