Here is the text we could read:
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address):
FOR COURT USE ONLY
FL-645
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
TELEPHONE NO.:
ATTORNEY FOR (Name):
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT:
NOTICE TO LOCAL CHILD SUPPORT AGENCY OF INTENT TO TAKE
INDEPENDENT ACTION TO ENFORCE SUPPORT ORDER
CASE NUMBER:
NOTICE
If you are receiving support enforcement services from the local child support agency, you may start independent
enforcement action 30 days after you send this notice to the local child support agency unless the local child support
agency objects.
You must personally deliver personally or mail this notice to the local child support agency.
You must file the independent action specified below within 180 days of the date this notice is served.
1. I am a parent of the minor children in this action.
2. I intend to start an independent enforcement action at least 30 days after this notice is delivered personally or mailed to the
local child support agency. The enforcement action to be taken is as follows (specify):
3. (Check whichever statement is true)
I am receiving public assistance.
public assistance from (county name):
I have applied for public assistance.
I intend to apply for
County for the children in this action.
I am not receiving public assistance for the children in this action.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
a.
b.
Date:
(TYPE OR PRINT NAME)
(SIGNATURE)
Form Adopted For Mandatory Use
Judicial Council of California
FL-645 [Rev. January 1, 2003]
NOTICE TO LOCAL CHILD SUPPORT AGENCY OF INTENT TO TAKE
INDEPENDENT ACTION TO ENFORCE SUPPORT ORDER
(Governmental)
Page 1 of 3
Family Code, 17404
www.courtinfo.ca.gov.
CASE NUMBER:
DECLARATION OF MAILING
I served a copy of this document by enclosing it in a sealed envelope and depositing the envelope
directly in the United States mail with postage paid
or
at my place of business for same day collection
and mailing with the United States mail, following our ordinary business practices with which I am readily familiar.
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT:
a. Date of deposit
b. Addressed as follows:
c. Place of deposit (city and state):
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 NOTICE)
FL-645 [Rev. January 1, 2003]
NOTICE TO LOCAL CHILD SUPPORT AGENCY OF INTENT TO TAKE
INDEPENDENT ACTION TO ENFORCE SUPPORT ORDER
(Governmental)
Page 2 of 3
INFORMATION SHEET FOR NOTICE TO LOCAL CHILD
SUPPORT AGENCY OF INTENT TO TAKE INDEPENDENT
ACTION TO ENFORCE SUPPORT ORDER
Please follow these instructions to complete the Notice to Local Child Support Agency of Intent to Take Independent Action to Enforce
Support Order (form FL-645) if you do not have an attorney to represent you. Your attorney, if you have one, should complete this
form.
When you have completed this notice, you should keep the original and mail a copy of the notice to the local child support agency. The
local child support agency must give you a written response to your notice within 30 days. You cannot proceed with an enforcement
action if the local child support agency notifies you within 30 days that it objects to your proposed enforcement action. If the local child
support agency either does not answer or does not object to your proposed enforcement action, you may file the proposed action. You
must file your enforcement action within 180 days of the date you send this notice to the local child support agency.
When you file your enforcement action with the court clerk, you should include the original copy of this notice and a copy of the local
child support agency's response if you received one. The address of the court clerk is listed in the telephone directory under "County
Government Offices." You may have to pay a filing fee. If you cannot afford to pay the filing fee, the court may waive it. For more
information about the filing fee and waiver of the filing fee, contact the court clerk.
INSTRUCTIONS FOR COMPLETING THE NOTICE TO LOCAL CHILD SUPPORT AGENCY OF INTENT TO TAKE INDEPENDENT
ACTION TO ENFORCE SUPPORT ORDER (TYPE OR PRINT ON FORM IN BLACK INK):
Front page, first box, top of form on left side: Print your name, address, and telephone number in this box if they are not already there.
Front page, second box on left side: Print your county's name and the court's address in the box. Use the same address for the court
that is on your most recent support order or judgment. If you do not have a copy of your most recent support order or judgment, you
can get one from either the court clerk or the local child support agency.
Front page, third box on left side: Print the names of the Petitioner/Plaintiff, Respondent/Defendant, and Other Parent in this box. Use
the same names listed in your most recent support order or judgment. If no name is listed for the Other Parent, leave that line blank.
Front page, first box, top of form on right side: Leave this box blank for the court's use.
Front page, second box on right side: Print your case number in this box. This number is also listed on your most recent support order
or judgment.
1.
2.
3.
This section states that you are the parent of the minor children.
In this space you must write the enforcement action that you intend to file.
a.
Check the correct box if you either receive welfare, have applied for welfare, or if you are going to apply for welfare for the
children. Write the name of the county where you receive or may receive welfare for the children.
Check this box if you do not receive and have not applied for welfare for the children.
b.
You must date the request, print your name and sign the form under penalty of perjury. When you sign the form, you are stating that
the information you have provided is true and correct.
Top of second page, box on left side: Print the names of Petitioner/Plaintiff, Respondent/Defendant, and Other Parent in this box.
Use the same names listed on the front page.
Top of second page, box on right side: Print your case number in this box. Use the same number as on the front page.
Declaration of mailing: Complete the declaration of mailing.
FL-645 [Rev. January 1, 2003]
NOTICE TO LOCAL CHILD SUPPORT AGENCY OF INTENT TO TAKE
INDEPENDENT ACTION TO ENFORCE SUPPORT ORDER
(Governmental)
Page 3 of 3
