ATTORNEY OR PARTY WITHOUT ATTORNEY TELEPHONE NO. FOR COURT USE ONLY ATTORNEY FOR (Name) SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: CASE NUMBER STIPULATION AND ORDER 1. THIS MATTER PROCEEDED AS FOLLOWS: a. ( ) By written stipulation without court appearance. b. ( ) By court appearance as follows: Date: Dept: ( ) Plaintiff/Petitioner present in court ( ) Defendant/Respondent present in court Judicial officer: ( ) Attorney present in court (Name): ( ) Attorney present in court (Name): c. The "obligor" for purposes of the order is ( ) Plaintiff/Petitioner ( ) Defendant/Respondent 2. THE PARTIES AGREE THAT a. All orders previously made in this action shall remain in full force and effect except as specifically modified below. b. Obligor shall pay child support for the following children: Name Date of birth (1) ( ) For a total of $ payable on the day of each month beginning (date): (2) ( ) Other (specify): (3) Any support ordered shall continue until further order of court, unless terminated by operation of law. c. ( ) Obligor owes support arrears as follows as of (date): ( ) Child support: $ ( ) Spousal support: $ ( ) Family support: $ ( ) Interest is not included and is not waived. ( ) Payable $ on the day of each month commencing (date): d. No provision of this order shall operate to limit any right to assess and collect interest and penalties as allowed by law. Interest accrues on the entire principal balance owing and not on installments as they become due. All liquidation payments shall be subject to modification. There shall be no limitation on collection of principal, interest, and penalties without further notice as allowed by law. e. ( ) Obligor shall provide health insurance coverage for the children. f. Insofar as the agreed support is below guideline formula The parties stipulate that: 1. The agreement is in the best interests of the children. 2. The needs of the children will be adequately met by the stipulated amounts. 3. The right to support has not been assigned to the county pursuant to W&I Section 11477 and no public assistance is pending. ___________________________________________________________________________________________________________________________ _ STIPULATION AND ORDER (Continued on reverse) Local Form F-3 Eff. 7/1/95 American LegalNet, Inc. www.FormsWorkflow.com PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: Custody g. ( ) Custody of the minor children of the parties is awarded as follows: Child's Name Birth date Legal custody to CASE NUMBER Physical custody to Visitation H. ( ) Visitation to the party without physical custody as follows: I. ( ) The court further orders (specify): Date: Respondent/Defendant Petitioner/Plaintiff Date: Attorney for Respondent/Defendant ORDER 3. IT IS SO ORDERED. 4. ( ) This order is based on the documents attached to this order. Attorney for Petitioner/Plaintiff Date: JUDICIAL OFFICER 5. Number of pages attached: ( ) Signature follows last attachment NOTICE: Any party required to pay child support must pay interest on overdue amounts at the "legal" rate, which is currently 10 percent. This can be a large added amount. NOTICE: Modification of the support order may be obtained by following appropriate Family Law procedures. FC 4010 STIPULATION AND ORDER Local Form F-3 Eff. 7/1/95 American LegalNet, Inc. www.FormsWorkflow.com Local Form F-3 Eff. 7/1/95 American LegalNet, Inc. www.FormsWorkflow.com