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Here is the text we could read:

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

FOR COURT USE ONLY

FL-630

TELEPHONE NO.:

E-MAIL ADDRESS:

ATTORNEY FOR (name):

FAX NO.:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

OTHER PARENT/PARTY:

JUDGMENT REGARDING PARENTAL OBLIGATIONS
            AMENDED

            SUPPLEMENTAL

CASE NUMBER:

PROPOSED

AMENDED PROPOSED    JUDGMENT.  This Judgment Regarding 
NOTICE: THIS IS A 
Parental Obligations will be entered by the court and will become legally binding unless you fill out and file  the 
Answer to Complaint or Supplemental Complaint Regarding Parental Obligations (Governmental) (form FL-610) with 
the court clerk within 30 days of the date you were served with the Summons and Complaint or Supplemental 
Complaint Regarding Parental Obligations (Governmental) (form FL-600). If you need form FL-610, you may get one 
from the local child support agency’s office, the court clerk, or the family law facilitator. The family law facilitator will  
help you fill out the forms. To file the answer, follow the procedures listed in the attached instructions

1.  a.

b.

a.

b.

NOTICE: THIS IS A JUDGMENT. It is now legally binding. 

2.  This matter proceeded as follows: 

Judgment entered under Family Code section 17430.  

By court hearing, appearances as follows:

(1) Date:
(2)

Dept.:
Petitioner/plaintiff present 
Respondent/defendant present 

Other parent/party present

Judicial officer:

Attorney present

(name):

Attorney present

(name):

Attorney present

(name):

(5) Local child support agency attorney (Family Code, §§ 17400,17406) (name):

Other (specify):

(3)

(4)

(6)

c. The parent ordered to pay support is the 

petitioner/plaintiff

respondent/defendant

other parent/party.

3. 
4. 

5.

This order is based on presumed income for the parent ordered to pay support under Family Code section 17400. 
Attached is a computer printout showing the parents' incomes and percentage of time each parent spends with the children. 
The printout, which shows the calculation of child support payable, will become the court's findings.       
This order is based on the attached documents (specify):

THE COURT ORDERS

item 6b below.

Name of Child

6.  a.

Petitioner/plaintiff

Respondent/defendant

Other parent/party

are the parents of the children named in 

b. The parent ordered to pay support must pay current child support as follows:

Date of birth

Monthly Support Amount 

NOTICE: Any party required to pay child support must pay interest on overdue amounts at the legal rate, which is  currently 
10 percent per year.

Form Adopted for Alternative Mandatory Use 
Instead of Form FL-692 
Judicial Council of California 
FL-630 [Rev. January 1, 2020]

JUDGMENT REGARDING PARENTAL OBLIGATIONS 
(Governmental)

Page 1 of 3

Family Code, §§ 17400, 17402, 
17404,17430 
www.courts.ca.gov

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

OTHER PARENT/PARTY:

CASE NUMBER:

FL-630

6.

b. 

(1)

Mandatory additional child support.
The parent ordered to pay support must pay additional monthly support for reasonable child-care costs, as follows:

(a)

One-half or

% or

(specify amount): $

per month of the costs.

Payments must be made to the 

other parent

State Disbursement Unit

child-care provider.

(b)

The parent ordered to pay support must pay reasonable uninsured health-care costs for the children, as follows:

One-half or

% or

(specify amount): $

Payments must be made to the 

other parent

State Disbursement Unit

per month of the costs.
health-care provider.

(2)

Other (specify):

$
For a total of: 

payable on the

day of each month

beginning (date):
The low-income adjustment applies.

The low-income adjustment does not apply because (specify reasons): 

(3)

(4)

c.

(5)

Any support ordered will continue until further order of court, unless terminated by operation of law.

