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FL-615 - Stipulation for Judgment or Supplemental Judgment Regarding Parental Obligations and Judgment (Governmental)
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Stipulation for Judgment or Supplemental Judgment Regarding Parental Obligations and Judgment (Governmental)
Text
Form ID: FL-615
Title: Stipulation for Judgment or Supplemental Judgment Regarding Parental Obligations and Judgment (Governmental)
Effective Date: 2020-01-01
Mandatory Form: yes
Languages: español
Info Page: https://selfhelp.courts.ca.gov/jcc-form/FL-615
Primary Download URL: https://www.courts.ca.gov/documents/fl615.pdf
Alternate Download URLs: https://www.courts.ca.gov/documents/fl615s.pdf
Form Detail Page:
Stipulation for Judgment or Supplemental Judgment Regarding Parental Obligations and Judgment (Governmental)
(FL-615)
Parents and the local child support agency tell the court about their agreement to name the parents of the child and for child support.
Get form FL-615
español
Get form FL-615 in Spanish
(Spanish)
Effective: January 1, 2020
PDF Text:
Form Adopted for Alternative Mandatory
Use Instead of Form FL-692
Judicial Council of California
FL-615 [Rev. January 1, 2020]
STIPULATION FOR JUDGMENT OR SUPPLEMENTAL JUDGMENT
REGARDING PARENTAL OBLIGATIONS AND JUDGMENT
(Governmental)
Family Code, §§ 17400,
17402,17406
www.courts.ca.gov
TELEPHONE NO.: FAX NO. (Optional):
E-MAIL ADDRESS:
ATTORNEY FOR (Name):
GOVERNMENTAL AGENCY (under Family Code, §§ 17400, 17406):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
CASE NUMBER:STIPULATION FOR
REGARDING PARENTAL OBLIGATIONS AND JUDGMENT
FOR COURT USE ONLY
FL-615
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 5
JUDGMENT SUPPLEMENTAL JUDGMENT
1. This matter proceeded as follows:
(1)
(2) Petitioner/plaintiff present
(3)
(4)
(6)
Other parent/party present
Local child support agency (Fam. Code, §§ 17400, 17406) by (name):(5)
Respondent/defendant present
Judicial Officer:
Attorney present (name):
Attorney present (name):
Attorney present (name):
Dept:Date:
2.
3. The parties agree that:
a.
b. per month.
(1) We have been fully informed of the guideline amount of support; we agree voluntarily to child support in the
per month; the agreement is in the best interest of the children; the needs of the children
will be met adequately by the agreed amount; the children are not receiving public assistance; no application for
public assistance is pending; and application of the guideline would be unjust and inappropriate in this case. We
understand that if the order is below the guideline, no change of circumstances need be shown for the court to
raise this order to the guideline amount. If the order is above the guideline, a change of circumstances will be
required to modify this order.
(2)
amount of $
c.
c.
The parent ordered to pay support has read and understands the Advisement and Waiver of Rights for Stipulation on page 5 of
this form. The parent ordered to pay support gives up these rights and freely agrees that a judgment may be entered in
accordance with this stipulation.
The parent ordered to pay support is the
This order is based on the attached documents (specify):
The computer printout attached shows 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.
The amount of support payable by the party ordered to pay support as calculated under the guideline is: $
Other (specify):
Other rebutting factors (specify):
other parent/party.respondent/defendantpetitioner/plaintiff
By court hearing, appearances as follows:
By written stipulation without court appearance.a.
b.
The guideline amount should be rebutted because of the following:
We agree to guideline support.
Page 2 of 5
item 3e below.
The parent ordered to pay support must pay current child support as follows:
Monthly support amountName of child Date of birth
(4)
Any support ordered will continue until further order of court, unless terminated by operation of law.
3. d.
e.
(3)
(5)
(1)
The parent ordered to pay support The parent receiving support
(2)
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.
Petitioner/plaintiff Respondent/defendant Other parent/party
For a total of: $ payable on the: day of each month
beginning (date):
f.
Mandatory additional child support.
Other (specify):
The low-income adjustment applies.
The low-income adjustment does not apply because (specific reasons):
are the parents of the children named in
Payments must be made to the other parent State Disbursement Unit child-care provider.
The parent ordered to pay support must pay reasonable uninsured health-care costs for the children, as follows:
Payments must be made to the other parent State Disbursement Unit health-care provider.
The parent ordered to pay support must pay additional monthly support for reasonable child-care costs, as follows:
(b)
(a)
(specify amount): $One-half or % or per month of the costs
(specify amount): $One-half or % or per month of the costs
must (1) provide and maintain health insurance
FL-615 [Rev. January 1, 2020] STIPULATION FOR JUDGMENT OR SUPPLEMENTAL JUDGMENT
REGARDING PARENTAL OBLIGATIONS AND JUDGMENT
(Governmental)
FL-615
CASE NUMBER:PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
Page 3 of 5
An earnings assignment order is issued.
In the event that there is a contract between a party receiving support and a private child support collector, the party 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 of past due support 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 party receiving support,
jointly.
If "The parent ordered to pay support" box is checked in item 3f, a health insurance coverage assignment must issue. m.
The Notice of Rights and Responsibilities (Health-Care Costs and Reimbursement Procedures) and Information Sheet on
Changing a Child Support Order ( ) is attached.
n.
p.
The parents must notify the local child support agency in writing within 10 days of any change in residence or employment.
o.
3.
q.
(2) day of each month
(3) Interest accrues on the entire principal balance owing and not on each installment as it becomes due.
(1)
For a total of $ payable: $ on the:
beginning (date):
Other (specify):
If this is a judgment on a Supplemental Complaint, it does not modify or supersede any prior judgment or order for support or
arrearages, unless specifically provided.
No provision of this judgment may operate to limit any right to collect the principal (total amount of unpaid support) or to charge
and collect interest and penalties as allowed by law. All payments ordered are subject to modification.
h.
i.
j.
g.
Name of child Date of birth Period of support Amount
All payments, unless specified in item 3e(1) above, must be made to the State Disbursement Unit at the address listed below
(specify address):
The parent ordered to pay support must pay child support for the past periods and in the amounts set forth below.
Other (specify):
The following person (the "other parent") is added as a party to this action (name):
k.
l.
FL-615 [Rev. January 1, 2020] STIPULATION FOR JUDGMENT OR SUPPLEMENTAL JUDGMENT
REGARDING PARENTAL OBLIGATIONS AND JUDGMENT
(Governmental)
FL-615
CASE NUMBER:PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
Page 4 of 5
JUDGMENT
4. THE COURT SO ORDERS.
JUDICIAL OFFICER
SIGNATURE FOLLOWS LAST ATTACHMENT
(TYPE OR PRINT NAME) (SIGNATURE OF OTHER PARENT)
(TYPE OR PRINT NAME) (SIGNATURE OF ATTORNEY FOR OTHER PARENT)
(TYPE OR PRINT NAME) (SIGNATURE OF ATTORNEY FOR LOCAL CHILD SUPPORT AGENCY)
(TYPE OR PRINT NAME) (SIGNATURE OF PETITIONER)
(TYPE OR PRINT NAME) (SIGNATURE OF ATTORNEY FOR PETITIONER)
(TYPE OR PRINT NAME) (SIGNATURE OF RESPONDENT)
(TYPE OR PRINT NAME) (SIGNATURE OF ATTORNEY FOR RESPONDENT)
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Number of pages attached:
FL-615 [Rev. January 1, 2020] STIPULATION FOR JUDGMENT OR SUPPLEMENTAL JUDGMENT
REGARDING PARENTAL OBLIGATIONS AND JUDGMENT
(Governmental)
FL-615
CASE NUMBER:PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
Page 5 of 5
I agree to the terms of this
stipulation freely and voluntarily.
RIGHT TO HAVE GENETIC TESTING
WHERE THE LAW PERMITS. I
understand that, where the law permits,
I have the right to have the court order
genetic testing. The court will decide
on the testing. The court could order that
I pay none, some, or all of the costs of the
genetic testing.
(PARTY’S SIGNATURE)
(TYPE OR PRINT NAME)
DECLARATION OF PERSON PROVIDING INTERPRETATION/TRANSLATION: The party/parties indicated below is/are unable to
read or understand this Stipulation for Judgment or Supplemental Judgment Regarding Parental Obligations and Judgment because
I certify under penalty of perjury under the laws of the State of California that I am competent to interpret or translate in the primary
language indicated above and that I have, to the best of my ability, read to, interpreted for, or translated for the above-named party the
Stipulation for Judgment or Supplemental Judgment Regarding Parental Obligations and Judgment in the party's primary language.
The above-named party said the terms of this Stipulation for Judgment or Supplemental Judgment Regarding Parental Obligations and
Judgment were understood by that party before signing it.
(SIGNATURE)
(TYPE OR PRINT NAME)
RIGHT TO BE REPRESENTED BY A
LAWYER. I understand that I have the right
to be represented by a lawyer of my choice
at my expense. If I cannot afford a lawyer to
represent me, I can ask the court to appoint
one to represent me free of charge only if I
dispute that I am the parent of the children
named in this action and only on the issue
of parentage. I understand that the attorney
for the local child support agency does not
represent me.
RIGHT TO A TRIAL. I understand that I
have a right to have a judicial officer (1)
determine if I am the parent of the children
named in the stipulation, (2) decide how
much child support I must pay, and (3)
decide how much I owe for arrearages
(unpaid support).
RIGHT TO CONFRONT AND CROSS-
EXAMINE WITNESSES. I understand that
in a trial any allegations made against me
must be proved. At the trial I may be
present with a lawyer when witnesses
testify, and I may ask them questions. I may
also present evidence and witnesses.
ADMISSION AND WAIVER OF RIGHTS. I
understand that by agreeing to the terms of
this stipulation, I am admitting that I am the
parent of the children named in the
stipulation and I am giving up the rights
stated above.
WHERE THE STIPULATION INCLUDES
CHILD SUPPORT.
I understand that I will have the duty to
obey the support order for the children
named in the stipulation until the order is
changed by the court or ended by law.
I also understand that the court will
order any support payments to be paid
directly from my wages or other
earnings and sent to the local child
support agency if one is assigned to
collect the support.
I have been advised of the amount of
guideline child support and how the
proposed child support amount was
determined.
WHERE THE STIPULATION INCLUDES
A PROVISION FOR HEALTH
INSURANCE. I understand that I must
keep health insurance coverage for the
minor children if insurance is available or
becomes available to me at no or
reasonable cost. A health insurance
coverage assignment/National Medical
Support Notice may be ordered to get
health insurance for my children.
I understand that the local child
support agency is required by state
law to enforce the duty of support.
I UNDERSTAND THAT IF I
WILLFULLY FAIL TO SUPPORT
MY CHILDREN, CRIMINAL
PROCEEDINGS MAY BE
INITIATED AGAINST ME.
COLLECTION OF SUPPORT. I
understand that any support I owe
may be collected from any of my
property. This collection may be
made by intercepting money owed
to me by the state or federal
government (such as tax refunds,
unemployment and disability
benefits, and lottery winnings), by
taking property I own, by placing a
lien on my property, or by any other
lawful means.
IF I AM REPRESENTED BY AN
ATTORNEY, MY ATTORNEY HAS
READ AND EXPLAINED TO ME
THE TERMS OF THE
STIPULATION AND THIS
ADVISEMENT AND WAIVER OF
RIGHTS, AND I UNDERSTAND
THESE TERMS.
2.
1.
3.
4.
5.
6.
a.
b.
c.
7.
8.
9.
10.
11.
12.
(SIGNATURE)
(TYPE OR PRINT NAME)
(PARTY’S SIGNATURE)
(TYPE OR PRINT NAME)
and the party has has not read the form
stipulation translated into this language.
and the party has has not read the form
stipulation translated into this language.
I have read and understand the Advisement and Waiver of Rights for Stipulation; or
Attached is a translation of this Advisement and Waiver of Rights for Stipulation in (specify language):
I understand the translation.
Date:
I understand the translation.
Date:
language is (specify): language is (specify):
Date: Date:
(Insert name): (Insert name): 's primary 's primary
ADVISEMENT AND WAIVER OF RIGHTS FOR STIPULATION
FL-615 [Rev. January 1, 2020] STIPULATION FOR JUDGMENT OR SUPPLEMENTAL JUDGMENT
REGARDING PARENTAL OBLIGATIONS AND JUDGMENT
(Governmental)
FL-615
CASE NUMBER:PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
Retrieval chunks
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#1
Form ID: FL-615 Title: Stipulation for Judgment or Supplemental Judgment Regarding Parental Obligations and Judgment (Governmental) Effective Date: 2020-01-01 Mandatory Form: yes Languages: español Info Page: https://selfhelp.courts.ca.gov/jcc-form/FL-615 Primary Download URL: https://www.courts.ca.gov/documents…
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#2
public assistance is pending; and application of the guideline would be unjust and inappropriate in this case. We understand that if the order is below the guideline, no change of circumstances need be shown for the court to raise this order to the guideline amount. If the order is above the guideline, a change of c…
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#3
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 …
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#4
If "The parent ordered to pay support" box is checked in item 3f, a health insurance coverage assignment must issue. m. The Notice of Rights and Responsibilities (Health-Care Costs and Reimbursement Procedures) and Information Sheet on Changing a Child Support Order ( ) is attached. n. p. The p…
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#5
CASE NUMBER:PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT/PARTY: Page 5 of 5 I agree to the terms of this stipulation freely and voluntarily. RIGHT TO HAVE GENETIC TESTING WHERE THE LAW PERMITS. I understand that, where the law permits, I have the right to have the court order genetic testing. The…
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#6
parent of the children named in the stipulation and I am giving up the rights stated above. WHERE THE STIPULATION INCLUDES CHILD SUPPORT. I understand that I will have the duty to obey the support order for the children named in the stipulation until the order is changed by the court or ended by law. I also u…
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#7
ADVISEMENT AND WAIVER OF RIGHTS FOR STIPULATION FL-615 [Rev. January 1, 2020] STIPULATION FOR JUDGMENT OR SUPPLEMENTAL JUDGMENT REGARDING PARENTAL OBLIGATIONS AND JUDGMENT (Governmental) FL-615 CASE NUMBER:PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT/PARTY: