FL -632 GOVERNMENTAL AGENCY (under Family Code, §§ 17400, 17406): _ _ _ _ _ _ RECORDING REQUESTED BY AND WHEN RECORDED MAIL TO: ALEXANDRA BAUER , CHIEF ATTORNEY LOS ANGELES COUNTY CSSD - VAN NUYS 7555 VAN NUYS BLVD VAN NUYS CA 91405-1949 200000001678104 TEL NO.: (866) 901-3212 FAX NO. (optional): (818) 902-4401 SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES STREET ADDRESS: 600 S COMMONWEALTH AVE MAILING ADDRESS: 6005 COMMONW EALTH AVE CITY AND ZIP CODE: LOS ANGELES 90005-4001 BRANCH NAME: CENTRAL CIVIL WEST FOR RECORDER'S USE ONLY PETITIONER/PLAINTIFF: JOHN MELENDEZ RESPONDENT/DEFENDANT: SUZANNA MELENDEZ OTHER PARENT: NOTICE REGARDING PAYMENT OF SUPPORT ____NOTICE OF ASSIGNED SUPPORT X SUBSTITUTION OF PAYEE 1. The obligor (the person paying support) in this proceeding is (name and last known address): JOHN MELENDEZ address on record at the Local Child Support Agency. Address may be released only upon an order from the court pursuant to Family Code Section 17212(c)(6) 2. a. 3. 4. (1) (2) (3) FOR COURT USE ONLY FILED Superior Court of California County of Los Angeles MAY 2 4 2017 Shern K. Carter Ulcer/Clerk By_______________ _ _ _ _ _ _ _ , Deputy CASE NUMBER: BD553131 The local child support agency is providing the following services (check all that apply): Current support Support arrears Medical support b. _ _ _ _ _ The local child support agency is no longer providing the services under title IV -D of the Social Security Act. a. b. The substituted payee is: The local child support agency (specify): Los Angeles County Child Support Services Department Other (specify): An abstract or notice of support judgment or support judgment was recorded as follows: County Date of recording Instrument number Book number 5. All payments must be made as follows (check all that apply): a. Income withholding payments must be directed to the State Disbursement Unit at (specify address): PO BOX 989067, W EST SACRAMENTO CA 95798-9067 b. X All current support payments other than income withholding payments must be sent to (specify): California State Disbursement Unit P.O. Box 989067 W est Sacramento, CA 95798-9067 c. I X I All arrears payments other than income withholding payments must be sent to (specify): California State Disbursement Unit P.O. Box 989067 W est Sacramento, CA 95798-9067 d. r--1 Other (specify): ac ie number THE SUBSTITUTED PAYEE MUST BE CONTACTED WHEN NOTICE TO A LIENHOLDER MAY OR MUST BE GIVEN. Pogo 1 of 2 Form Adopted for Mandatory lice Judicial Council of California FL -632 (Rev. July 1,2016) NOTICE REGARDING PAYMENT OF SUPPORT (Governmental) Family Coda, riff 4200,4201, 4204, 4350, 4351, 4506.3, 17400 wwvv courts=oov TEAM P2 PETITIONER/PLAINTIFF: JOHN MELENDEZ RESPONDENT/DEFENDANT: SUZANNA MELENDEZ OTHER PARENT: CASE NUMBER: BD553131 6. F-1 An assignment of support rights by operation of law under Welfare and Institutions Code section 11477(a) has been made to the county of (specify): 7 . a . X Each parent must notify the local child support agency in writing within 10 days of any change in residence or employment. b. 1 - 1 Each parent must complete a Child Support Case Registry Form (FL -191) and deliver it to the court within 10 days of any change in residence or employment. X Date: 04/18/2017 -ANNA GALOIAN 'ON'OAIR PRINAAME) 1). (SIGNATURE) A notary public or other officer t ompleting this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfUlness, accuracy, or -validity of that document. NOTICE: No acknowledgment is required when this form is recorded by a local child support agency. ACKNOWLEDGMENT (To be completed when this form is recorded by a person or entity other than a local child support agency.) STATE OF CALIFORNIA COUNTY OF On , before me, (here insert name and title of the officer) personally appeared who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature (s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. (SIGNATURE OF NOTARY) (Seal) FL -632 [Rev. July 1, 20153 NOT ICE REGARDING PAYMENT OF SUPPORT (Governmental) P.:se 2 o12 TEAM P2 (FAX)818 888 7071 P . 0 0 2 / 0 0 7 04/12/2017 0 6 : 1 1 L a u r a W h i t e f i e l d , E s q . % AURA WHITEFIELD SBN: 174249 ,AW OFFICES OF LAURA WHITEF1ELD 3309 1/2Comercio Way Woodland Hills, CA 91364 3 (818) 704-9500; Fax (8.18) 888-7071, R t i t i a N e D 4 vikm1L-y lkov v.) 5 Attorney for P e titione r I JOHN MELENDEZ 6 7 8 9 10 11 12 13 14 15 16 17 02 - 1 S og CONFO1IVIIEK.7 COP./ ORIGINAL. PILED Superior Court of Ceilforniir C o u n t y o f i.Ov A nt : ognf, NOV 0 alb Sherri R. Carter, Executive Unit:icor:hem By:, Eileen D au g h er t y . Deputy SUPERIOR COURT FOR THE STATE OF CALIFORNIA COUNTY OF LOS ANGELES JOHN MELENDEZ Petitioner, and SUZANNA MELENDEZ, ) CASE NO; BD 553 131 ) ) ) ) ) ) ) ) ) IT IS HEREBY STIPULATED as and between the parties, PETITIONER JOHN MELENDEZ and RESPONDENT, SUZANNA MELENDEZ as follows: Respondent, STIPULATION RE MODIFICATION