FL-350 - Stipulation to Establish or Modify Child Support and Order

Summary

Stipulation to Establish or Modify Child Support and Order

Text

Form ID: FL-350
Title: Stipulation to Establish or Modify Child Support and Order
Effective Date: 2022-01-01
Mandatory Form: yes
Languages: 汉语, 한국어, español, Tagalog, Tiếng Việt
Info Page: https://selfhelp.courts.ca.gov/jcc-form/FL-350
Primary Download URL: https://www.courts.ca.gov/documents/fl350.pdf
Alternate Download URLs: https://www.courts.ca.gov/documents/fl350c.pdf, https://www.courts.ca.gov/documents/fl350k.pdf, https://www.courts.ca.gov/documents/fl350s.pdf, https://www.courts.ca.gov/documents/fl350t.pdf, https://www.courts.ca.gov/documents/fl350v.pdf
Form Detail Page:
Stipulation to Establish or Modify Child Support and Order
(FL-350)
Parents tell the court about their agreement to make an initial (the first) order for child support or modify (change) existing orders. The court also uses this to make their agreement a court order.
Get form FL-350
汉语
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(Chinese Simplified)
한국어
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(Korean)
español
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(Spanish)
Tagalog
Get form FL-350 in Tagalog
(Tagalog)
Tiếng Việt
Get form FL-350 in Vietnamese
(Vietnamese)
Effective: January 1, 2022
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How-to instructions for Child Support
Go to
Child Support Form Packets
PDF Text:
Form Adopted for Mandatory Use 
Judicial Council of California 
FL-350 [Rev. January 1, 2022]
STIPULATION TO ESTABLISH OR MODIFY 
CHILD SUPPORT AND ORDER
Family Code, § 4065 
FL-350
PARTY WITHOUT ATTORNEY OR ATTORNEY STATE BAR NUMBER:
NAME:
FIRM NAME:
STREET ADDRESS:
CITY: STATE: ZIP CODE:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER:
RESPONDENT:
OTHER PARTY:
STIPULATION TO ESTABLISH OR MODIFY 
CHILD SUPPORT AND ORDER
FOR COURT USE ONLY
CASE NUMBER:
INSTRUCTIONS 
 
 
 
 
 
 
 
 
• Use this form if the parents have an agreement about child support. After this form is completed and signed by both parents, it must 
be filed and approved by the court. A court case (for example, a divorce case) must already be open before this form can be used. 
• If the local child support agency is involved in your case, a lawyer from their office must also approve and sign the agreement.
• If the local child support agency is not involved in your case, each parent must also complete and submit a Child Support Case 
Registry Form when filing this agreement with the court.
• When you file the agreement with the court, the clerk may ask the parents to pay a filing fee. If you cannot afford the fee, you must
fill out these forms: Request to Waive Court Fees and Order on Court Fee Waiver (Superior Court)
• For more information about child support, go to , and for help completing this form, talk
to the or in your county.
1 The child support orders below are agreed to by:
a. (name): , who is the Petitioner Respondent Other party , and
b. (name): , who is the Petitioner Respondent Other party .
CHILD SUPPORT
2 We agree that (name): must pay to (name):
child support as listed below, beginning on (date): .
a. The children are:
Name of child Date of birth Monthly amount
(1)
(2)
(3)
(4)
(5) Additional children are listed on an attached page.
Basic child support. (Add up the monthly amounts for all children listed above.) Total: $ , payable
on the first of the month other (specify): .
b. The parents agree to pay additional child support as follows:
Instructions: For each item you select in the table on page 2, you must also tell the court how the expense will be paid 
each month. 
• Percentage: You can select “50% by each parent” or use a different split (for example, Name 1: 70%, Name 2: 30%). 
-OR-
• Dollar amount: You can input a fixed dollar amount (for example, Name 2 will pay $150/month for child care costs). 
(Note: if the actual monthly cost for that item later changes, you will then also need to change the court order;  
 this will not happen automatically.)   Page 1 of 3

FL-350 [Rev. January 1, 2022] STIPULATION TO ESTABLISH OR MODIFY 
CHILD SUPPORT AND ORDER
Page 2 of 3
FL-350
PETITIONER:
RESPONDENT:
OTHER PARTY:
CASE NUMBER:
Additional child support
Percentage Dollar amount
50% by  
each 
parent
(name): (name): (name): (name):
Reasonable uninsured healthcare costs for child % % $ /month $ /month
Childcare costs related to job or job training % % $ /month $ /month
Educational costs for child % % $ /month $ /month
Costs for other special needs of child % % $ /month $ /month
Travel expenses for visitation % % $ /month $ /month
Other (specify): % % $ /month $ /month
2 c. Total monthly child support. (Basic child support + additional child support, if dollar amount selected.)                
(name): will pay: $ , payable on the first of the month
other (specify): .
3 Health insurance for the child will be provided by (choose one or both parents) (name):
and (name): if available at no or reasonable cost from their job or self-employment.
A 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.    
FINANCIAL INFORMATION
4 We have attached a printout of a computer calculation of our financial information. (If you do not attach a printout, fill out items
5 and 6 , and 7 if applicable. A free child support calculator is available at
-OR-
5 The net monthly disposable income of (name): is: $ , and
the net monthly disposable income of (name): is: $ .
(Note: Child support is based on the net disposable income of each parent, which is how much money is left each month after  
 taxes and certain other items like health insurance, union dues, or other child support paid are subtracted from their pay.)
6 Based on our parenting time arrangement, on average the child is with (name): %
of the time and with (name): % of the time each month.
7 We agree to allow hardships in calculating child support. A hardship is being experienced by one or both parents as follows:
a. (name): : $ per month because of (specify):
b. (name): : $ per month because of (specify):
GUIDELINE SUPPORT AMOUNT
(You must complete item 8 , and item 9 or 10 , as applicable.)
8 Guideline child support is  $ per month, payable by (name): .
9 We agree to guideline child support.
10 We do not agree to guideline child support.
a. We agree to child support in the amount of: $ per month; the agreement is in the best interest of the children; 
the needs of the children will be adequately met by the agreed amount; and application of the guideline would be unjust or 
inappropriate in this case. 
b.
Other reasons why the guideline amount should not be used (specify):