The parent receiving support   (1) must provide and maintain health insurance 

The parent ordered to pay support
coverage for the children if available at no or reasonable cost and keep the local child support agency informed of the 
availability of the coverage (the cost is presumed to be reasonable if it does not exceed 5 percent of gross income to add 
a child); (2) if health insurance is not available, provide coverage when it becomes available; (3) within 20 days of the 
local child support agency’s request, complete and return a health insurance form; (4) provide to the local child support 
agency all information and forms necessary to obtain health-care services for the children; (5) present any claim to secure 
payment or reimbursement to the other parent or caretaker who incurs costs for health-care services for the children; and 
(6) assign  any rights to reimbursement to the other parent or caretaker who incurs costs for health-care services for the 
children. The  parent ordered to provide health insurance must seek continuation of coverage for the child after the child 
attains the age  when the child is no longer considered eligible for coverage as a dependent under the insurance contract, 
if the child is  incapable of self-sustaining employment because of a physically or mentally disabling injury, illness, or 
condition and is  chiefly dependent upon the parent providing health insurance for support and maintenance.

d.

The parent ordered to pay support must pay child support for the past periods and in the amounts set forth below:  
Name of Child

Period of support 

Date of birth

Amount

(1)

Other (specify):

FL-630 [Rev. January 1, 2020]

Page 2 of 3

JUDGMENT REGARDING PARENTAL OBLIGATIONS 
(Governmental)

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

OTHER PARENT/PARTY:

CASE NUMBER:

FL-630

6. 

d.

(2)

For a total of: 

$

payable: $ 

on the: 

day of each month

(3)

beginning (date):
Interest accrues on the entire principal balance owing and not on each installment as it becomes due. 

e.

If this is a judgment on a Supplemental Complaint, it does not modify or supersede any prior judgment or order for support or  
arrearage, unless specifically provided.

f. No provision of this judgment can operate to limit any right to collect the principal (total amount of unpaid support) or to charge  

and collect interest and penalties as allowed by law. All payments ordered are subject to modification.

g. All payments, unless specified in item 6b(1) above, must be made to the State Disbursement Unit at the address listed below 

(specify address):  

h.
i.

j.

k.

l.

m.

An earnings assignment order is issued.

In the event that there is a contract between a party receiving support and a private child support collector, the party ordered to  
pay support must pay the fee charged by the private child support collector. This fee must not exceed 33 1/3 percent of the total 
amount of past due support nor may it exceed 50 percent of any fee charged by the private child support collector. The money  
judgment created by this provision is in favor of the private child support collector and the party receiving support, jointly. 

If "The parent ordered to pay support" box is checked in item 6c, a health insurance coverage assignment must issue. 

The parents must notify the local child support agency in writing within 10 days of any change in residence or employment.

The form Notice of Rights and Responsibilities (Health-Care Costs and Reimbursement Procedures) and Information Sheet on 
Changing a Child Support Order (form FL-192) is attached.

The following person (the "other parent/party") is added as a party to this action (name): 

n.

The court further orders (specify):

Date:

Number of pages attached:

Approved as conforming to court order.
Date:

(SIGNATURE OF ATTORNEY FOR THE PARENT ORDERED TO PAY SUPPORT)

JUDICIAL OFFICER

SIGNATURE FOLLOWS LAST ATTACHMENT

FL-630 [Rev. January 1, 2020]

Page 3 of 3

JUDGMENT REGARDING PARENTAL OBLIGATIONS 
(Governmental)

Judgment Regarding Parental Obligations (Governmental)

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the California state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from selfhelp.courts.ca.gov (2023-03)
Page(s): 3
Fields(s): 114
Average fields per page: 38
Reading Level: Grade 8
LIST Grouping(s): FA-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