OF CHILD SUPPORT AND ORDER THEREON 8 The Stipulation and Order Re Modification of Judgment of October 8, 2013 and which was 19 20 21 22 23 24 25 26 27 .28 filed and entered on May 27, 2015 shall be modified as follows: 1. Petitioner shall pay to Respondent the S UM of $400,00 per month, as and for child Support for the parties' two minor children, Lily Belle Melendez (DOB; 12/07/00) and Oscar David Melendez (DOB; 01/06/06) payable one half, (1/2) on the first, ( l'i), and one half on the fifteenth, (1511') day of each and every calendar month commencing November 1, 2016. This sum shall be inclusive of any child care costs for the minor children Incurred by either prey. 2. The above payments shall continue for each Minor child until such child reaches the age , • of 18 years, dies, marries or is otherwise emancipated or until further order of the court , whichever • occurs first, The above payments shall continue for an unmarried child who has attained the age of • 18 years, is a full time high school student and who is not self supporting, until the child complete's the MARRIAGE OP mELENGEZ, I.pASC CASE I/ BD 553131 STIPULATION RE mompiCATION Or mum) surpoRT AND ORM THEREON 04/12/2017 06:11 Laura Wh i tef e I d, Esq • • • • (FAX)818 888 7071 P.003/007 1 j 12th grade or attains the: age of nineteen (19) years, which ever occurs first. • 2 3. The parties acknowledge, understand and stipulate the child support agreed to 3 herein may not conform to the guideline amounts under the state of California and is baied upon 4 the following factors: 1) Income- Petitioner' gross monthly employment earnings based upon the 5 imputed amount of $1,73100; Time Share -Petitioner's custodial time with the minor child at 20%; 6 Tax Filing Status 7Petitioner's tax filing status as Single with one deduction/exemption for tax filing • 7 purposes, Health Insurance - Petitioner' health insurance costs in the approximate amount of $300.00 8 per month. 2) Income - Respondent's gross monthly combined employment and self employment 9 earnings in the approximate amount of $5,496.00, Time Share -Respondent's custodial time with the 10 minor child at 80%; Tax Filing Status -Respondent's tax filing status as Head of Household with 3 11.. deductions/ exemptions for tax filing purposes, Health Insurance - Respondent's monthly health 12 insurance cost in the approximate amount of $202,00 per month, Union Dues •• Respondent's monthly • 13 union dues in the amount of $195.00 per month 14 4. The parties acknowledge and declare: a) that they are fully informed of their rights 15 concerning child support pursuant to Family Code §40651 b) the financial' support agreement with 16 respect to the minor child is agreed to without coercion or duress; c) the agreed upon support is in 17 lIthe best interests of the minor children involved; d) the needs of the minor children shall be 18 adequately met by the stipulated agreement and e) the right to support has not been assigned to the 19 county pursuant to 'Welfare & Institutions Code §11477 and no Public Assistance Application is 20 pending. 21 5. The parties acknowledge that he or she has read and understands the terms and. 22 provisions of the Information Sheet on Changing a Child Support Order Form FL -192 A which is 23 attached hereto and incorporated herein. .24 6. This Stipulation resolves all issues contained in Petitioner's Request For Order, for 25 Modification of child support filed October 5, 2D16 and set for hearing on November 21, 2016, • 26 7. . Petitioner has been represented hi these post judgment proceedings including the 27 negotiation, preparation and execution pf this Stipulation by Laura Whitefield, Attorney at La.w, 28 11 MARMAGZ OF MRLENDEZ LASC CAS!, H OD 5313I STIPULATION RR MODIPICATION CV CHILD SUPPORT AND mem THXRZON, - 2 - 04/12/2017 06:11 Laura Wh tef I e I Esq (FAX)8188887071 PX04/007 8. Respondent has represented herself in Pro Per in these proceedings including the , • 2I negotiation, preparation and execution of Stipulation, Respondent has been advised that she ha i the 3 right to have this 'document reviewed by legal counsel or to have legal counsel represent her at any • 4 stage of these proceedings. 5 9. Each party shall be responsible to pay his or her own attorney fees and 6 costs, , 7 10, This Stipulation may be executed in counterparts, each of which shall be deemed to 8 be an original and transmitted by facsimile, electronic mail or any other electronic means intended to 9 preserve the original graphic and pictorial appearance of any signatures to the Stipulation. Each such 10 counterpart, facsimile or pdf signature shall constitute an original document pursuant to California 11 Rules of Court, Rule 2,305(d). 