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

Form FL-350 or the "Stipulation To Establish Or Modify Child Support And Order" is a form issued by the California Courts.

The form was last revised in January 1, 2017 and is available for digital filing. Download an up-to-date Form FL-350 in PDF-format down below or look it up on the California Courts Forms website.

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FL-350
STATE BAR NO:
ATTORNEY OR PARTY WITHOUT ATTORNEY:
FOR COURT USE ONLY
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/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
CASE NUMBER:
STIPULATION TO ESTABLISH OR MODIFY
CHILD SUPPORT AND ORDER
1.
a.
Mother’s net monthly disposable income: $
Father’s net monthly disposable income: $
-OR-
b.
A printout of a computer calculation of the parents’ financial circumstances is attached.
2.
Percentage of time each parent has primary responsibility for the children:
Mother:
%
Father:
%
3.
a.
A hardship is being experienced by the mother: $
per month because of (specify):
The hardship will last until (date):
b.
A hardship is being experienced by the father: $
per month because of (specify):
The hardship will last until (date):
4.
, referred to as “the parent ordered to
The amount of child support payable by (name):
pay support," as calculated under the guideline is: $
per month.
5.
We agree to guideline support.
6.
The guideline amount should be rebutted because of the following:
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 rebutting factors (specify):
7.
The parent ordered to pay support must pay child support as follows beginning (date):
a.
BASIC CHILD SUPPORT
Child’s name
Monthly amount
Payable to (name):
Total: $
payable
on the first of the month
other (specify):
b.
In addition, the parent ordered to pay support must pay the following:
(1)
on (date):
$
per month for child care costs to (name):
per month for health-care costs not covered by insurance
(2)
$
to (name):
on (date):
per month for special educational or other needs of the children
(3)
$
to (name):
on (date):
(4)
other (specify):
c.
Total monthly child support payable by the parent ordered to pay support will be: $
payable
on the first of the month
other (specify):
d. When a person who has been ordered to pay child support is in jail or prison or is involuntarily institutionalized for any period of
more than 90 days in a row, the child support order is temporarily stopped. However, the child support order will not be stopped
if the person who owes support has the financial ability to pay that support while in jail, prison, or an institution. It will also not
be stopped if the reason the person is in jail, prison, or an institution is because the person didn't pay court ordered child
support or committed domestic violence against the supported person or child. The child support order starts again on the first
day of the month after the person is released from jail, prison, or an institution.
Page 1 of 2
Form Adopted for Mandatory Use
STIPULATION TO ESTABLISH OR MODIFY
Family Code, § 4065
Judicial Council of California
www.court.ca.gov
CHILD SUPPORT AND ORDER
FL-350 [Rev. January 1, 2017]
FL-350
STATE BAR NO:
ATTORNEY OR PARTY WITHOUT ATTORNEY:
FOR COURT USE ONLY
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/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
CASE NUMBER:
STIPULATION TO ESTABLISH OR MODIFY
CHILD SUPPORT AND ORDER
1.
a.
Mother’s net monthly disposable income: $
Father’s net monthly disposable income: $
-OR-
b.
A printout of a computer calculation of the parents’ financial circumstances is attached.
2.
Percentage of time each parent has primary responsibility for the children:
Mother:
%
Father:
%
3.
a.
A hardship is being experienced by the mother: $
per month because of (specify):
The hardship will last until (date):
b.
A hardship is being experienced by the father: $
per month because of (specify):
The hardship will last until (date):
4.
, referred to as “the parent ordered to
The amount of child support payable by (name):
pay support," as calculated under the guideline is: $
per month.
5.
We agree to guideline support.
6.
The guideline amount should be rebutted because of the following:
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 rebutting factors (specify):
7.
The parent ordered to pay support must pay child support as follows beginning (date):
a.
BASIC CHILD SUPPORT
Child’s name
Monthly amount
Payable to (name):
Total: $
payable
on the first of the month
other (specify):
b.
In addition, the parent ordered to pay support must pay the following:
(1)
on (date):
$
per month for child care costs to (name):
per month for health-care costs not covered by insurance
(2)
$
to (name):
on (date):
per month for special educational or other needs of the children
(3)
$
to (name):
on (date):
(4)
other (specify):
c.
Total monthly child support payable by the parent ordered to pay support will be: $
payable
on the first of the month
other (specify):
d. When a person who has been ordered to pay child support is in jail or prison or is involuntarily institutionalized for any period of
more than 90 days in a row, the child support order is temporarily stopped. However, the child support order will not be stopped
if the person who owes support has the financial ability to pay that support while in jail, prison, or an institution. It will also not
be stopped if the reason the person is in jail, prison, or an institution is because the person didn't pay court ordered child
support or committed domestic violence against the supported person or child. The child support order starts again on the first
day of the month after the person is released from jail, prison, or an institution.
Page 1 of 2
Form Adopted for Mandatory Use
STIPULATION TO ESTABLISH OR MODIFY
Family Code, § 4065
Judicial Council of California
www.court.ca.gov
CHILD SUPPORT AND ORDER
FL-350 [Rev. January 1, 2017]
FL-350
PETITIONER/PLAINTIFF:
CASE NUMBER:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
8.
a.
Health insurance will be maintained by (specify name):
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.
b.
A health insurance coverage assignment will issue if health insurance is available through employment or other group
plan or otherwise is available at reasonable cost. Both parents are ordered to cooperate in the presentation, collection,
and reimbursement of any medical claims.
c.
Any health expenses not paid by insurance will be shared: Mother:
%
Father:
%
9.
a.
An earnings assignment order is issued.
b.
We agree that service of the earnings assignment be stayed because we have made the following alternative
arrangements to ensure payment (specify):
10.
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 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 party receiving support, jointly.
11.
Travel expenses for visitation will be shared: Mother:
%
Father:
%
12.
We agree that we will promptly inform each other of any change of residence or employment, including the employer’s
name, address, and telephone number.
13.
Other (specify):
We agree that we are fully informed of our rights under the California child support guidelines.
14.
15.
We make this agreement freely without coercion or duress.
16.
The right to support
a.
has not been assigned to any county, and no application for public assistance is pending.
b.
has been assigned or an application for public assistance is pending in (county name):
If you checked b., an attorney for the local child support agency must sign below, joining in this agreement.
Date:
(TYPE OR PRINT NAME)
(SIGNATURE OF ATTORNEY FOR LOCAL CHILD SUPPORT AGENCY)
Notice: If the amount agreed to is less than the guideline amount, no change of circumstances need be shown to obtain a change in
the support order to a higher amount. If the order is above the guideline, a change of circumstances will be required to modify this
order. This form must be signed by the court to be effective.
Date:
(TYPE OR PRINT NAME)
(SIGNATURE OF PETITIONER)
Date:
(TYPE OR PRINT NAME)
Date:
(SIGNATURE OF RESPONDENT)
(TYPE OR PRINT NAME)
Date:
(SIGNATURE OF ATTORNEY FOR PETITIONER)
(TYPE OR PRINT NAME)
(SIGNATURE OF ATTORNEY FOR RESPONDENT)
THE COURT ORDERS
a.
17.
The guideline child support amount in item 4 is rebutted by the factors stated in item 6.
b.
Items 7 through 13 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 stipulation, all provisions of any previous orders
made in this action will remain in effect.
Date:
JUDGE OF THE SUPERIOR COURT
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. This can be a large added amount.
STIPULATION TO ESTABLISH OR MODIFY
Page 2 of 2
FL-350 [Rev. January 1, 2017]
CHILD SUPPORT AND ORDER
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Download Form FL-350 Stipulation to Establish or Modify Child Support and Order - California

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