California Form Fl 615 PDF Details

The California FL-615 form plays a critical role in the realm of family law, particularly concerning child support and parental obligations. Designed for use by governmental agencies and drafted under specific sections of the Family Code, it facilitates a structured agreement between parties regarding child support without necessitating a court appearance. The form outlines the mechanism by which parties can stipulate to the amount of support, understanding their rights and agreeing to a judgment accordingly. It includes provisions for current support payments, healthcare costs, payment of arrearages, and the maintenance of health insurance for children. Moreover, it addresses how support payments should be made, the potential issuance of an earnings assignment order, and the procedure for notifying changes in residence or employment. It also contains advisements and waivers of rights for individuals stipulating to child support, ensuring they fully understand the agreement entered into. Used correctly, the FL-615 form represents a comprehensive tool for documenting agreements on parental obligations efficiently, highlighting the importance of informed consent in family law proceedings.

QuestionAnswer
Form NameCalifornia Form Fl 615
Form Length5 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 15 sec
Other namesselfsustaining, arrearages, rebutted, fl 615 form

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per month.

FL-615

GOVERNMENTAL AGENCY (under Family Code, §§ 17400, 17406):

FOR COURT USE ONLY

TELEPHONE NO.:

FAX NO. (Optional):

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:

STIPULATION FOR

 

JUDGMENT

 

 

SUPPLEMENTAL JUDGMENT CASE NUMBER:

 

 

 

 

 

REGARDING PARENTAL OBLIGATIONS AND JUDGMENT

 

 

 

 

 

 

 

 

 

 

1. This matter proceeded as follows:

 

 

 

By written stipulation without court appearance.

a.

 

b.

 

By court hearing, appearances as follows:

 

(1)

Date:

 

Dept:

 

Judicial Officer:

(2)

 

Petitioner/plaintiff present

 

 

Attorney present (name):

 

 

 

(3)

 

Respondent/defendant present

 

 

Attorney present (name):

 

 

 

(4)

 

Other parent/party present

 

 

Attorney present (name):

 

 

 

(5)

Local child support agency (Fam. Code, §§ 17400, 17406) by (name):

(6)

 

Other (specify):

 

 

 

 

 

c.The parent ordered to pay support is the

petitioner/plaintiff

respondent/defendant

other parent/party.

2.

3.

This order is based on the attached documents (specify):

The parties agree that:

a.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.

b. The amount of support payable by the party ordered to pay support as calculated under the guideline is: $

 

 

We agree to guideline support.

 

 

The guideline amount should be rebutted because of the following:

 

 

(1)

 

 

We have been fully informed of the guideline amount of support; we agree voluntarily 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 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) Other rebutting factors (specify):

c. 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.

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

 

 

 

Form Adopted for Alternative Mandatory

STIPULATION FOR JUDGMENT OR SUPPLEMENTAL JUDGMENT

Family Code, §§ 17400,

Use Instead of Form FL-692

REGARDING PARENTAL OBLIGATIONS AND JUDGMENT

17402,17406

Judicial Council of California

www.courts.ca.gov

FL-615 [Rev. January 1, 2020]

(Governmental)

 

 

 

FL-615

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

OTHER PARENT/PARTY:

CASE NUMBER:

3. d.

 

Petitioner/plaintiff

 

Respondent/defendant

 

Other parent/party

are the parents of the children named in

item 3e below.

e. The parent ordered to pay support must pay current child support as follows:

Name of child

Date of birth

Monthly support amount

(1)

Mandatory additional child support.

(2)

(a) The parent ordered to pay support must pay additional monthly support for reasonable child-care costs, as follows:

 

One-half or

 

 

 

% or

 

 

(specify amount): $

 

per month of the costs

Payments must be made to the

 

other parent

 

State Disbursement Unit

 

child-care provider.

 

 

 

(b) The parent ordered to pay support must pay reasonable uninsured health-care costs for the children, as follows:

 

 

One-half or

 

 

 

% or

 

 

(specify amount): $

 

per month of the costs

Payments must be made to the

 

other parent

 

State Disbursement Unit

 

health-care provider.

 

 

 

 

Other (specify):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(3)

(4)

For a total of: $

payable on the:

day of each month

beginning (date):

 

 

The low-income adjustment applies.

The low-income adjustment does not apply because (specific reasons):

(5)Any support ordered will continue until further order of court, unless terminated by operation of law.

f.

The parent ordered to pay support

The parent receiving support must (1) provide and maintain health insurance

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.

FL-615 [Rev. January 1, 2020]

STIPULATION FOR JUDGMENT OR SUPPLEMENTAL JUDGMENT

REGARDING PARENTAL OBLIGATIONS AND JUDGMENT

Page 2 of 5

(Governmental)

FL-615

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

OTHER PARENT/PARTY:

CASE NUMBER:

3. g.

The parent ordered to pay support must pay child support for the past periods and in the amounts set forth below.

Name of child

Date of birth

Period of support

Amount

(1)

(2)

(3)

Other (specify):

 

 

 

For a total of $

payable: $

on the:

day of each month

beginning (date):

 

 

 

Interest accrues on the entire principal balance owing and not on each installment as it becomes due.

h.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.

i.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.

j.All payments, unless specified in item 3e(1) above, must be made to the State Disbursement Unit at the address listed below (specify address):

k.An earnings assignment order is issued.

l.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.

m.If "The parent ordered to pay support" box is checked in item 3f, a health insurance coverage assignment must issue.

n.The parents must notify the local child support agency in writing within 10 days of any change in residence or employment.

o.The Notice of Rights and Responsibilities (Health-Care Costs and Reimbursement Procedures) and Information Sheet on Changing a Child Support Order (form FL-192) is attached.

p.

 

The following person (the "other parent") is added as a party to this action (name):

q.

Other (specify):

FL-615 [Rev. January 1, 2020]

STIPULATION FOR JUDGMENT OR SUPPLEMENTAL JUDGMENT

REGARDING PARENTAL OBLIGATIONS AND JUDGMENT

Page 3 of 5

(Governmental)

FL-615

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

OTHER PARENT/PARTY:

Date:

CASE NUMBER:

(TYPE OR PRINT NAME)

Date:

(TYPE OR PRINT NAME)

Date:

(TYPE OR PRINT NAME)

Date:

(TYPE OR PRINT NAME)

Date:

(TYPE OR PRINT NAME)

Date:

(TYPE OR PRINT NAME)

Date:

(TYPE OR PRINT NAME)

(SIGNATURE OF ATTORNEY FOR LOCAL CHILD SUPPORT AGENCY)

(SIGNATURE OF PETITIONER)

(SIGNATURE OF ATTORNEY FOR PETITIONER)

(SIGNATURE OF RESPONDENT)

(SIGNATURE OF ATTORNEY FOR RESPONDENT)

(SIGNATURE OF OTHER PARENT)

(SIGNATURE OF ATTORNEY FOR OTHER PARENT)

JUDGMENT

4.THE COURT SO ORDERS.

Date:

Number of pages attached:

JUDICIAL OFFICER

SIGNATURE FOLLOWS LAST ATTACHMENT

FL-615 [Rev. January 1, 2020]

STIPULATION FOR JUDGMENT OR SUPPLEMENTAL JUDGMENT

REGARDING PARENTAL OBLIGATIONS AND JUDGMENT

Page 4 of 5

(Governmental)

FL-615

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

OTHER PARENT/PARTY:

CASE NUMBER:

ADVISEMENT AND WAIVER OF RIGHTS FOR STIPULATION

1. RIGHT TO BE REPRESENTED BY A

5. ADMISSION AND WAIVER OF RIGHTS. I

8.

I agree to the terms of this

 

LAWYER. I understand that I have the right

understand that by agreeing to the terms of

 

stipulation freely and voluntarily.

 

to be represented by a lawyer of my choice

this stipulation, I am admitting that I am the

9.

I understand that the local child

 

at my expense. If I cannot afford a lawyer to

 

parent of the children named in the

 

support agency is required by state

 

represent me, I can ask the court to appoint

stipulation and I am giving up the rights

 

 

 

law to enforce the duty of support.

 

one to represent me free of charge only if I

stated above.

 

 

10.

I UNDERSTAND THAT IF I

 

dispute that I am the parent of the children

6. WHERE THE STIPULATION INCLUDES

 

named in this action and only on the issue

CHILD SUPPORT.

 

WILLFULLY FAIL TO SUPPORT

 

of parentage. I understand that the attorney

 

MY CHILDREN, CRIMINAL

 

a. I understand that I will have the duty to

 

 

for the local child support agency does not

 

PROCEEDINGS MAY BE

 

obey the support order for the children

 

 

represent me.

 

INITIATED AGAINST ME.

 

named in the stipulation until the order is

 

2. RIGHT TO A TRIAL. I understand that I

11. COLLECTION OF SUPPORT. I

 

have a right to have a judicial officer (1)

changed by the court or ended by law.

 

understand that any support I owe

 

b. I also understand that the court will

 

 

determine if I am the parent of the children

 

may be collected from any of my

 

order any support payments to be paid

 

 

named in the stipulation, (2) decide how

 

property. This collection may be

 

directly from my wages or other

 

 

much child support I must pay, and (3)

 

made by intercepting money owed

 

earnings and sent to the local child

 

 

decide how much I owe for arrearages

 

to me by the state or federal

 

support agency if one is assigned to

 

 

(unpaid support).

 

government (such as tax refunds,

 

collect the support.

 

3. RIGHT TO CONFRONT AND CROSS-

 

unemployment and disability

c. I have been advised of the amount of

 

 

EXAMINE WITNESSES. I understand that

 

benefits, and lottery winnings), by

 

in a trial any allegations made against me

guideline child support and how the

 

taking property I own, by placing a

 

must be proved. At the trial I may be

proposed child support amount was

 

lien on my property, or by any other

 

present with a lawyer when witnesses

determined.

 

lawful means.

 

testify, and I may ask them questions. I may 7. WHERE THE STIPULATION INCLUDES

12.

IF I AM REPRESENTED BY AN

 

also present evidence and witnesses.

A PROVISION FOR HEALTH

ATTORNEY, MY ATTORNEY HAS

4. RIGHT TO HAVE GENETIC TESTING

INSURANCE. I understand that I must

 

READ AND EXPLAINED TO ME

 

WHERE THE LAW PERMITS. I

keep health insurance coverage for the

 

THE TERMS OF THE

 

understand that, where the law permits,

minor children if insurance is available or

 

STIPULATION AND THIS

 

I have the right to have the court order

becomes available to me at no or

 

ADVISEMENT AND WAIVER OF

 

genetic testing. The court will decide

reasonable cost. A health insurance

 

RIGHTS, AND I UNDERSTAND

 

on the testing. The court could order that

coverage assignment/National Medical

 

THESE TERMS.

 

I pay none, some, or all of the costs of the

Support Notice may be ordered to get

 

 

 

genetic testing.

health insurance for my children.

 

 

 

 

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:

 

 

 

 

 

 

 

 

(TYPE OR PRINT NAME)

(PARTY’S SIGNATURE)

(TYPE OR PRINT NAME)

(PARTY’S SIGNATURE)

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

 

(Insert name):

 

 

 

 

's primary

 

(Insert name):

 

 

 

's primary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

language is (specify):

 

 

 

 

language is (specify):

 

 

 

 

 

 

 

 

 

 

 

 

and the party

 

 

has

 

has not read

the form

and the party

 

 

has

 

has not read

the form

 

 

 

stipulation translated into this language.

 

 

stipulation translated into this language.

 

 

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.

 

Date:

 

Date:

 

 

 

 

 

(TYPE OR PRINT NAME)

 

(TYPE OR PRINT NAME)

 

 

 

 

 

(SIGNATURE)

 

(SIGNATURE)

FL-615 [Rev. January 1, 2020]

STIPULATION FOR JUDGMENT OR SUPPLEMENTAL JUDGMENT

 

 

REGARDING PARENTAL OBLIGATIONS AND JUDGMENT

 

 

(Governmental)

For your protection and privacy, please press the Clear

 

 

 

 

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rebutted completion process explained (part 1)

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rebutted conclusion process clarified (step 2)

3. Completing Petitionerplaintiff, Respondentdefendant, Other parentparty, are the parents of the children, item e below, The parent ordered to pay support, Name of child, Date of birth, Monthly support amount, Mandatory additional child support, The parent ordered to pay support, Onehalf or, or, specify amount , and per month of the costs is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

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4. All set to fill in the next portion! In this case you've got all these The lowincome adjustment does not, Any support ordered will continue, The parent ordered to pay support, The parent receiving support, must provide and maintain health, coverage for the children if, FL Rev January , STIPULATION FOR JUDGMENT OR, Page of , REGARDING PARENTAL OBLIGATIONS AND, and Governmental fields to do.

The parent ordered to pay support, must provide and maintain health, and The lowincome adjustment does not inside rebutted

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The parent ordered to pay support, For a total of beginning date, and day of each month in rebutted

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