f_l_page_fill_text__1 was FL-630[0].Page1[0].FillText\.06\.d\.1\.Other[0] (0.57 conf)
f_l_page_fill_text_b_name was FL-630[0].Page1[0].FillText\.02\.b\.5\.name[0] (0.42 conf)
f_l_page_cb_choice_b was FL-630[0].Page1[0].CBChoice_2b[0] (0.39 conf)
f_l_page_cb_choice was FL-630[0].Page1[0].CBChoice_cb[0] (0.39 conf)
f_l_page_area_petitioner_cb__1 was FL-630[0].Page1[0].#area[2].petitioner_cb[0] (0.36 conf)
f_l_page_hearing_date was FL-630[0].Page1[0].HearingDate[0] (0.34 conf)
f_l_page_hearing_dept__1 was FL-630[0].Page1[0].HearingDept[0] (0.34 conf)
f_l_page_hearing_dept__2 was FL-630[0].Page1[0].HearingDept[1] (0.34 conf)
f_l_page_area_petitioner_cb__2 was FL-630[0].Page1[0].#area[3].petitioner_cb[1] (0.36 conf)
f_l_page_area_text_field__1 was FL-630[0].Page1[0].#area[4].TextField2[0] (0.34 conf)
f_l_page_area_check_box__1 was FL-630[0].Page1[0].#area[4].CheckBox61[0] (0.41 conf)
f_l_page_area_petitioner_cb__3 was FL-630[0].Page1[0].#area[5].petitioner_cb[2] (0.36 conf)
f_l_page_area_text_field__2 was FL-630[0].Page1[0].#area[6].TextField2[1] (0.34 conf)
f_l_page_area_check_box__2 was FL-630[0].Page1[0].#area[6].CheckBox61[1] (0.41 conf)
f_l_page_area_petitioner_cb__4 was FL-630[0].Page1[0].#area[7].petitioner_cb[3] (0.36 conf)
f_l_page_area_text_field__3 was FL-630[0].Page1[0].#area[8].TextField2[2] (0.34 conf)
f_l_page_area_check_box__3 was FL-630[0].Page1[0].#area[8].CheckBox61[2] (0.41 conf)
f_l_page_area_petitioner_cb__5 was FL-630[0].Page1[0].#area[12].petitioner_cb[4] (0.36 conf)
f_l_page_area_check_box__4 was FL-630[0].Page1[0].#area[13].CheckBox19[0] (0.41 conf)
f_l_page_area_petitioner_cb__6 was FL-630[0].Page1[0].#area[14].petitioner_cb[5] (0.36 conf)
f_l_page_area_petitioner_cb__7 was FL-630[0].Page1[0].#area[14].petitioner_cb[6] (0.36 conf)
f_l_page_area_petitioner_cb__8 was FL-630[0].Page1[0].#area[14].petitioner_cb[7] (0.36 conf)
f_page_p_party_info_phone was FL-630[0].Page1[0].p1Caption[0].AttyPartyInfo[0].Phone[0] (0.41 conf)
f_l_page_p_party_info__1 was FL-630[0].Page1[0].p1Caption[0].AttyPartyInfo[0].Fax[0] (0.41 conf)
f_page_p_party_info_email was FL-630[0].Page1[0].p1Caption[0].AttyPartyInfo[0].Email[0] (0.41 conf)
f_l_page_p_party_info__2 was FL-630[0].Page1[0].p1Caption[0].AttyPartyInfo[0].AttyFor[0] (0.45 conf)
f_page_p_party_info_area__1 was FL-630[0].Page1[0].p1Caption[0].AttyPartyInfo[0].#area[0].TextField2[0] (0.39 conf)
f_page_p_party_info_area__2 was FL-630[0].Page1[0].p1Caption[0].AttyPartyInfo[0].#area[1].TextField2[1] (0.39 conf)
f_page_p_party_info_text__1 was FL-630[0].Page1[0].p1Caption[0].AttyPartyInfo[0].TextField2[2] (0.39 conf)
f_page_p_party_info_text__2 was FL-630[0].Page1[0].p1Caption[0].AttyPartyInfo[0].TextField2[3] (0.39 conf)
f_page_p_party_info_text__3 was FL-630[0].Page1[0].p1Caption[0].AttyPartyInfo[0].TextField2[4] (0.39 conf)
f_l_page_p_info_county was FL-630[0].Page1[0].p1Caption[0].CourtInfo[0].CrtCounty[0] (0.37 conf)
f_l_page_p_info_street was FL-630[0].Page1[0].p1Caption[0].CourtInfo[0].CrtStreet[0] (0.37 conf)
f_l_page_p_caption_info was FL-630[0].Page1[0].p1Caption[0].CourtInfo[0].CrtMailingAdd[0] (0.41 conf)
f_l_page_p_caption_court_info_crt_city_zip was FL-630[0].Page1[0].p1Caption[0].CourtInfo[0].CrtCityZip[0] (0.39 conf)
f_l_page_p_court_branch was FL-630[0].Page1[0].p1Caption[0].CourtInfo[0].CrtBranch[0] (0.37 conf)
f_page_p_title_party_name__1 was FL-630[0].Page1[0].p1Caption[0].TitlePartyName[0].TitlePartyName[0].Party1[0] (0.32 conf)
f_page_p_title_party_name__2 was FL-630[0].Page1[0].p1Caption[0].TitlePartyName[0].TitlePartyName[0].Party2[0] (0.32 conf)
f_page_p_title_party_name__3 was FL-630[0].Page1[0].p1Caption[0].TitlePartyName[0].TitlePartyName[0].Party3[0] (0.32 conf)
f_page_p_form_title_field__1 was FL-630[0].Page1[0].p1Caption[0].FormTitle[0].#field[0] (0.32 conf)
f_page_p_form_title_field__2 was FL-630[0].Page1[0].p1Caption[0].FormTitle[0].#field[1] (0.32 conf)
f_l_page_p_form_title was FL-630[0].Page1[0].p1Caption[0].FormTitle[0].AmendedNo[0] (0.36 conf)
f_page_p_form_title was FL-630[0].Page1[0].p1Caption[0].FormTitle[0].SupplementalNo[0] (0.31 conf)
f_l_page_p_case_number was FL-630[0].Page1[0].p1Caption[0].CaseNumber[0].CaseNumber[0] (0.36 conf)
f_l_page_text_field__1 was FL-630[0].Page1[0].TextField6[0] (0.34 conf)
f_l_page_text_field__2 was FL-630[0].Page1[0].TextField6[1] (0.34 conf)
f_l_page_text_field__3 was FL-630[0].Page1[0].TextField6[2] (0.34 conf)
f_l_page_date_field__1 was FL-630[0].Page1[0].DateField1[0] (0.37 conf)
f_l_page_date_field__2 was FL-630[0].Page1[0].DateField2[0] (0.37 conf)
f_l_page_date_field__3 was FL-630[0].Page1[0].DateField3[0] (0.37 conf)
f_l_page_text_field__4 was FL-630[0].Page1[0].TextField7[0] (0.34 conf)
f_l_page_text_field__5 was FL-630[0].Page1[0].TextField8[0] (0.34 conf)
f_l_page_text_field__6 was FL-630[0].Page1[0].TextField9[0] (0.34 conf)
f_l_page_fill_text__2 was FL-630[0].Page1[0].FillText64[0] (0.42 conf)
f_l_page_area_check_box__5 was FL-630[0].Page1[0].#area[17].CheckBox61[3] (0.41 conf)
f_l_page_check_box was FL-630[0].Page1[0].CheckBox61[4] (0.41 conf)
f_l_page_fill_text__3 was FL-630[0].Page2[0].FillText64[0] (0.42 conf)
f_l_page_fill_text__4 was FL-630[0].Page2[0].FillText64[1] (0.42 conf)
f_l_page_fill_text__5 was FL-630[0].Page2[0].FillText64[2] (0.42 conf)
f_l_page_subform_case_number was FL-630[0].Page2[0].#subform[1].CaseNumber[0].CaseNumber[0] (0.36 conf)
f_l_page_title_party_name__1 was FL-630[0].Page2[0].#subform[1].TitlePartyName[0].Party1[0] (0.35 conf)
f_l_page_title_party_name__2 was FL-630[0].Page2[0].#subform[1].TitlePartyName[0].Party2[0] (0.35 conf)
f_l_page_title_party_name__3 was FL-630[0].Page2[0].#subform[1].TitlePartyName[0].Party3[0] (0.35 conf)
f_l_page_area_petitioner_cb__9 was FL-630[0].Page2[0].#area[0].petitioner_cb[0] (0.36 conf)
f_l_page_area_text_field__4 was FL-630[0].Page2[0].#area[2].TextField2[0] (0.34 conf)
f_l_page_area_text_field__5 was FL-630[0].Page2[0].#area[3].TextField2[1] (0.34 conf)
f_l_page_area_petitioner_cb__10 was FL-630[0].Page2[0].#area[4].petitioner_cb[1] (0.36 conf)
f_l_page_area_petitioner_cb__11 was FL-630[0].Page2[0].#area[5].petitioner_cb[2] (0.36 conf)
f_l_page_area_petitioner_cb__12 was FL-630[0].Page2[0].#area[6].petitioner_cb[3] (0.36 conf)
f_l_page_area_text_field__6 was FL-630[0].Page2[0].#area[8].TextField2[2] (0.34 conf)
f_l_page_area_text_field__7 was FL-630[0].Page2[0].#area[9].TextField2[3] (0.34 conf)
f_l_page_area_petitioner_cb__13 was FL-630[0].Page2[0].#area[10].petitioner_cb[4] (0.36 conf)
f_l_page_area_petitioner_cb__14 was FL-630[0].Page2[0].#area[11].petitioner_cb[5] (0.36 conf)
f_l_page_area_petitioner_cb__15 was FL-630[0].Page2[0].#area[12].petitioner_cb[6] (0.36 conf)