FL-350 [Rev. January 1, 2022] STIPULATION TO ESTABLISH OR MODIFY 
CHILD SUPPORT AND ORDER
Page 3 of 3
FL-350
PETITIONER:
RESPONDENT:
OTHER PARTY:
CASE NUMBER:
OTHER ORDERS
11 a. We agree to promptly tell each other our new mailing address if it changes.
b. We agree to promptly tell each other our new employment information if we change jobs.
12 Other agreements related to child support (specify):
13 a. An earnings assignment order is issued. All child support payments must be made through the State Disbursement Unit.
b. We agree to stay (stop) the service of the earnings assignment because we have made the following alternative
arrangements to ensure payment (specify): .
14 In the event that there is a contract between a parent receiving support and a private child support collector, the parent 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 in arrears 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 parent receiving support, jointly.
15 We agree that we are fully informed of our rights under the California child support guidelines. This agreement is in the best interest 
of the child. We make this agreement freely without coercion or duress.   
16 Notice of Rights and Responsibilities (Health-Care Costs and Reimbursement Procedures) and Information Sheet on Changing 
a Child Support Order must be attached and is incorporated into this order.
17 Has the right to support been assigned to a county or is an application for public assistance pending?  Yes No
(If you checked "Yes" a lawyer from the local child support agency must also approve and sign the agreement.)
18 The local child support agency has reviewed and approves of this agreement.
Date:
(TYPE OR PRINT NAME)
 (SIGNATURE OF ATTORNEY FOR LOCAL CHILD SUPPORT AGENCY)
NOTICE: Any parent required to pay child support must pay interest on overdue amounts at the “legal” rate, which is  
currently 10 percent per year. If the parents agree to a child support order less than the guideline amount, the order can be 
modified without showing a change of circumstances. If the order is above the guideline, a change of circumstances will be 
required to modify the order. This form must be signed by all parties and the court to be effective.
Date:
(TYPE OR PRINT NAME)
 (SIGNATURE OF PETITIONER RESPONDENT OTHER PARTY)
Date:
(TYPE OR PRINT NAME)
 (SIGNATURE OF PETITIONER RESPONDENT OTHER PARTY)
Date:
(TYPE OR PRINT NAME)
 (ATTORNEY FOR PETITIONER RESPONDENT OTHER PARTY)
Date:
(TYPE OR PRINT NAME) (ATTORNEY FOR PETITIONER RESPONDENT OTHER PARTY)
THE COURT ORDERS
19 a. The guideline child support amount in item 8 is rebutted by the factors stated in item 10 .
b. Items 1 through 3 and items 11 through 14 are ordered. All child support payments must continue until further order of the
 court, or until the child marries, dies, is emancipated, or reaches age 18. The duty of support continues as to an unmarried 
child who has attained the age of 18 years, is a full-time high school student, and resides with a parent, until the time the child 
completes the 12th grade or  attains the age of 19 years, whichever first occurs. Except as modified by this agreement, all 
provisions of any previous orders made in this action will remain in effect.
Date:
JUDICIAL OFFICER

Retrieval chunks

• #1

  Form ID: FL-350 Title: Stipulation to Establish or Modify Child Support and Order Effective Date: 2022-01-01 Mandatory Form: yes Languages: 汉语, 한국어, español, Tagalog, Tiếng Việt Info Page: https://selfhelp.courts.ca.gov/jcc-form/FL-350 Primary Download URL: https://www.courts.ca.gov/documents/fl350.pdf Alternat…

• #2

  • When you file the agreement with the court, the clerk may ask the parents to pay a filing fee. If you cannot afford the fee, you must fill out these forms: Request to Waive Court Fees and Order on Court Fee Waiver (Superior Court) • For more information about child support, go to , and for help completing this for…

• #3

  and (name): if available at no or reasonable cost from their job or self-employment. A 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, …

• #4

  12 Other agreements related to child support (specify): 13 a. An earnings assignment order is issued. All child support payments must be made through the State Disbursement Unit. b. We agree to stay (stop) the service of the earnings assignment because we have made the following alternative arrangements to ensure p…

• #5

  19 a. The guideline child support amount in item 8 is rebutted by the factors stated in item 10 . b. Items 1 through 3 and items 11 through 14 are ordered. All child support payments must continue until further order of the court, or until the child marries, dies, is emancipated, or reaches age 18. The duty of suppo…