How To Form Payment History Details

Fl 421 is a nutrient that is found in all plants and plays an important role in photosynthesis. When light shines on the plant, it activates the fl 421 molecule, which helps turn carbon dioxide into sugar. This process is necessary for the plant to grow and thrive. Without fl 421, plants would not be able to produce food or oxygen. Researchers are still studying this molecule and its effects on plant growth, but so far they have found that it is very beneficial to the health of plants.

If you want to first understand how much time you need to prepare the fl 421 and the number of pages it has, here is some detailed data that could be helpful.

QuestionAnswer
Form NameFl 421
Form Length2 pages
Fillable?Yes
Fillable fields174
Avg. time to fill out35 min 22 sec
Other namesfl421, fl 421 california, parentage attachment online, fl421 riverside county form

Form Preview Example

FL-421

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

OTHER PARENT:

CASE NUMBER:

PAYMENT HISTORY FOR (check one):

Child Spousal Unreimbursed medical

Year

FamilyMedical

Other (specify):

Year

Unreimbursed child care

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

TOTAL

 

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

TOTAL

Page 1 of ________

Form Approved for Optional Use

Judicial Council of California FL-421 [Rev. July 1, 2003]

PAYMENT HISTORY ATTACHMENT

(Family Law—Governmental—Uniform Parentage Act)

Family Code, §§ 5230.5, 17524 (a), 17526(c)

www.courtinfo.ca.gov

INSTRUCTIONS FOR COMPLETING PAYMENT RECORD

You must complete a separate Payment History Attachment form for each type of support paid. Enter the year, list the amount ordered, and the amount paid for each month during that year. If the amounts repeat in a column, you can use an arrow as shown in the example below. Add the amounts in each column to get the yearly totals. Enter the totals at the bottom.

Attach additional sheets and supporting documents (bills, receipts, and other proof of expense) as necessary.

 

x

 

Child

Year

2000

 

 

Year

2001

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AMOUNT

 

AMOUNT

AMOUNT

AMOUNT

 

 

 

 

ORDERED

 

PAID

ORDERED

 

PAID

 

 

 

 

 

 

 

 

 

 

 

January

100

 

0

100

100

 

 

 

 

 

 

 

 

 

 

 

 

 

February

 

 

 

 

 

 

 

0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

March

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

April

 

 

 

100

 

 

100

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

May

 

 

 

100

 

 

0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

June

 

 

 

100

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

July

 

 

 

0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

August

 

 

 

 

 

 

 

100

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

September

 

 

 

 

 

 

 

100

 

 

October

 

 

 

100

 

 

0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

November

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

December

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL

1,200

 

600

1,200

400

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

x Spousal

 

AMOUNT

AMOUNT

 

ORDERED

PAID

 

 

 

January

100

0

 

 

 

 

February

 

 

 

 

March

 

 

 

 

 

 

 

 

 

 

 

 

 

April

 

 

100

 

 

 

 

 

May

 

 

100

 

 

 

 

 

June

 

 

100

 

 

 

 

 

July

 

 

0

 

 

 

 

 

August

 

 

 

 

 

 

 

 

 

September

 

 

 

 

October

 

 

100

 

 

 

 

 

November

 

 

 

 

 

 

 

 

 

 

 

 

 

December

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL

1,200

600

 

 

 

 

 

UNREIMBURSED CHILD CARE, MEDICAL, OR OTHER EXPENSES:

You must complete a separate Payment History Attachment form for each type of unreimbursed expense. If you have more than one bill, receipt, and other proof of expense per month use an additional declaration page (form MC-031) or separate page. 1.) Itemize each expense; 2.) attach proof of bill or payment; 3.) mark each bill or payment with an Exhibit # _____; 4.) group the bills, receipts, and

other proof of expense in chronological order for each month; and 5.) enter the total bills, receipts, and other proof of expense for each month. If your court order did not state a specific due date for reimbursement, then include that amount in the month that the expense was incurred.

 

 

Unreimbursed child care expenses

 

Unreimbursed medical expenses

 

x

x

 

 

 

Year

2001

 

 

 

 

 

Year

2001

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AMOUNT

 

AMOUNT

 

 

 

 

AMOUNT

 

AMOUNT

 

 

 

ORDERED

 

PAID

 

 

 

ORDERED

 

PAID

 

 

 

 

 

 

 

 

 

 

 

 

 

 

January

50% ($200)

 

0

 

 

January

50% ($200)

 

0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

February

50% ($200)

 

100

 

 

February

 

 

 

 

 

 

50% ($200)

 

 

 

 

 

 

 

 

 

 

March

 

0

 

 

March

50% ($200)

 

0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

April

50% ($200)

 

50

 

 

 

April

50% ($75)

 

0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

May

 

 

 

 

 

 

 

May

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

June

 

 

 

 

 

 

 

June

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

July

 

 

 

 

 

 

 

July

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

August

 

 

 

 

 

 

August

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

September

 

 

 

 

 

 

September

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

October

 

 

 

 

 

 

October

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

November

 

 

 

 

 

 

November

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

December

 

 

 

 

 

 

December

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL

$400

 

150

 

 

TOTAL

$237.50

 

0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form MC-031

Petitioner/Plaintiff

CASE NUMBER

 

Defendant/Respondent

 

I request reimbursement for 50% of these expenses, which are supported by copies of bills, receipts, and other proof of expense.

01/04/01

Dr. Adams

$45.00

Exhibit A

01/08/01

Dr. Lee, D.D.S.

$155.00

Exhibit B

02/15/01

AB X-ray Inc.

$200.00

Exhibit C

04/26/01

Kids Therapy

$75.00

Exhibit D

Child care expenses:

 

 

 

 

 

 

01/02

ABC School

50% ($200)

 

 

 

 

02/02

ABC School

50% ($200)

 

 

Exhibit E

 

03/02

ABC School

50% ($200)

 

 

 

 

 

 

 

04/02

ABC School

50% ($200)

 

 

 

 

 

 

 

 

 

 

 

 

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

. . . . . . . . . . . . . . . . . . . . . . . . . . .

 

(TYPE OR PRINT NAME)

(SIGNATURE OF DECLARANT)

Form MC-031 ATTACHED DECLARATION

FL-421 [Rev. July 1, 2003]

PAYMENT HISTORY ATTACHMENT

(Family Law—Governmental—Uniform Parentage Act)

How to Edit Fl 421

Completing what form 421 is not difficult. Our experts developed our PDF tool to make it convenient and enable you to fill in any form online. Below are a few steps that you should follow:

Step 1: You should press the orange "Get Form Now" button at the top of this page.

Step 2: Now you are on the form editing page. You may edit and add text to the document, highlight specified content, cross or check certain words, include images, insert a signature on it, erase needless fields, or take them out completely.

Get the what form 421 PDF and enter the information for every single part:

fl 421 form fields to complete

Provide the demanded information in the area May, June, July, August, September, October, November, December, TOTAL, January, February, March, April, May, and June.

step 2 to finishing fl 421 form

The application will ask you for particulars to effortlessly fill in the section September, October, November, December, TOTAL, Form Approved for Optional Use, Judicial Council of California, PAYMENT HISTORY ATTACHMENT, (Family Law—Governmental—Uniform, Page 1 of , Family Code, and www.

stage 3 to completing fl 421 form

Step 3: If you are done, select the "Done" button to export your PDF form.

Step 4: To prevent all of the difficulties in the long run, you should create at the very least several copies of the form.

If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .