ATTORNEY OR PARTY WITHOUT ATTORNEY OR GOVERNMENTAL AGENCY (under Family Code §§ 17400, 17406) 
(Name and Address):

FOR COURT USE ONLY

FL-670

TELEPHONE NO.:

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:

NOTICE OF MOTION FOR JUDICIAL REVIEW OF LICENSE DENIAL

CASE NUMBER:

See reverse for instructions.
1. On (date):

denied a release form that would enable me to obtain the following license (specify):

the local child support agency of (specify county):

Name and address of licensing agency:

2.  I seek a judicial review of the local child support agency's denial on the following grounds (check all that apply):

There is no order for me to pay child support in this action.

I am not the person ordered to pay child support in this action.

I am in compliance with the order to pay child support in this action.

I am in compliance with payments on the schedule for payment of arrearages or reimbursement.

Other (specify):

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)

3.  A hearing on this motion will be held as follows:

Date:
Address:

Time:

Room:

a.

b.

c.

d.

e.

Date:

Form Adopted for Mandatory Use
Judicial Council of California
FL-670 [Rev. January 1, 2003]

NOTICE OF MOTION FOR
JUDICIAL REVIEW OF LICENSE DENIAL
(Governmental)

Page 1 of 2

Family Code, § 17520

www.courtinfo.ca.gov

PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT:

CASE NUMBER:

This motion should be filed with a hearing scheduled as soon as possible after your local child support agency review.

1.

INSTRUCTIONS
Complete the application on the reverse. Contact the clerk of the court for a hearing date, time, and place. Insert the information in 
box 3 on the reverse.

File the original Notice of Motion for Judicial Review of License Denial (form FL-670) with the court and keep two copies, because 
you will need them later.

Serve a copy of this form on the local child support agency which has certified your name for nonpayment of child support not later 
than seven days after the filing in court. Service of the papers may be made by (a) personal delivery    OR    (b) mailing the papers 
by first-class mail, postage prepaid, to the last known address of the other party. Anyone at least 18 years of age EXCEPT A PARTY 
may personally serve or mail the papers. Be sure whoever serves the papers fills out and signs the proof of service below.

At the time of service I was at least 18 years of age and not a party to this legal proceeding.

PROOF OF SERVICE

I served a copy of the Notice of Motion for Judicial Review of License Denial (form FL-670) in the manner shown below.

Manner of service on LOCAL CHILD SUPPORT AGENCY
a.

Personal service. I personally delivered these papers to the local child support agency as follows:
(1) Local child support agency (name):
(2) Address where served:

(3) Date delivered:

(4) Time delivered:

b.

First-class mail. I deposited these papers with the United States Postal Service, in a sealed envelope with postage fully 
prepaid.  I  am  a  resident  of  or  employed  in  the  county  where  the  notice  was  mailed.  The  envelope  was  addressed  and 
mailed as follows:
(1) Local child support agency (name):
(2) Address on envelope:

(3) Date mailed:

(4) Place of mailing (city, state):

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

2.

3.

4.

5.

6.

Date:

(TYPE OR PRINT NAME)

(SIGNATURE OF PERSON WHO SERVED THE NOTICE)

FL-670 [Rev. January 1, 2003]

NOTICE OF MOTION FOR
JUDICIAL REVIEW OF LICENSE DENIAL
(Governmental)

Page 2 of 2