Get Ca Fl-665 2016

Page 1 of 3 Form Adopted for Alternative Mandatory Use Instead of Form FL-692 Judicial Council of California FL-665 Rev. July 1 2011 Governmental Family Code 4251 www. FL-665 FOR COURT USE ONLY ATTORNEY OR PARTY WITHOUT ATTORNEY Name State Bar number and address To keep other people from seeing what you entered on your form please press the Clear This Form button at the end of the form when finished. FAX NO. Optional TELEPHONE NO. E-MAIL ADDRESS Optional ATTORNEY FOR Name SUPERIOR COURT OF CALIFORNIA COUNTY OF STREET ADDRESS MAILING ADDRESS CITY AND ZIP CODE BRANCH NAME PETITIONER/PLAINTIFF RESPONDENT/DEFENDANT OTHER PARENT CASE NUMBER FINDINGS AND RECOMMENDATION OF COMMISSIONER 1. Name specify hearing this matter as a temporary judge. 2. THIS MATTER PROCEEDED AS FOLLOWS a* By court hearing appearances as follows Dept. 1 Date Petitioner/plaintiff present Respondent/defendant present objected to Commissioner name Judicial officer Attorney present name Other parent present 5 Local child support agency attorney Family Code 17400 17406 by name Other specify other parent. b. The parent ordered to pay support is the Attached is a computer printout showing the parents income and percentage of time each parent spends with the child ren. The printout which shows the calculation of child support payable will become the court s findings. This recommended order is based on the attached documents specify 5. THE COMMISSIONER RECOMMENDS THE FOLLOWING a* All orders previously made in this action remain in full force and effect except as modified below. mother father b. Name of parent are the parents of the children listed below. Name of child Date of birth Monthly support amount Mandatory additional child support one-half or or specify amount per month of the costs. Payments must be made to the State Disbursement Unit child-care provider. 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. courts. ca*gov 5. c* 1 health-care provider. For a total of The low-income adjustment applies. payable on the day of each month beginning date 5 Any support ordered will continue until further order of court unless terminated by operation of law. 6 As provided in Family Code section 4007. 5 the obligation of the person ordered to pay support will be temporarily suspended for any period after the first 90 consecutive days in which the person ordered to pay support is incarcerated or involuntarily institutionalized unless that person has the ability to pay support during that time or has committed certain crimes. Immediately after the person ordered to pay support is released from incarceration or involuntary institutionalization the support order will restart in the same amount as it was before it was temporarily suspended* d. The parent receiving support must 1 provide and maintain health insurance 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 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.