12 /1/ • 13 /1/ 1 4 / 1 / ' 15 / / / 16 I i i 17 / / / 1 8 •/ / / • 19 I i i • • .20 / / / / / , 22 //./ ' 23 I I I 24 / I l 25 11/ .26 /1/ • : 2 7 28 1 1M A R R I A G EO FM E L E N D E Z L A S CC A S E N B D5 5 3 1 3 1 S T I P U L A T I O NR EM O D I F I C A T I O NO FC H I L DS U P P O R TA N DO R D E RT H E R E O N - 3 - 04/12/2017 06:11 Laura Whitefieldo Esq. (FAX)818 888 7071 P 005/007 2 3 4 5 7 8 • 9 :10 1 • 12 13 14 4.6 , 17' 18 19 • 20 2.1 22 '.23 25 26 ' 21. 28 11. Each party, represent that they have read all 'of the terms and provisions of this Stipulation and agree to sant' e, and have entered into this Stipulation voluntarily without undue influence, fraud coercion or misrepresentation. Each party farther dedlare that they understand the terms and provisidns as set forth in this Stipulation and are fully aware of its content and legal effect. Each patty by his/her signature below, agrees that their execution of this Stipulation shall render this Stipulation enforceable whether or not it is entered as an order of the Court, This Stipulation shall not depend upon entry as a California Court Order for its effectiveness. IT IS SO STIPULATED APPROVED AS TO FORK AND CONTENT: DATED: n IN DATED: I) APPROVED AS TO PORN; DATED:_____________ .IT IS SO ORDERED: DATED:, 111)4.ilik. _ _ _ _ _ _ _ _ _ NARMAGE OVIWZIANDEZ JOHN AIELENDEZ Petit choir SUZANNA MELENDBZ Respondent in Pro Per AURA WI-11TEPIELD Attofney for Petitioner; MEL,ENDEZ bBPARTMENT 014 MILD 'S'UPPORT SERVICES LAM CASS # D U$ 1 1 3 1 3 1 DIANNA GOULIMALTMAN lic 1 l4 t n AB T . , E it a a v v ia s ifx3 10111).9ALTMA . G e lm iliz g e r iz t - Los Angeles Superior Court .7134t.p., STIFT:RATION AZ MODIFICATION OF CHILD suProter AND ORDUR THEREON - 4 - Alm 04/12/2017 06:12 Laura Whi tef ield, Esq. (FAX)818 888 7071 P.006/007 FL -192 NOTICE OF RIGHTS AND RESPONSIBILITIES Health -Caro Cos ts and Reimburs ement Procedures IF YOU HAVE A CHILD SUPPORT ORDER THAT INCLUDES A PROVISION FOR THE REIMBURSEMENT OF A PORTION OF THE CHILD'S OR CHILDREN'S HEALTH-CARE COSTS AND THOSE COSTS ARE NOT PAID By INSURANCE, THE LAW SAYS: ; • 1, Notice. You mUst give the other parent an itemized , statement of the charges that have been billed for arty health- • care costs not paid by Insurance. You must give this • • ststernent to the other parent within a reasonable time, but no more than $0 days after those oasts were given to you. • 2, Proof. of full payment, If you have already paid all of the • uninsured costs, yoU must (1) give the other parent proof that you paid thorn and (2) ask for reimbursement for the other . parent's court -ordered share of those costs. 3. Proof of partial payment, If you have paid only your share of the uninsured costs, you must (1) give the other parent Proof that you paid your share, (2) ask that the other parent ." pay his or her share of the oosts directly to the health -cars provider, and (3) give the other parent the information • • necessary for that parent to be able to pay the bill. 4. Payment by notified parent. If you receive notice from a parent that an Uninsured health-care cost has been incurred, • ' • . YOU must pay your share of that cost within the time the court •orders ; or If the court has not specified a period of time, you must make payment (1) within 30 days from the time you were given notice of the nmount due, (2) according to any payment . "schedule set by the health-care provider, (3) according to a schedule agreed to In Writing by you and the other parent, or .(4) according'to a schedule adopted by the court. 9, Disputed eharges, If you dispute a charge, you may file a .motion In court to resolve the dispute, but only If you pay that charge before filing your motion, if you claim that the other party has failed to reimburse you for a payment, or the other party has failed to make a payment to the provider after proper notice has been given, you may file a motion in court to resolve . the 'dispute. The court Will presume that if uninsured costs have been paid, those costs were reasonable, The court may award . attorney fees and costs agalhst a party who has been Unreasonable. 0, Court -ordered Insurance coverage, If a parent provides health-care insurance as ordered by the court, that Insurance must be used at all times to the extent that It is available for • health-care costs. Burden to prove. The party claiming that the coverage Is Inedepate to meet the child's needs has the burden of ' proving that to the court. b. Cost of additional coverage. If a parent purchases health- . care Insurance In addition to that ordered by the court, that parent must pay all the costa or the additional coverage, In addition, if a parent uses alternative coverage that coats more then the coverage provided'by court order, that parent must pay the difference, • Form Approved tor Optional LW Judicial Council of California • • • . FL -i(12 i1isv,JanUarit,2o151 7. Preferred health providers, if the court -ordered coverage designates a preferred health-care provider, that provider must be used at: all timesdoneistent with the terms of the health Insurance policy, When any party uses a heeith-dare provider other than the preferred provider, any health-care costs that would have been peld by the preferred health , provider If that provider had bean used must be the sole responsibility of the party Incurring those poets, NOTICE OF RIGHTS AND RESPONSIBILITIES Health -Care Costa and Reimbursement Procedures Papp i Of2 Family Cadi:$1 4042, 4063 www.coUris.m0V 04/1212017 06 : 12 Laura Wh tef I a Esq . g , . (FAX)818 888 7071 P , 007/007 , • ' • • INFORMATION SHEET ON CHANGING A CHILD SUPPORT ORDER FL -102 • . General Information • The court has Just made a child Support order In your case. This order will remain the same unless a party to the action requests that the support be changed (modified), An order for child support can be modified only by filing a motion to change child support and : serving each party Involved in your case. If both parents and the local child support agency (If It Is Involved) agree on a new child support amount, you can complete, have all parties sign, and file with the court a Stipulation to Establish or Modify Child Support and Order (form FL450) or Stipulation and Order (Governmental) (form FL -625), When a Child Support Order May ae Modified . The court take* eeveral things Into account when ordering the payment of child support, First, the number of children Is considered. Next, the net incomes of both 'Parents are determined, along with the percentage of time each parent has physical custody of the children, The cour,t considers both parties' tax filing status and may consider hardshipe, such as a child of another relationship, An existing order for child support may be modified when the net Income of one of the parents changes significantly, the parenting • schedule changes significantly, or a new child is born. ‘. Examples • You have been ordered to pay $500 per month in child support. You lose your job, You will continue to owe,8500 per month, plus 10 percent Interest on any unpaid support, unless you file a motion to modify your child support to a lower amountand die eoUrt ' orders a reduction, ;• You are currently receiving $300 per month in child support from the other parent, whose net Income has just Increased • substantially. You will continue to receive $300 par month unless you file a motion to modify your child support to a higher amount • and the court orders an Increase. • .• You are paying child support based upon having physical custody of your children 30 percent of the time, After several months It turns • out that you actually have physical custody of (ha children 50 percent of the time. You may file a motion to modify child support to a lower amount, • • How to Change a Child Support Order To change a child support order, you must file papers with the court. Remember: You must follow the order you have now. • What &ohne, riet 1 t;oaril • • If you are reeking to change a child support order open with the local child support agency, you must fill out one of these forms: .FL -680, Notice of Motion (Governmental) or FL -683 Order to Show Cattsu (Governmental) and • FL -684, Request for Order'and Supporting Declaration (Governmental) If you are asking to change a child support order that Is not open with the local child support agency, you must fill out one of these ' forms: • .w FL -300, Request for Order or •• FL -390, Notice of Motion and Motion for Simplified Modification of Order for Child, Spousal, or Family Support „.. „You must also fill out one of these forms: : • • w FL -150, Income and Expense Declaration or FL -156, Financlel Statement (Simplified) • • t 1 What if I am not sure which forms to fill out? • • • Talk to the family law facilitator at your court, ,•,. After 3/00 fill out the farms, file them with the court clerk and ask for a hearing date. Write the hearing date on the form, . The olark will ask you to pay a Mine fee. If you cannot afford the fee, fill cut these forms, too: • • Form FW-001, Request to Waive Court Fees • Form FW-003, Order on Court Fee Waiver (Superior Court) YOU must serve the other parent, If the local child support agency Is Involved, serve It too. This means someens 15 or over —not you —must serve the other parent copies of your flied court forms et leest 16 court day's before the hearing, Add 5 calenderclaya If you serve by mail witnin cutout's 000 close 07 Levu eroceoure section iuuo ;or ewer tiitIALIIILOI - Court days are weekdays when the court Is open for business (Monday through Friday except court holidays), Calendar days Include all days Of the month, Including weekends and holidays. To find court holidays, go to www.courts,cavv/holidays.htm. , The server Must also serve blank copies of these forms: I FL -320, Responsive Declaration to Request for Order and FL -150, Income and Expense Decleretion, or FL -155, Financial Statement (Simplified) Then the server fills out and signs a Proof of Service (form FL -330 or FL -335). Take this form to the clerk and file it. • Oo to your hearing and ask the Judge to change the support. Bring your tax returns from the last two years end your lest two • months' pay ;Aube, The judge will look at your information, listen to both parents, and make an order. After the hearing, fill out: • FL -340, Findings and Order After Hearing and * FL -342, Child Support Information and Order Attachment Need help? Contact the family law facilitator In your county or call your county'e bar association and ask for an experienced family lawyer. PIAnp. tny,Ja nua r y1, 20101 NOTiCE OF RIGHTS ANffi-RESPONSIBILITES Health -Care Coats and Reimbursement Procedures Ma 2 of 2 • 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 LAURA WHITEFIELD SBN: 174249 LAW OFFICES OF LAURA WiiITEFIELD 5309½ Comercio Way IF Woodland Hills, CA 91364 (818) 704-9500; Fax: (818) 888-7071 mig vAl\IIII-N 2 8 Attorney for Petitioner JOHN MELENDEZ FILED Superior Court of California County of Los Angeles Y42 NOV 6 U2016 Sherri R. Carter, Executive Officer/Clerk By_k Deputy .1-171,1gn SUPERIOR COURT FOR THE STATE OF CALIFORNIA COUNTY OF LOS ANGELES JOHN MELENDEZ ) CASE NO: BD 553 131 ) Petitioner, ) ) STIPULATION RE MODIFICATION and ) OF CHILD SUPPORT AND ORDER ) THEREON SUZANNA MELENDEZ, ) ) ) Respondent. ) _____________________________________________) IT IS HEREBY STIPULATED as and between the parties, PETITIONER JOHN MELENDEZ and RESPONDENT, SUZANNA MELENDEZ as follows: The Stipulation and Order Re Modification of Judgment of October 8, 2013 and which was filed and entered on May 27, 2015 shall be modified as follows: 1. Petitioner shall pay to Respondent the sum of $400.00 per month, as and for child support for the parties' two minor children, Lily Belle Melendez (DOB: 12/07/00) and Oscar David Melendez (DOB: 01/06/06) payable one half, (1/2) on the first, (?), and one half on the fifteenth, (15th) day of each and every calendar month commencing November 1, 2016. This sum shall be inclusive of any child care costs for the minor children incurred by either party. 2. The above payments shall continue for each minor child until such child reaches the age of 18 years, dies, marries or is otherwise emancipated or until further order of the court, whichever occurs first. The above payments shall continue for an unmarried child who has attained the age of 18 years, is a full time high school student and who is not self supporting, until the child completes the MARRIAGE OF MELENDEZ LASC CASE # BD 553131 STIPULATION RE MODIFICATION OF CHILD SUPPORT AND ORDER THEREON • 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 12th grade or attains the age of nineteen (19) years, which ever occurs first. 3. The partiegfacknowledge, understand and stipulate the child support agreed to herein may not conform to the guideline amounts under the state of California and is based upon the following factors: 1) Income- Petitioner' gross monthly employment earnings based upon the imputed amount of $1,733.00; Time Share -Petitioner's custodial time with the minor child at 20%; Tax Filing Status -Petitioner's tax filing status as Single with one deduction/exemption for tax filing purposes, Health Insurance - Petitioner' health insurance costs in the approximate amount of $300.00 per month. 2) Income - Respondent's gross monthly combined employment and self employment earnings in the approximate amount of $5,496.00, Time Share -Respondent's custodial time with the minor child at 80%; Tax Filing Status -Respondent's tax filing status as Head of Household with 3 deductions/ exemptions for tax filing purposes, Health Insurance - Respondent's monthly health insurance cost in the approximate amount of $202.00 per month, Union Dues - Respondent's monthly union dues in the amount of $195.00 per month 4. The parties acknowledge and declare: a) that they are fully informed of their rights concerning child support pursuant to Family Code §4065; b) the financial support agreement with respect to the minor child is agreed to without coercion or duress; c) the agreed upon support is in the best interests of the minor children involved; d) the needs of the minor children shall be adequately met by the stipulated agreement and e) the right to support has not been assigned to the county pursuant to Welfare & Institutions Code §11477 and no Public Assistance Application is pending. 5. The parties acknowledge that he or she has read and understands the terms and provisions of the Information Sheet on Changing a Child Support Order Form FL -192 A which is attached hereto and incorporated herein. 6. This Stipulation resolves all issues contained in Petitioner's Request For Order for Modification of child support filed October 5, 2016 and set for hearing on November 21, 2016. 