ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and address):

FOR COURT USE ONLY

FL-455

ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF

TELEPHONE NO.:

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

OTHER PARENT:

STAY

TERMINATION OF STAY

OF SERVICE OF EARNINGS ASSIGNMENT ORDER

CASE NUMBER:

APPLICATION FOR STAY
(NOTICE: If this application is made separately from a hearing on support, you must get a hearing date from the clerk and give notice. 
See below.)

2.

I request that the court stay the service of the earnings assignment order in this case because (check one or more applicable reasons):
I have paid fully and on time the previously ordered support for the last 12 months, and I do not owe any back support 
1.
(arrearages).
I have not been subject to a support order for the last 12 months, but I have posted
clerk of the court in the amount of $
back support (arrearages).
Service of the earnings assignment would cause extraordinary hardship on me as follows (state reasons):
(Note: You must prove these reasons at any hearing on this application by clear and convincing evidence.)

, which is equal to three months' support, and I do not owe any

a cash bond    with the

cash

3.

I have a written agreement with the party receiving support that provides a stay of service of the earnings assignment order. A 
copy of the agreement is attached. (Note: This agreement must be signed by the local child support agency if support is 
payable to a county officer designated for that purpose.)
My employer or the local child support agency has been unable to deliver the support payments to the recipient for at least six 
months because the recipient has not notified my employer or the local child support agency of a change of address. (Attach a 
statement made under oath by employer or local child support agency.)

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

4.

5.

Date:

(TYPE OR PRINT NAME)

(SIGNATURE OF APPLICANT)

A hearing on this application will be held as follows:

NOTICE OF HEARING

a. Date:

Time:

Dept.:

Room:

b. The address of the court

is shown above

is:

Form Adopted for Mandatory Use
Judicial Council of California
FL-455 [Rev. January 1, 2003]

STAY OF SERVICE OF EARNINGS ASSIGNMENT ORDER

Page 1 of 2

Family Code, §§ 5260, 5261
www.courtinfo.ca.gov

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

OTHER PARENT:

CASE NUMBER:

APPLICATION FOR TERMINATION OF STAY

I request that the court terminate the stay of service of the earnings assignment previously issued in this case
on (date):

because (check one or more applicable reasons):

The person required to make payments has missed at least one payment of support, which continues unpaid. (Note: A false 
statement about missed payments is punishable as contempt.)
I am
and I wish the stay terminated.

the person required to make the payments

the local child support agency,

The reasons for granting the stay no longer exist. (A hearing is required. See page 1 for notice of hearing.)

(State facts showing that the previous reasons for granting the stay no longer exist.)

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 APPLICANT)

PROOF OF SERVICE BY MAIL

1.

I am at least 18 years of age and not a party to this cause. I am a resident of or employed in the county where the mailing took 
place, and my residence or business address is (specify):

2.

I served a copy of this Stay of Service of Earnings Assignment Order by enclosing it in a sealed envelope with first-class postage 
fully prepaid and depositing it in the United States Postal Service as follows:

Date of deposit:
Place of deposit (city, state):

a.
b.
c. Addressed as follows:

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)

ORDER

GOOD CAUSE APPEARING:
1.
2.
3.

Service of the earnings assignment order issued in this action is stayed.
The stay of service granted above will terminate without further order on (date):
The previous stay of service of the earnings assignment order made on (date):
and the earnings assignment order previously issued in this case may be served.

is terminated,

(JUDICIAL OFFICER)

FL-455 [Rev. January 1,  2003]

STAY OF SERVICE OF EARNINGS ASSIGNMENT ORDER

Page 2 of 2

1.

2.

3.

3

Date:

Date:

Date: