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

TELEPHONE AND FAX NOS.:

FOR COURT USE ONLY

FL-616

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

OTHER PARENT:

DECLARATION FOR AMENDED PROPOSED JUDGMENT

CASE NUMBER:

1.

The local child support agency is providing enforcement services in this case.

2.

On (date):
the Obligor pay child support based on the California support guideline. The amount of the support requested was based on the
Obligor's gross monthly income as follows (check one):

a Summons and Complaint Regarding Parental Obligations (form FL-600) was filed requesting 

Presumed income as provided by law.

Known income of:  $

per month.

3.
3.

Since the service of the Summons and Complaint Regarding Parental Obligations (form FL-600)

the local child support agency has received additional income information that would result in a different support order.  
According to this information,                             Obligor's gross monthly income is:  $
Obligee's gross monthly income is:  $

Obligor's income has become unknown.

Other (specify):

4.

An amended proposed judgment is attached.

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

 a.

b.

a.

b.

c.

Date:

(TYPE OR PRINT NAME)

(SIGNATURE OF DECLARANT)

Form Adopted for Mandatory Use
Judicial Council of California
FL-616 [Rev. January 1, 2003]

DECLARATION FOR AMENDED PROPOSED JUDGMENT

(Governmental)

Page 1 of 2

Family Code, § 17400, 
17406
www.courtinfo.ca.gov

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

OTHER PARENT:

CASE NUMBER:

5.   

I served this declaration and the attached amended proposed judgment on the Obligor.

PROOF OF SERVICE

Personal delivery. I personally delivered this declaration and judgment to the Obligor as follows:

Mail. I deposited this declaration and judgment in the United States mail, in a sealed envelope with postage
 fully prepaid. I used first-class mail. The envelope was addressed and mailed 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 PERSON WHO SERVED OBLIGOR)

6.

I served this declaration and the attached amended proposed judgment on the other parent.

Personal delivery.  I personally delivered this declaration and judgment to the other parent as follows:

Mail.  I deposited this declaration and judgment in the United States mail, in a sealed envelope with postage 
fully prepaid. I used first-class mail. The envelope was addressed and mailed as follows:

(1) Name:
(2) Address where delivered:

(3) Date of delivery:
(4) Time of delivery:

(1) Name:
(2) Address:

(3) Date of mailing:
(4) Place of mailing (city and state):

(1) Name:
(2) Address where delivered:

(3) Date of delivery:
(4) Time of delivery.

(1) Name:
(2) Address:

(3) Date of mailing:
(4) Place of mailing (city and state):

a.

b.

a.

b.

Date:

Date:

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 PERSON WHO SERVED OTHER PARENT)

FL-616 [Rev. January 1, 2003]

DECLARATION FOR AMENDED PROPOSED JUDGMENT

Page 2 of 2

(Governmental)