Form FL-626 at a glance
What it is: FL-626 is the Stipulation and Order Waiving Unassigned Arrears (Governmental).
Who signs: Date, (TYPE OR PRINT NAME) and (SIGNATURE OF PARTY WAIVING PAST SUPPORT) are entered by the party waiving past support. Date, (TYPE OR PRINT NAME) and (SIGNATURE OF PARTY ORDERED TO PAY SUPPORT) are entered by the party ordered to pay support.
This form is to be filled out if the party to whom support is owed wishes to give up the right to past-due support that is owed to him or her. If either party has any questions about the possible consequences of this waiver, he or she should ask an attorney. If either party has any questions about the case or the information on this form, he or she should ask the Family Law Facilitator or the local child support agency.
A filled-in Form FL-626 example: the other parent waives past child support
How to fill out Form FL-626, box by box
Attorney or party without attorney
Enter the Name, State Bar number, and address under ATTORNEY OR PARTY WITHOUT ATTORNEY.
The FAX NO. and the E-MAIL ADDRESS are optional.
Parties
Box 1: the party waiving past support is the petitioner/plaintiff, the respondent/defendant, the other parent or other (specify).
Box 2: the party ordered to pay support is the petitioner/plaintiff, the respondent/defendant, the other parent or other (specify).
Box 3: the party ordered to pay support and the party waiving past support are the parties to this agreement.
Amount of past-due support
14. After As of (date calculated), enter the date.
a. NON-AID ARREARS are the amounts owed personally to the party waiving past support before this waiver becomes effective.
For Child support, Spousal/family support and Other (specify), enter the Principal, the Interest and the Time Period.
b. AID ARREARS are the amounts assigned and owed to a public agency and cannot be waived by the parties.
If the box at item 14c is checked you may be prohibited from any future challenge regarding the amount of past-due support indicated at items 14a and 14b.
c. The parties agree that the amounts in items 14a and 14b will be considered a final determination by the court of the amount of past-due support.
d. The parties agree that the amounts stated represent the amount of past-due support indicated by the local child support agency records. However, in agreeing to this waiver of Non-Aid arrears, the parties have not reached an agreement regarding the accuracy of the amount of past-due support as stated.
Waiver of past-due support
15. Check and complete either a or b, but not both, and add other applicable provisions.
a. Upon payment by party ordered to pay support of the sum of $ to the local child support agency on or before (date), the Non-Aid arrears set forth in paragraph 14a shall be deemed paid in full.
b. Upon payment by party ordered to pay support of the sum of $ to the local child support agency on or before (date), the parent ordered to pay support shall owe the following sums for Non-Aid support.
For Child support, Spousal/family support and Other (specify), enter the Principal, the Interest and the Time period as of (date).
c. Other (specify). See attachment 15 for additional provisions.
Conditions of waiver
This waiver of past-due support is conditioned on the party ordered to pay support agreements set forth in this document. If the party ordered to pay support fails to perform any condition, then this waiver is NULL and VOID and of no force or effect whatsoever.
However, if box 14c is checked, the setting of support arrears in items 14a and 14b will continue to be valid as the court's determination of the amount of support arrearage.
Additional conditions of this waiver (optional) (i.e., lump-sum payment, timely payment of current support, etc.).
See attachment 16 for additional conditions of waiver. Each party must initial or sign all additional pages.
The signatures
Date, (TYPE OR PRINT NAME) and (SIGNATURE OF PARTY WAIVING PAST SUPPORT) are entered by the party waiving past support.
Attorney and local child support agency signatures
Date, (TYPE OR PRINT NAME) and (SIGNATURE OF ATTORNEY FOR PARTY WAIVING PAST SUPPORT).
Date, (TYPE OR PRINT NAME) and (SIGNATURE OF ATTORNEY FOR PARTY ORDERED TO PAY SUPPORT).
LOCAL CHILD SUPPORT AGENCY: Date, (TYPE OR PRINT NAME, TITLE, AND COUNTY) and (SIGNATURE OF REPRESENTATIVE OF LOCAL CHILD SUPPORT AGENCY).
Interpretation or translation
DECLARATION OF PERSON PROVIDING INTERPRETATION/TRANSLATION (if applicable): certify under penalty of perjury under the laws of the State of California that you are competent to interpret or translate in the primary language indicated.
More rules for Form FL-626
Box 4: the parties understand their right to be represented by an attorney, at their expense, in connection with these proceedings.
Box 5: the amounts owed for Non-Aid arrears (past-due child support ordered to be paid personally to the party waiving support) remain owed until paid. There is no time limit for the collection of past-due support.
Box 6: all methods to collect or enforce the amounts past due may be used until the past due support is paid in full, including, but not limited to, wage assignments, levy on assets, tax refund interception, license suspension, property liens, and contempt. The parties understand that a waiver of support will stop all collection efforts of the support waived.
Box 7: if the amount of past-due support is unknown or uncertain, the parties have the right to have the local child support agency review and audit the amount due, and if they are not satisfied with the agency's audit, they have the right to have a court hearing to determine the amount due.
Item 8: once the party waiving past support gives up his or her right to past-due support, he or she can never request payment of the amount given up or ask the local child support agency or court to reinstate the amount given up, UNLESS he or she has specifically retained the right to do so as part of item 16.
9. the party waiving past support cannot give up the right to collect Aid arrears (past-due child support that belongs to the county in exchange for receipt of public assistance benefits), nor can he or she give up the right to future child support.
This stipulation does not affect the current child support order. If there is a current child support order, that order still remains in full force and effect.
10. The parties have had sufficient time to read and think about this stipulation and to discuss it with any and all advisors, counselors, or attorneys of their choosing.
13. The party waiving past support has thought about and decided that it is in his or her best interest and the best interest of his or her children to give up this support arrearage.
11. the party waiving past support has not been promised anything by the party ordered to pay support, the local child support agency, the court, or anyone else, to induce him or her to give up amounts owed to him or her, except as specifically set forth in writing in this stipulation.
12. the party waiving past support has not been threatened in any way (physically, emotionally, or otherwise) by the party ordered to pay support, the local child support agency, the court, or anyone else, to force him or her to give up support amounts.
Item 17: this stipulation and order does not modify or affect the duty of the party ordered to pay current support that accrues, or any support arrears that may accumulate, after the date set forth in item 14.
19. This form contains the entire understanding and agreement of the parties, and there have been no verbal or other written promises or conditions by anyone, except as stated in this form.
18. each party understands that the local child support agency does not represent him or her in this matter. Neither party has been given legal advice from the local child support agency, or any of its attorneys, or the family law facilitator, in regard to this stipulation.
Sources
[1] Form FL-626 (Rev. January 1, 2009), Stipulation and Order Waiving Unassigned Arrears (Governmental), Judicial Council of California (the Official source link on this page).