SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE BLYTHE 265 N. Broadway, Blythe, CA 92225 HEMET 880 N. State St., Hemet, CA 92543 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number and Address) INDIO 46-200 Oasis St., Indio, CA 92201 RIVERSIDE 4175 Main St., Riverside, CA 92501 RI-FL03 FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): PETITIONER: RESPONDENT: OTHER: CASE NUMBER: STIPULATION AND ORDER ON REQUEST FOR ORDER THE PARTIES STIPULATE AND AGREE AS FOLLOWS: 1. Child Custody and Visitation This court has jurisdiction over the minor children under Family Code §§ 3421 ­ 3424. Notice and an opportunity to be heard were given as provided by the laws of the State of California. The habitual residence of the children is the United States of America. The parties acknowledge that they were advised that any violation of this order may result in civil or criminal penalties, or both. Legal and physical custody of the children shall be as follows: Child's Name Birth Date Legal Custody to Physical Custody to a. b. (1) (2) (3) Petitioner Respondent shall have the following visitation: Supervised visitation as stated in FL-341(A), which is attached. As stated in the Order Pursuant to Referral to Child Custody Recommending Counseling Services, consisting of pages, which was filed on , and is attached. Other: 2. a. Child Support Petitioner Respondent shall pay child support of $ per month due ½ on the 1st day and ½ on the 15th day of each month commencing , and continuing until further order of the court or until each child marries, b. dies, is emancipated, reaches age 19, or reaches age 18 and is not a full-time high school student, which ever first occurs. Support is allocated between minor children as follows: Child's name: Monthly Amount: Child's Name Monthly Amount $ $ $ $ $ $ Page 1 of 3 Approved for Optional Use Riverside Superior Court RI-FL03 [Rev, 05/27/14] STIPULATION AND ORDER ON REQUEST FOR ORDER riverside.courts.ca.gov/localfrms/localfrms.shmtl American LegalNet, Inc. www.FormsWorkFlow.com PETITIONER: RESPONDENT: CASE NUMBER: c. d. A printout of a computer calculation and finding is attached. Non-Guideline Child Support: The parties agree that: (1) they are fully informed of their rights concerning guideline child support; (2) they have agreed to the child support provisions of this Stipulation without coercion or duress; (3) this Stipulation in the best interests of the children involved; (4) the needs of the children will be adequately met by this agreed-upon child support; and (5) they have not assigned the right to support to the county and no public assistance application is pending. Child Support Arrears Petitioner from month commencing Respondent owes to the other parent child support arrears in the principal amount of $ to Arrears shall at $ until paid in full. Per month due for the of each 3. 4. Additional Child Support Orders: a. An Income Withholding Order for the above child support shall issue. b. (1) (2) Child Care. Petitioner The sum of $ Respondent shall pay to the other parent for child care costs related to employment: per month commencing . A sum equal to ½ of the verifiable daycare expenses. c. (1) Health Care Respondent shall obtain and/or maintain for the minor children medical, dental and visual insurance, Petitioner of available at reasonable cost through employment, self-employment, or union affiliation. The cost is presumed reasonable if it does not exceed 5% of the responsible parent's gross income. (2) 5. Any health expenses not paid by insurance shall be shared Petitioner 50% and Respondent 50%. If the person who receives child support enters into a contract with a private child support collector, the party ordered to pay support must pay the fee charged by the private support collector. The fee must not exceed 33 % of the total amount of arrears nor may it exceed 50% 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. Spousal/Partner Support Petitioner Respondent shall pay spousal/partner support of $ per month, due ½ on the 1st, and ½ on the 6. 15th day of each month commencing and continuing until the death of either party, remarriage or registration of a new domestic partnership by the party receiving support, further order of the court or termination date of 7. Spousal/Partner Support Arrears Petitioner period from Respondent owes to the other party spousal/partner support arrears in the principal amount of $ to Arrears shall be paid at $ per month due until paid in full. of each month commencing Page 2 of 3 Approved for Optional Use Riverside Superior Court RI-FL03 [Rev. 05/27/14] American LegalNet, Inc. www.FormsWorkFlow.com STIPULATION AND ORDER ON REQUEST FOR ORDER riverside.courts.ca.gov/localfrms/localfrms.shmtl PETITIONER: RESPONDENT: CASE NUMBER: 8. Attorney's Fees a. Petitioner Respondent will directly pay the attorney for costs Petitioner payable in full by Respondent $ . contribution towards fees and $ b. Petitioner Respondent will directly pay the attorney's fees for payable in installments of $ on the until paid in full. Petitioner Respondent of each month commencing on If any payment is more than 30 days overdue the entire unpaid balance will immediately become due with interest at the legal rate from the date of default. The legal rate is currently 10 percent per year. c. 9. a. Neither party shall be responsible for attorney's fees and costs except as otherwise ordered by the court. Exclusive Use Petitioner Respondent will have exclusive use, possession and control of the vehicle described as: Other Orders: family residence motor 10. 11. Based on this stipulation the parties agree to vacate the hearing on the Request for Order set for . Dated: (TYPE OR PRINT NAME) (SIGNATURE OF PETITIONER OR SIGNATURE OF ATTORNEY FOR PETITIONER) (TYPE OR PRINT NAME) (SIGNATURE OF RESPONDENT OR SIGNATURE OF ATTORNEY FOR RESPONDENT) IT IS SO ORDERED Dated: (JUDICIAL OFFICER) Number of pages attached: Each attachment to this stipulation and order is incorporated into this order, and the parties are ordered to comply with each attachment's provisions. Page 3 of 3 Approved for Optional Use Riverside Superior Court RI-FL03 [Rev. 05/27/14] STIPULATION AND ORDER ON REQUEST FOR ORDER riverside.courts.ca.gov/localfrms/localfrms.shmtl American LegalNe