f_l_page_area_text_field__8 was FL-630[0].Page2[0].#area[13].TextField2[4] (0.34 conf)
f_l_page_date_ft was FL-630[0].Page2[0].on_date_ft[0] (0.36 conf)
f_l_page_area_petitioner_cb__16 was FL-630[0].Page2[0].#area[14].petitioner_cb[7] (0.36 conf)
f_l_page_area_petitioner_cb__17 was FL-630[0].Page2[0].#area[14].petitioner_cb[8] (0.36 conf)
f_l_page_area_petitioner_cb__18 was FL-630[0].Page2[0].#area[16].petitioner_cb[9] (0.36 conf)
f_l_page_text_field__7 was FL-630[0].Page2[0].TextField6[0] (0.34 conf)
f_l_page_text_field__8 was FL-630[0].Page2[0].TextField6[1] (0.34 conf)
f_l_page_text_field__9 was FL-630[0].Page2[0].TextField6[2] (0.34 conf)
f_l_page_date_field__4 was FL-630[0].Page2[0].DateField1[0] (0.37 conf)
f_l_page_date_field__5 was FL-630[0].Page2[0].DateField2[0] (0.37 conf)
f_l_page_date_field__6 was FL-630[0].Page2[0].DateField3[0] (0.37 conf)
f_l_page_text_field__10 was FL-630[0].Page2[0].TextField7[0] (0.34 conf)
f_l_page_text_field__11 was FL-630[0].Page2[0].TextField8[0] (0.34 conf)
f_l_page_text_field__12 was FL-630[0].Page2[0].TextField9[0] (0.34 conf)
f_l_page_text_field__13 was FL-630[0].Page2[0].TextField7[1] (0.34 conf)
f_l_page_text_field__14 was FL-630[0].Page2[0].TextField8[1] (0.34 conf)
f_l_page_text_field__15 was FL-630[0].Page2[0].TextField9[1] (0.34 conf)
f_l_page_area_petitioner_cb__19 was FL-630[0].Page2[0].#area[17].petitioner_cb[10] (0.36 conf)
f_l_page_area_check_box__6 was FL-630[0].Page2[0].#area[18].CheckBox61[0] (0.41 conf)
f_l_page_area_check_box__7 was FL-630[0].Page2[0].#area[19].CheckBox61[1] (0.41 conf)
f_l_page_text_field__16 was FL-630[0].Page2[0].TextField11[0] (0.34 conf)
f_l_subform_fill_text__1 was FL-630[0].#subform[2].FillText66[0] (0.40 conf)
f_l_subform_fill_text__2 was FL-630[0].#subform[2].FillText67[0] (0.40 conf)
f_l_subform_case_number was FL-630[0].#subform[2].#subform[3].CaseNumber[0].CaseNumber[0] (0.32 conf)
f_l_subform_title_party_name__1 was FL-630[0].#subform[2].#subform[3].TitlePartyName[0].Party1[0] (0.30 conf)
f_l_subform_title_party_name__2 was FL-630[0].#subform[2].#subform[3].TitlePartyName[0].Party2[0] (0.30 conf)
f_l_subform_title_party_name__3 was FL-630[0].#subform[2].#subform[3].TitlePartyName[0].Party3[0] (0.30 conf)
f_l_subform_date_ft__1 was FL-630[0].#subform[2].on_date_ft[0] (0.41 conf)
f_l_subform_area_petitioner_cb__1 was FL-630[0].#subform[2].#area[0].petitioner_cb[0] (0.38 conf)
f_l_subform_area_petitioner_cb__2 was FL-630[0].#subform[2].#area[1].petitioner_cb[1] (0.38 conf)
f_l_subform_hearing_date was FL-630[0].#subform[2].HearingDate[0] (0.34 conf)
f_l_subform_area_r_b_choice was FL-630[0].#subform[2].#area[2].RB2Choice2[0] (0.38 conf)
f_l_subform_fill_text__3 was FL-630[0].#subform[2].FillText1081[0] (0.40 conf)
f_l_fill_text_date_signing was FL-630[0].#subform[2].FillText\.date\.signing[0] (0.40 conf)
f_l_subform_date_ft__2 was FL-630[0].#subform[2].on_date_ft[1] (0.41 conf)
f_l_subform_date_ft__3 was FL-630[0].#subform[2].on_date_ft[2] (0.41 conf)
f_l_subform_fill_text__4 was FL-630[0].#subform[2].FillText65[0] (0.40 conf)
f_l_subform_check_box__1 was FL-630[0].#subform[2].CheckBox80[0] (0.34 conf)
f_l_subform_check_box__2 was FL-630[0].#subform[2].CheckBox[0] (0.34 conf)
f_l_subform_text_field was FL-630[0].#subform[2].TextField10[0] (0.34 conf)

