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					COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : GOVERNMENTAL AGENCY (under Family Code, §§ 17400,17406): :
TELEPHONE NO. (Optional): E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional):

FL-687

Index No.

FOR COURT USE ONLY

Plaintiff(s) -against-

: : : :

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SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:

PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT:

Defendant(s) : ......................................................

ORDER AFTER HEARING THE PEOPLE OF THE STATE OF NEW YORK
1. This matter proceeded as follows: TO a. Date: Dept.: b. Petitioner/plaintiff present c. Respondent/defendant present d. GREETINGS: Other parent present Uncontested By stipulation Judicial officer: Attorney present (name): Attorney present (name): Attorney present (name):

CASE NUMBER:

Contested

aside, you and each of you attend before , the Honorable at the Court g. County of (the parent ordered to pay support) is The obligor petitioner/plaintiff respondent/defendant located at in room , on the day of , 20 otherat , parent o'clock in the noon, and at any recessed 2. Attached is a computer printout give evidence as a witness in percentage of the each parent or adjourned date, to testify and showing the parents’ income and this action ontime part of the spends with the children.
The printout, which shows the calculation of child support payable, will become the court’s findings. 3. This order is based on the attached documents (specify):

e. Local child support agency attorney (Family Code, §§ 17400, 17406) by (name): Other (specify): f. WE COMMAND YOU, that all business and excuses being laid

THE COURT ORDERS the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages 4. a. All orders previously made in this action remain in full force and effect except as specifically modified below. b. Obligor is the parent of and must pay current child support for the following children: Name Date of birth

Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to sustained as a result of your failure to comply.
Monthly , one of the support amount Justices of the

Witness, Honorable Court in County,

day of

, 20

(Attorney must sign above and type name below)

(1) (2) (3)

Other (specify):

Attorney(s) for
For a total of: $ beginning (date): payable on the: day of each month The low-income adjustment applies. The low-income adjustment does not apply because (specify reasons): Office and by operation of (4) Any support ordered will continue until further order of court, unless terminatedP.O. Address law. 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. Telephone No.:
Form Adopted for Alternative Mandatory Use in Lieu of Form FL-692 Judicial Council of California FL-687 [Rev. July 1, 2005]

Facsimile No.: E-Mail ORDER AFTER HEARING Address: (Governmental)Mobile Tel. No.:

Page 1 of 2 Family Code, §§ 17402, 17404,17400 www.courtinfo.ca.gov

American LegalNet, Inc. www.USCourtForms.com

PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT:

CASE NUMBER:

4. c.

Obligor owes support arrears as follows, as of (date): Child support: $ Spousal support: $ (1) (2) Interest is not included and is not waived. day of each month Payable: $ on the: (3) (4)

Family support: $

beginning (date): Interest accrues on the entire principal balance owing and not on each installment as it becomes due.

d. No provision of this order 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. e. All payments must be made to (name and address of agency):

f. g.

An Order/Notice to Withhold Income for Child Support (form FL-195) must issue. Obligor Obligee must (1) provide and maintain health insurance coverage for the children if it is available through employment or a group plan, or otherwise available at no or reasonable cost, and must keep the local child support agency informed of the availability of the coverage; (2) if health insurance is not available, provide coverage when it becomes available; (3) within 20 days of the local child support agency 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; (6) assign any rights to reimbursement to the other parent or caretaker who incurs costs for health-care services for the children. If the “Obligor” box is checked, a health insurance coverage assignment must issue.

h. The parents must notify the local child support agency in writing within 10 days of any change in residence or employment. i. j. The Notice of Rights and Responsibilities and Information Sheet on Changing a Child Support Order (form FL-192) is attached. The following person (the “other parent”) is added as a party to this action under Family Code section 17404 (name):

k.

The court further orders (specify):

Date: 5. Number of pages attached: Approved as conforming to court order: Date:

JUDICIAL OFFICER

SIGNATURE FOLLOWS LAST ATTACHMENT

(SIGNATURE OF ATTORNEY FOR OBLIGOR)

FL-687 [Rev. July 1, 2005]

ORDER AFTER HEARING
(Governmental)

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