Fl 420 Form PDF Details

When dealing with family law, particularly in matters concerning financial support, accuracy and transparency in payment histories are paramount. The FL-420 form serves a critical role in this domain, facilitating a structured way for individuals to declare payment histories related to child support, spousal support, family support, medical support, unreimbursed medical expenses, and unreimbursed child care expenses. Designed for use in the Superior Court of California, it addresses both attorneys and parties without attorneys, including governmental agencies, specifying the need for meticulous documentation of support obligations and payments made or received. This document not only provides a detailed breakdown of principal amounts and interest (where applicable) concerning arrearages but also emphasizes transparency and legal accountability. By mandating a declaration under penalty of perjury, the form underscores the importance of truthfulness and accuracy in reporting, serving as a crucial tool in family law proceedings to ensure that all parties have a clear and accurate understanding of financial responsibilities and histories. Additionally, it incorporates privacy measures, advising users to clear their information after printing to protect sensitive data, thus reflecting a thoughtful balance between transparency in legal processes and personal privacy.

QuestionAnswer
Form NameFl 420 Form
Form Length1 pages
Fillable?Yes
Fillable fields8
Avg. time to fill out1 min 55 sec
Other namesfl420, fl 420 printable, declaration payment, fl declaration payment history

Form Preview Example

FL-420

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state Bar number, and address) or

FOR COURT USE ONLY

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

To keep other people from

 

 

 

 

seeing what you entered on

 

 

your form, please press the

 

 

Clear This Form button at the

TELEPHONE NO.:

FAX NO. (Optional):

end of the form when finished.

E–MAIL ADDRESS (Optional):

 

 

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:

DECLARATION OF PAYMENT HISTORY

CASE NUMBER:

1.Declaration of (name):

2.Based on my records or my recollection, I declare that the information on the attached pages showing the amounts ordered and the amounts paid are true and correct for the following obligations (check all that apply):

 

 

 

a.

 

Child support

 

 

d.

 

 

 

Medical support

 

 

 

 

g.

 

Other (specify):

 

 

 

 

 

 

 

 

 

 

 

 

 

b.

 

Spousal support

 

 

e.

 

 

 

Unreimbursed medical expenses

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c.

 

Family support

 

 

f.

 

 

 

Unreimbursed child care expenses

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. Number of pages attached:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUPPORT ARREARAGE SUMMARY

 

 

 

 

 

 

 

 

 

 

This summary is for arrearage for the periods specified in the attached pages.

 

 

 

 

 

 

 

 

 

 

Interest is calculated through (specify date):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Principal:

 

 

 

 

Interest (optional):

 

 

Total Arrearage:

 

 

 

 

CHILD SUPPORT:

$

 

 

 

 

$

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

SPOUSAL SUPPORT:

$

 

 

 

 

$

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

FAMILY SUPPORT:

$

 

 

 

 

$

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

MEDICAL SUPPORT:

$

 

 

 

 

$

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

UNREIMBURSED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MEDICAL EXPENSES:

$

 

 

 

 

$

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

UNREIMBURSED

 

 

 

 

 

 

$

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

CHILD CARE EXPENSES: $

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER (specify):

$

 

 

 

 

$

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTICE: Interest that is not calculated is not waived

 

 

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

Submitted by:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(TYPE OR PRINT NAME)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(SIGNATURE)

 

 

 

 

 

Details of the arrearage statement, consisting of (specify number)

pages, are attached.

 

 

 

 

 

 

Page 1 of 1

 

 

 

Form Adopted for Mandatory Use

 

 

DECLARATION OF PAYMENT HISTORY

 

 

 

 

 

 

Family Code, §§ 5230.5,

 

 

 

 

Judicial Council of California

 

 

 

 

 

 

 

 

17524(a), 17526(c)

 

 

 

 

 

(Family Law—Governmental—Uniform Parentage Act)

 

 

 

 

FL-420 [Rev. January 1, 2003]

 

www.courtinfo.ca.gov

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For your protection and privacy, please press the Clear This Form

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How to Edit Fl 420 Form Online for Free

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Step 1: To get started, click the orange button "Get Form Now".

Step 2: Once you've entered the editing page fl 420 form, you will be able to see all the actions readily available for the file in the upper menu.

You will need to enter the following data if you need to complete the document:

portion of gaps in california payment history

Put the asked data in the abc, Number, of, pages, attached def, Other, specify Date, TYPE, OR, PRINT, NAME SIGNATURE, OF, DE, CLARA, NT SUPPORT, AR, REAR, AGE, SUMMARY Principal, Interest, optional and Total, Ar, rear, age segment.

Completing california payment history part 2

Write the vital information in Date, Submitted, by TYPE, OR, PRINT, NAME SIGNATURE, Page, of, Family, Code, ac www, court, in, foca, gov Laura, Lynn, Morgan and Morgan, ILoveYou box.

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