We've done our best to group similar variables togther to avoid overwhelming the user.

Suggested Screen 0:

f_l_page_fill_text__1
f_l_page_fill_text_b_name
f_l_page_cb_choice_b
f_l_page_cb_choice
f_l_page_area_petitioner_cb__1
f_l_page_hearing_date
f_l_page_hearing_dept__1
f_l_page_hearing_dept__2
f_l_page_area_petitioner_cb__2
f_l_page_area_text_field__1
f_l_page_area_check_box__1
f_l_page_area_petitioner_cb__3
f_l_page_area_text_field__2
f_l_page_area_check_box__2
f_l_page_area_petitioner_cb__4
f_l_page_area_text_field__3
f_l_page_area_check_box__3
f_l_page_area_petitioner_cb__5
f_l_page_area_check_box__4
f_l_page_area_petitioner_cb__6
f_l_page_area_petitioner_cb__7
f_l_page_area_petitioner_cb__8
f_page_p_party_info_phone
f_l_page_p_party_info__1
f_page_p_party_info_email
f_l_page_p_party_info__2
f_page_p_party_info_area__1
f_page_p_party_info_area__2
f_page_p_party_info_text__1
f_page_p_party_info_text__2
f_page_p_party_info_text__3
f_l_page_p_info_county
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Judgment Regarding Parental Obligations (Governmental)

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