FL-630 GOVERNMENTAL AGENCY (under Family Code, §§ 17400, 17406): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS: 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/PARTY: JUDGMENT REGARDING PARENTAL OBLIGATIONS AMENDED SUPPLEMENTAL CASE NUMBER: 1. a. NOTICE: THIS IS A AMENDED PROPOSED JUDGMENT. This Judgment PROPOSED Regarding Parental Obligations will be entered by the court and will become legally binding unless you fill out and file the Answer to Complaint or Supplemental Complaint Regarding Parental Obligations (Governmental) (form FL-610) with the court clerk within 30 days of the date you were served with the Summons and Complaint or Supplemental Complaint Regarding Parental Obligations (Governmental) (form FL-600). If you need form FL-610, you may get one from the local child support agency's office, the court clerk, or the family law facilitator. The family law facilitator will help you fill out the forms. To file the answer, follow the procedures listed in the attached instructions. b. NOTICE: THIS IS A JUDGMENT. It is now legally binding. 2. This matter proceeded as follows: a. Judgment entered under Family Code section 17430. b. By court hearing, appearances as follows: (1) Date: Dept.: Judicial officer: (2) (3) (4) (5) (6) Petitioner/plaintiff present Respondent/defendant present Other parent/party present Other (specify): Attorney present (name): Attorney present (name): Attorney present (name): Local child support agency attorney (Family Code, §§ 17400,17406) (name): c. The parent ordered to pay support is the other parent/party. respondent/defendant petitioner/plaintiff This order is based on presumed income for the parent ordered to pay support under Family Code section 17400. Attached is a computer printout showing the parents' incomes and percentage of time each parent spends with the children. The printout, which shows the calculation of child support payable, will become the court's findings. This order is based on the attached documents (specify): 5. 3. 4. THE COURT ORDERS Respondent/defendant Petitioner/plaintiff 6. a. Other parent/party item 6b below. b. The parent ordered to pay support must pay current child support as follows: Name of child Date of birth are the parents of the children named in Monthly support amount 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-630 [Rev. January 1, 2017] JUDGMENT REGARDING PARENTAL OBLIGATIONS (Governmental) Family Code, §§17400,17402, 17404,17430 www.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com FL-630 PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT/PARTY: CASE NUMBER: 6. b. (1) Mandatory additional child support. (a) The parent ordered to pay support must pay additional monthly support for reasonable child-care costs, as follows: one-half or % or per month of the costs. (specify amount): $ other parent State Disbursement Unit child-care provider. Payments must be made to the (b) The parent ordered to pay support must pay reasonable uninsured health-care costs for the children, as follows: per month of the costs. one-half or % or (specify amount): $ Payments must be made to the other parent State Disbursement Unit health-care provider. Other (specify): (2) (3) (4) For a total of: $ beginning (date): payable on the: day of each month The low-income adjustment applies. The low-income adjustment does not apply because (specify reasons): (5) Any support ordered will continue until further order of court, unless terminated by operation of law. (6) When a person who has been ordered to pay child support is in jail or prison or is involuntarily institutionalized for any period of more than 90 days in a row, the child support order is temporarily stopped. However, the child support order will not be stopped if the person who owes support has the financial ability to pay that support while in jail, prison, or an institution. It will also not be stopped if the reason the person is in jail, prison, or an institution is because the person didn't pay court ordered child support or committed domestic violence against the supported person or child. The child support order starts again on the first day of the month after the person is released from jail, prison, or an institution. c. The parent ordered to pay support The parent receiving support must (1) provide and maintain health insurance coverage for the children if available at no or reasonable cost and keep the local child support agency informed of the availability of the coverage (the cost is presumed to be reasonable if it does not exceed 5 percent of gross income to add a child); (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. The parent ordered to pay support must pay child support for the past periods and in the amounts set forth below: Name of child Date of birth Period of support Amount d. FL-630 [Rev. January 1, 2017] JUDGMENT REGARDING PARENTAL OBLIGATIONS (Governmental) Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com FL-630 PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT/PARTY: CASE NUMBER: 6. d. (1) Other (specify): (2) (3) e. f. g. For a total of: $ payable: $ on the: