FL-643 - Declaration About Parent's Income or Earning Capacity During Judgment Periods (Governmental)

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Declaration About Parent's Income or Earning Capacity During Judgment Periods (Governmental)

Text

Form ID: FL-643
Title: Declaration About Parent's Income or Earning Capacity During Judgment Periods (Governmental)
Effective Date: 2026-01-01
Mandatory Form: no
Languages: 汉语, 한국어, español, Tagalog, Tiếng Việt
Info Page: https://selfhelp.courts.ca.gov/jcc-form/FL-643
Primary Download URL: https://www.courts.ca.gov/documents/fl643.pdf
Alternate Download URLs: https://www.courts.ca.gov/documents/fl643c.pdf, https://www.courts.ca.gov/documents/fl643k.pdf, https://www.courts.ca.gov/documents/fl643s.pdf, https://www.courts.ca.gov/documents/fl643t.pdf, https://www.courts.ca.gov/documents/fl643v.pdf
Form Detail Page:
Declaration About Parent's Income or Earning Capacity During Judgment Periods (Governmental)
(FL-643)
Tell the judge why the child support amount was based on more money than you were actually making at the time.
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(Vietnamese)
Effective: January 1, 2026
PDF Text:
Page 1 of 2
Form Approved for Optional Use 
Judicial Council of California 
FL-643 [Rev. January 1, 2026]
DECLARATION ABOUT PARENT'S INCOME OR EARNING CAPACITY 
DURING JUDGMENT PERIODS  
(Governmental)
Family Code, §§ 17400, 17432
FL-643
GOVERNMENTAL AGENCY (under Family Code, §§ 17400, 17406) OR 
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address):
TELEPHONE NO.: FAX NO. (Optional):
EMAIL ADDRESS:
ATTORNEY FOR (name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
FOR COURT USE ONLY
DECLARATION ABOUT PARENT'S INCOME OR EARNING CAPACITY DURING 
JUDGMENT PERIODS
CASE NUMBER:
1. I am:
a. the parent ordered to pay support.
b. the person ordered to receive support.
c. a representative of the local child support agency providing services in this case.
2. On (date):  a Judgment Regarding Parental Obligations (form FL-630) Judgment Regarding
Parental Obligations (UIFSA) (form FL-530) was entered by default using earning capacity or presumed income, instead of
actual income.
3. The actual income of the parent ordered to pay support and other factors needed to calculate the correct support for the 
time periods in the judgment are listed below (see item 6 in the Judgment to find the relevant time period):
Time periods in judgment 
(enter start and end dates)
Average monthly  
income
Percentage of 
time with 
children 
Monthly guideline 
support requested Source of income
a. from 
(month/year)         
to 
(month/year)       $ /month % $ /month
b. from 
(month/year)         
to 
(month/year)       $ /month % $ /month
c. from 
(month/year)         
to 
(month/year)       $ /month % $ /month
d. from 
(month/year)         
to 
(month/year)       $ /month % $ /month
e. from 
(month/year)         
to 
(month/year)       $ /month % $ /month
f. from 
(month/year)         
to 
(month/year)       $ /month % $ /month
g. from 
(month/year)         
to 
(month/year)       $ /month % $ /month
h. from 
(month/year)         
to 
(month/year)       $ /month % $ /month
4. Additional proof about the parent ordered to pay support's actual income during the time periods in the judgment is attached. 
(Black out the Social Security number from any papers you attach, like paycheck stubs.)

FL-643 [Rev. January 1, 2026] DECLARATION ABOUT PARENT'S INCOME OR EARNING CAPACITY 
DURING JUDGMENT PERIODS  
(Governmental)
Page 2 of 2
FL-643
PETITIONER:
RESPONDENT:
OTHER PARENT/PARTY:
CASE NUMBER:
5. Information regarding the earning capacity of the parent ordered to pay support needed to calculate the correct support 
amount for the time periods in the judgment is
a. provided in Earning Capacity Factors Attachment (form ).
b. as follows (specify):
 
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME)
 (SIGNATURE OF DECLARANT)

Retrieval chunks

• #1

  Form ID: FL-643 Title: Declaration About Parent's Income or Earning Capacity During Judgment Periods (Governmental) Effective Date: 2026-01-01 Mandatory Form: no Languages: 汉语, 한국어, español, Tagalog, Tiếng Việt Info Page: https://selfhelp.courts.ca.gov/jcc-form/FL-643 Primary Download URL: https://www.courts.ca.…

• #2

  time periods in the judgment are listed below (see item 6 in the Judgment to find the relevant time period): Time periods in judgment (enter start and end dates) Average monthly income Percentage of time with children Monthly guideline support requested Source of income a. from (month/year) to (month/year…