Dcss 0569 PDF Details

Navigating child support can often be a complex and sensitive matter for many families, making the accuracy and transparency of support payment records paramount. The DCSS 0569 form, known officially as the Declaration of Support Payment History, comes into play here as a critical document issued by the California Department of Child Support Services. Designed to facilitate a clear, comprehensive account of child support, spousal support, and other related financial obligations, this form requires parties to meticulously document both the amount of support ordered by the court and the actual payments made each month. Its detailed structure helps in determining any past due support, ensuring a fair assessment for all involved parties. Not only does it cater to child and spousal support, but it also extends to family support, medical support, unreimbursed medical expenses, and more, with separate pages for each category to avoid confusion. Significantly, the form also provides a section for declaring periods of incarceration or institutionalization that might have impacted the ability to make support payments. With its non-confidential nature, the DCSS 0569 serves as a vital tool for both the custodial and noncustodial parents to review and, if necessary, dispute the recorded payment history, backed by the requirement for proof of payments in disagreements. Moreover, the form emphasizes the importance of legal accuracy and integrity, as it must be filled out under penalty of perjury. To assist with any difficulties or questions regarding the form, the state of California recommends seeking help from the local court's Family Law Facilitator Office, highlighting the support system in place for navigating these waters.

QuestionAnswer
Form NameDcss 0569
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namescompleting payment history online, support declaration payments, custodial completing declaration form, dcss 0569 fillable

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

DEPARTMENT OF CHILD SUPPORT SERVICES

DECLARATION OF SUPPORT PAYMENT HISTORY

DCSS 0569 (06/17/2018)

INSTRUCTIONS FOR COMPLETING THE DECLARATION

OF SUPPORT PAYMENT HISTORY

On the back of this page is the Declaration of the Support Payment History for your case. Please provide the amount of support that was ordered by the court and the amount that was paid for each month. These figures will help determine the amount of the past due support owed, if any.

Within the boxes on the bottom half of the page, please complete the:

"Amount Ordered" column for each year

Fill in the amount of support that was ordered by the court each month since your order began. If there has been a change in your order, make sure each month reflects the correct amount of support due.

"Amount Paid" column for each year

Fill in the dollar amount of support paid in that month. If more than one payment was made in a given month, put the total dollar amount of support paid. Put the dollar amount next to the month in which the payment was actually paid, and not the month the payments were intended to cover. If needed, you may attach more sheets.

Within the boxes on the bottom half on the page, only if it applies to your case, please complete the:

“Incarceration/Institutionalization History"

Fill in the details of any time periods during which the other parent of your child was involuntarily confined in a state prison, county jail, juvenile facility, mental health facility, or other facility. If needed, you may attach additional sheets.

Please complete a separate page(s) for child support, spousal support, family support, medical support, unreimbursed medical expenses, and other types of support not listed. DO NOT combine child support and spousal support unless your court order combines the two support payments into a "family" support order.

Be aware that this Declaration is not confidential and may be given to the other parent or party in your case for review. If there is a disagreement regarding the payment history, the parties may be required to present proof of payments, for example, cancelled checks, or receipts.

If you have questions and/or need assistance with child support forms, you can get free help from your local court's Family Law Facilitator Office. Information for the Family Law Facilitator can be found at the California Courts website at http://www.courts.ca.gov/selfhelp-facilitators.htm.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

DEPARTMENT OF CHILD SUPPORT SERVICES

DECLARATION OF SUPPORT PAYMENT HISTORY

DCSS 0569 (06/17/2018)

Person completing this form (name):

 

 

 

I am the:

 

 

 

 

 

Support Payment History for (check one):

Child

Spousal

Family

Unreimbursed medical expenses

Medical

Other (specify):

 

 

Custodial Party Noncustodial Parent

 

YEAR

 

 

YEAR

 

 

YEAR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AMOUNT

 

AMOUNT

AMOUNT

AMOUNT

AMOUNT

AMOUNT

 

ORDERED

 

PAID

ORDERED

 

PAID

ORDERED

 

PAID

January

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

February

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

March

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

April

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

May

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

June

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

July

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

August

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

September

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

October

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

November

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

December

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Incarceration/Institutionalization History

BEGIN DATE

(MM/DD/YYYY)

RELEASE DATE (MM/DD/YYYY)

FACILITY/INSTITUTION NAME AND LOCATION

OTHER DETAILS, SUCH AS CHARGING

OFFENSE(S), CONVICTION(S),

VICTIM NAME(S), COURT WHERE

SENTENCED, ETC.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. I am aware that this may be provided to the other parent for their verification and that either party may be required to provide documentation.

Signature:

 

Date:

 

CSE Case Number:

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How to Edit Dcss 0569 Online for Free

You can certainly complete forms working with our PDF editor. Updating the support declaration payments document is a breeze as soon as you stick to the following steps:

Step 1: Step one should be to pick the orange "Get Form Now" button.

Step 2: You will find all the actions that you can take on the file as soon as you've accessed the support declaration payments editing page.

The next segments will constitute the PDF document that you'll be creating:

portion of blanks in declaration of support payment history

Type in the requested information in the space DCSS, Person completing this form name, I am the, Custodial Party, Noncustodial Parent, Support Payment History for check, Child, Spousal, Family, Unreimbursed medical expenses, Medical, Other specify, YEAR, AMOUNT ORDERED, and YEAR.

Finishing declaration of support payment history stage 2

Write the main particulars in December, IncarcerationInstitutionalization, BEGIN DATE MMDDYYYY, RELEASE DATE MMDDYYYY, FACILITYINSTITUTION NAME AND, OTHER DETAILS SUCH AS CHARGING, and I declare under penalty of perjury section.

part 3 to finishing declaration of support payment history

The space Signature, Date, CSE Case Number, and Page of should be for you to place both sides' rights and obligations.

Filling in declaration of support payment history part 4

Step 3: As you press the Done button, your ready document can be easily exported to each of your gadgets or to electronic mail given by you.

Step 4: Ensure you stay clear of possible issues by making minimally 2 duplicates of the form.

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