7. Petitioner has been represented in these post judgment proceedings including the negotiation, preparation and execution of this Stipulation by Laura Whitefield, Attorney at Law. MARRIAG E O F MELENDEZ LASC CASE # BD 553131 S TIP ULATION RE MODIFICATION OF CHILD S UP P ORT AND ORDER THEREON - 2 - S • 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 8. Respondent has represented herself in Pro Per in these proceedings including the negotiation, preparation and execution of Stipulation. Respondent has been advised that she has the right to have this document reviewed by legal counsel or to have legal counsel represent her at any stage of these proceedings. 9. Each party shall be responsible to pay his or her own attorney fees and costs. 10. This Stipulation may be executed in counterparts, each of which shall be deemed to be an original and transmitted by facsimile, electronic mail or any other electronic means intended to preserve the original graphic and pictorial appearance of any signatures to the Stipulation. Each such counterpart, facsimile or pdf signature shall constitute an original document pursuant to California Rules of Court, Rule 2.305(d). / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / MARRIAG E O F MELENDEZ LAS C CAS E II BD 553131 S TIP ULATION RE MODIFICATION OF CHILD S UP P ORT AND ORDER THEREON - 3 - • 1 2 3 4 5 6 7 8 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 11, Each party, represent that they have read all of the terms and provisions of this Stipulation and agree. to same, and have entered into this Stipulation voluntarily without undue influence, fraud coercion or misrepresentation, Each party further declare that they understand the terms and provisions as set forth in this Stipulation and are fully aware of its content and legal effect. Each party by his/ter signature below, agrees that their execution of this Stipulation shall render this Stipulation enforceable whether or not it is entered as an order of the Court. This Stipulation shall not depend upon entry as a California Court Order for its effectiveness. IT IS SO STIPULATED - APPROVED AS TO FORM AND CONTENT: DATED: DATED: APPROVED AS TO FORM: DATED: di - I G DATED: I I IT IS SO ORDERED: MARRIAGE OF MELENPEZ JOHN/MELENDEZ Petitidnek SUZANNA MELENDEZ Respondent in Pro Per A WHITEF1ELD ney for Petitioner, MELENDEZ 4411QA S..1_1101t DEPARTMENT OF CFII/:_,D SUFRT SERVICES •11. 0 ..F. -T -•••• / 1\ iricsrrin -r-kryn "-TN T , 01/01111AGOVUISAINN LASC CASE # BD 553131 STIPULATION RE MODIFICATION OF CHILD SUPPORT AND ORDER THEREON - 4 - ATTORNEY (NAME AND ADDRESS); TELEP HONE NO: Laura Whitefield • Law Offices of Laura Whitefield g ATTORNEY FOR: Father DISSOMASTER REPORT CAS E NUMBER: 2016, Monthly Input Data Number of children % time with NCP Filing status # Federal exemptions Wages + salary 401(k) emp. contribution Self-employment income Other taxable income TANF plus CS received Other nontaxable income New -spouse income Wages + salary Self-employment income SS paid other marriage Retirement contrib if All Required union dues Nec job -related exp. Adj. to income (ATI) SS paid other marriage CS paid other relationship Health insurance Itemized deductions Other medical expenses Property tax expenses Ded. Interest expense Charitable contribution Miscellaneous itemized Required union dues Mandatory retirement Hardship deduction Other gdl. deductions AMT-info (IRS Form 6251) Child support add-ons Father Mother 0 2 20% 0% Single HH/MLA 1* 3* 1,733 5,000 0 0 0 0* o* 0 0 Guideline (2016) Nets (adjusted) Father Mother Total - Support CS Payor Presumed Basic CS Add-ons Per Kid Child 1 Child 2 Spousal support Total Proposed, CS Payor Presumed Basic CS Add-ons Per Kid Child 1 Child 2 Spousal support Total Combined Savings No releases _1,486 4,289 5,775 Father (159) (159), . 0 (50) (109) blocked (159) tactic 9 Father (159) (159) 0 (50) (109) blocked (159) 0 Cash Flow Analysis Father Mother Guideline Payrp entjcost)/Inef it (159) 159 Net spendable income 1,327 4,448 % combined spendable 23% 77% Total taxes 247 711 # withholding 1 8 allowances Net wage paycheCk/mo 1,431 4,263 Proposed Payment (cost)/benefit (159) 159 Net spendable income 1,327 4,448 NSI change from gdl 0 ''/0 combined spendable 23% 77% % of saving over gdl 0% 0% Total taxes 247 711 # withholding 1 8 allowances Net wage paycheck/mo 1,431 4,263 Default Case Settings F it Ag fixlseystirasiearVZOM DissoMaster Report (Monthly) Laura Whitefield, Law Offices of Laura Whitefield Page 1 of 1 1 1 / 2 / 2 0 1 6 7 : 1 2 P M 42,3 1 4 1 S • FL -192 NOTICE OF RIGHTS AND RESPONSIBILITIES Health -Care Costs and Reimbursement Procedures IF YOU HAVE A CHILD SUPPORT ORDER THAT INCLUDES A PROVISION FOR THE REIMBURSEMENT OF A PORTION OF THE CHILD'S OR CHILDREN'S HEALTH-CARE COSTS AND THOSE COSTS ARE NOT PAID BY INSURANCE, THE LAW SAYS: 1. No tic e . You must give the other parent an itemized statement of the charges that have been billed for any health- care costs not paid by insurance. You must give this statement to the other parent within a reasonable time, but no more than 30 days after those costs were given to you. 2. Proof of full payment. If you have already paid all of the uninsured costs, you must (1) give the other parent proof that you paid them and (2) ask for reimbursement for the other parent's court -ordered share of those costs. 3. Proof of partial payment. If you have paid only your share of the uninsured costs, you must (1) give the other parent proof that you paid your share, (2) ask that the other parent pay his or her share of the costs directly to the health-care provider, and (3) give the other parent the information necessary for that parent to be able to pay the bill. 4. Payment by notified parent. If you receive notice from a parent that an uninsured health-care cost has been incurred, you must pay your share of that cost within the time the court orders; or if the court has not specified a period of time, you must make payment (1) within 30 days from the time you were given notice of the amount due, (2) according to any payment schedule set by the health-care provider, (3) according to a schedule agreed to in writing by you and the other parent, or (4) according to a schedule adopted by the court. 5. Disputed charges. If you dispute a charge, you may file a motion in court to resolve the dispute, but only if you pay that charge before filing your motion. If you claim that the other party has failed to reimburse you for a payment, or the other party has failed to make a payment to the provider after proper notice has been given, you may file a motion in court to resolve the dispute. The court will presume that if uninsured costs have been paid, those costs were reasonable. The court may award attorney fees and costs against a party who has been unreasonable. 6. Court -ordered insurance coverage. If a parent provides health-care insurance as ordered by the court, that insurance must be used at all times to the extent that it is available for health-care costs. a. Burden to prove. The party claiming that the coverage is inadequate to meet the child's needs has the burden of proving that to the court. b. Cost of additional coverage. If a parent purchases health- care insurance in addition to that ordered by the court, that parent must pay all the costs of the additional coverage. In addition, if a parent uses alternative coverage that costs more than the coverage provided by court order, that parent must pay the difference. 7. Preferred health providers. If the court -ordered coverage designates a preferred health-care provider, that provider must be used at all times consistent with the terms of the health insurance policy. When any party uses a health-care provider other than the preferred provider, any health-care costs that would have been paid by the preferred health provider if that provider had been used must be the sole responsibility of the party incurring those costs. Pogo 1012 Form Approved for Optional Use Judicial Council of California FL -192 Rev. January 1,20151 NOTICE OF RIGHTS AND RESPONSIBILITIES Health -Care Costs and Reimbursement Procedures Family Coda, firt 4002, 4003 www.courts.ca,gov t 1 A • • • INFORMATION SHEET ON CHANGING A CHILD SUPPORT ORDER General Information The court has just made a child support order in your case. This order will remain the same unless a party to the action requests that the support be changed (modified). An order for child support can be modified only by filing a motion to change child support and serving each party involved in your case.,If both parents and the local child support agency (if It is Involved) agree on a new child support amount, you can complete, have all parties sign, and file with the court a Stipulation to Establish or Modify Child Support and Order (form FL -350) or Stipulation and Order (Governmental) (form FL -625). When a Child Support Order May Be Modified The court takes several things into account when ordering the payment of child support. First, the number of children is considered. Next, the net incomes of both parents are determined, along with the percentage of time each parent has physical custody of the children. The court considers both parties' tax filing status and may consider hardships, such as a child of another relationship. An existing order for child support may be modified when the net Income of one of the parents changes significantly, the parenting schedule changes significantly, or a new child is born. Examples • You have been ordered to pay $500 per month In child support. You lose your job. You will continue to owe $500 per month, plus 10 percent interest on any unpaid support, unless you file a motion to modify your child support to a lower amount and the court orders a reduction. • You are currently receiving $300 per month in child support from the other parent, whose net Income has just increased substantially. You will continue to receive $300 per month unless you file a motion to modify your child support to a higher amount and the court orders an increase. • You are paying child support based upon having physical custody of your children 30 percent of the time. After several months It turns out that you actually have physical custody of the children 50 percent of the time. You may file a motion to modify child support to a lower amount. FL -192 How to Change a Child Support Order To change a child support order, you must file papers with the court. Remember: You must follow the order you have now. What forms do I need? If you are asking to change a child support order open with the local child support agency, you must fill out one of these forms: • FL -680, Notice of Motion (Governmental) or FL -683 Order to Show Cause (Governmental) and • FL -684, Request for Order and Supporting Declaration (Governmental) If you are asking to change a child support order that is not open with the local child support agency, you must fill out one of these forms: • FL -300, Request for Order or • FL -390, Notice of Motion and Motion for Simplified Modification of Order for Child, Spousal, or Family Support You must also fill out one of these forms: • FL -150, Income and Expense Declaration or FL -155, Financial Statement (Simplified) What if I am not sure which forms to fill out? Talk to the family law facilitator at your court. After you fill out the forms, file them with the court clerk and ask for a hearing date. Write the hearing date on the form. The clerk will ask you to pay a filing fee. If you cannot afford the fee, fill out these forms, too: • Form FW-001, Request to Waive Court Fees • Form FW-003, Order on Court Fee Waiver (Superior Court) You must serve the other parent. If the local child support agency is involved, serve it too. This means someone 18 or over —not you —must serve the other parent copies of your filed court forms at least 16 court days before the hearing. Add 5 calendar days if you serve by mall within California (see Code of Civil Procedure section 1005 for other situations). Court days are weekdays when the court is open for business (Monday through Friday except court holidays). Calendar days Include all days of the month, including weekends and holidays. To find court holidays, go to www.courts.ca.gov/holidays,htm. The server must also serve blank copies of these forms: • FL -320, Responsive Declaration to Request for Order and FL -150, Income and Expense Declaration, or • FL -155, Financial Statement (Simplified) Then the server fills out and signs a Proof of Service (form FL -330 or FL -335). Take this form to the clerk and file it. Go to your hearing and ask the judge to change the support. Bring your tax returns from the last two years and your last two months' pay stubs. The judge will look at your information, listen to both parents, and make an order. After the hearing, fill out: • FL -340, Findings and Order After Hearing and • FL -342, Child Support Information and Order Attachment Need help? Contact the family law facilitator in your county or call your county's bar association and ask for an experienced family lawyer. FL -192 Bev. January 1, 2015] NOTICE OF RIGHTS AND RESPONSIBILITES Health -Care Costs and Reimbursement Procedures Page 2 of 2 YIN • 1^,1-- ' Sr 4 LIN • STATE: C-er - - TELEPHONE NO.: g < 1 5 I 8117 FAX NO.: E-MAIL ADDRESS: (-4„....„ a..„, 04.-0 C ATTORNEY FOR (namo): PARTY WITHOUT ATTORNEY OR ATTORNEY j z o t STATE BAR NUMBER: NAME: S o -n FIRM NAME: STREET ADDRESS: /C/(9 3 a CAA effa.,0 S ciTY:SkAr fr1/4,41 0 ( + . - KS ZIP CODE: C l / SUPERIOR COURT OF CALIFORNIA, COUNTY OF / . . . - . 0 5 A n - Q , I e . 3 STREET ADDRESS: MAILING ADDRESS: (.0 0 0 5 CITY AND ZIP CODE: L...., p c C P r 1 2 Q 0 (. 5 :‘ BRANCH NAME: ci ...eziro...1.--ciu \ , ,,,,,ri \ S + PETITIONER: N 41,3 ave.,1-tf-O-Q?... 1 RESPONDENT: < a,-2, 0,41 n tm.e,1-enue-z..„ OTHER PARENT/PARTY: Q • ,'"1 I t FL -320 FOR couRr USE ONLY F I L E D Superior Court of COD Pao County of Los 'Mete Viel 2. 2, 2,016 Sherri R, Carter, bucuttv ()Mod Cierit 41Xputy A -Au RESPONSIVE DECLARATION TO REQUEST FOR ORDER FIEARIN3iDrA6 Read Information Sheet: TIME: I t W I DEPARTMENT OR ROOM: F CASE NUMBER: D S 53 Responsive Declaration to Request for Order (form FL -320 -INFO) for more information about this form. 1. I I RESTRAINING ORDER INFORMATION a. I I No domestic violence restraining/protective orders are now in effect between the parties in this case. b. I I I agree that one or more domestic violence restraining/ protective orders are now in effect between the parties In this case. 2. I I CHILD CUSTODY VISITATION (PARENTING TIME) a. I consent to the order requested for child custody (legal and physical custody). b. _ _ _ _ _ _ I consent to the order requested for visitation (parenting time). c. I do not consent to