FOR COURT USE ONLY ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): TELEPHONE NO.: FAX NO.(Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRAL DIVISION, FAMILY COURT, 1555 6TH AVE., SAN DIEGO, CA 92101 CENTRAL DIVISION, MADGE BRADLEY, 1409 4TH AVE. SAN DIEGO, CA 92101 EAST COUNTY DIVISION, 250 E. MAIN ST., EL CAJON, CA 92020 NORTH COUNTY DIVISION, 325 S. MELROSE DR., VISTA, CA 92081 SOUTH COUNTY DIVISION, 500 3RD AVE., CHULA VISTA, CA 91910 PETITIONER RESPONDENT CASE NUMBER STIPULATION AND ORDER ON ORDER TO SHOW CAUSE/ NOTICE OF MOTION Hearing Date: Time: Petitioner: Present Present Present Department: Not present. Represented by: Third Party: p.m. Not present. Represented by: Respondent: a.m. Not present. Represented by: THE PARTIES STIPULATE AND AGREE THAT THE FOLLOWING CHECKED ITEMS ARE: Temporary orders pending the trial of this action or further order of the court. 1. LEGAL CUSTODY: Legal custody of the minor child(ren) is awarded 2. Orders of modification. PHYSICAL CUSTODY: Physical custody of the minor child(ren) is awarded to the 3. VISITATION: The petitioner jointly to the petitioner petitioner to the respondent. respondent. respondent is awarded the following visitation rights: (a) Reasonable visitation with the minor child(ren) as mutually agreed upon between the parties. (b) Specific visitation with the minor child(ren): (state specific visitation) The child(ren) will be picked up at, and returned to, their residence by the party having visitation. The party with physical custody is required to have the child(ren) ready at the designated time, with appropriate clothing provided. However, if the party with visitation fails to appear within hour(s) of the designated time, visitation rights for that specific visitation period are relinquished. The child(ren) must be fed before being returned and all clothing provided must be returned with the child(ren). CHILD SUPPORT: 4. (a) Base child support must be paid by petitioner respondent beginning and continuing until further order of the court, or until the child marries, dies, is emancipated, reaches age 19, or reaches age 18 and is not a full-time high school student, whichever occurs first, as follows: Child's Name Date of Birth Monthly Amount Payable to (name) See attachment ____ for additional child support information. Due: on the 1st of the month ½ on the 1st and ½ on the 15th of the month other: (b) Child care costs related to employment or reasonably necessary job training must be paid by the $ per month or % of the total incurred to be paid as follows: in sum of (c) This stipulated amount is in compliance with Family Code section 4050 et seq., and section 4053. SDSC D-036 (Rev. 10/10) STIPULATION AND ORDER ON ORDER TO SHOW CAUSE/ NOTICE OF MOTION petitioner respondent Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com SHORT TITLE 5. (a) (b) 6. CASE NUMBER An Income Withholding Order is issued pursuant to Family Code section 5230. Stipulation to waive service of an Incoming Withholding Order is made. Child support payments made pursuant to an Income Withholding Order are to be made payable to the State Disbursement Unit (SDU) and sent to: P.O. Box 989067, West Sacramento, CA 95798. 7. (a) SPOUSAL SUPPORT: The petitioner respondent will pay to the month commencing month. (b) 8. petitioner , payable respondent spousal support of $ on the 1st of the month. per week ½ on the 1st and ½ on the 15th of the other: . Jurisdiction reserved until trial. PAYMENTS: Pursuant to Family Code sections 2023 and 2620, each party will pay installments to the following creditors as they become due: PETITIONER RESPONDENT Amount Creditor Amount Creditor See attachment ____ for additional payment information. 9. MEDICAL AND DENTAL: Petitioner Respondent is ordered to maintain all medical and dental benefits available through employment and/or union affiliation, pay the premiums, and cooperate in the presentation, collection, and reimbursement of any claims under such policy for the minor child(ren) and petitioner respondent. 10. ATTORNEY'S FEES: Petitioner Respondent will directly pay the attorney for contribution toward fees and $ until paid in full. petitioner costs (on account) payable in installments of $ respondent $ on the of each month, The exclusive use of the residence and furnishings located at 11. is awarded to the 12. petitioner and of the respondent. OTHER ORDERS: See attachment ____ for other orders. 13. All other issues are reserved until the time of the next hearing date or trial. 14. This matter is continued to for further hearing on all issues. at a.m. p.m. in Department the following issues only: . 15. Attorney for Petitioner Respondent to prepare formal order. This stipulation covers all matters in dispute in the Order to Show Cause/Notice of Motion. This order, when signed by the court, is the formal order. No further documents are necessary. Date: Signature of Petitioner Attorney for Petitioner Date: Signature of Respondent Attorney for Respondent IT IS SO ORDERED. Fee waiver considered and no repayment is ordered at this time. Date: Judge/Commissioner of the Superior Court SDSC D-036 (Rev. 10/10) STIPULATION AND ORDER ON ORDER TO SHOW CAUSE/ NOTICE OF MOTION Page 2 of 2