FL-632
GOVERNMENTAL AGENCY (under Family Code, §§ 17400, 17406): RECORDING REQUESTED BY AND WHEN RECORDED MAIL TO:
FOR RECORDER'S USE ONLY TELEPHONE NO.: FAX NO.: FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:
PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT:
NOTICE REGARDING PAYMENT OF SUPPORT
NOTICE OF ASSIGNED SUPPORT SUBSTITUTION OF PAYEE
CASE NUMBER:
1. The obligor (the person paying support) in this proceeding is (name and last known address):
2. a.
The local child support agency is providing the following services (check all that apply): Current support (1) Support arrears (2) Medical support (3) The local child support agency is no longer providing the services under title IV-D of the Social Security Act. The substituted payee is: The local child support agency (specify): a. Other (specify): b. An abstract or notice of support judgment or support judgment was recorded as follows: Date of recording County Book number Instrument number
b. 3.
4.
Page 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): b. c. d. All current support payments other than income withholding payments must be sent to (specify): All arrears payments other than income withholding payments must be sent to (specify): Other (specify):
THE SUBSTITUTED PAYEE MUST BE CONTACTED WHEN NOTICE TO A LIENHOLDER MAY OR MUST BE GIVEN.
Page 1 of 2 Family Code, §§ 4200, 4201, 4204, 4350, 4351, 4506.3, 17400 www.courtinfo.ca.gov
Form Adopted for Mandatory Use Judicial Council of California FL-632 [Rev. July 1, 2008]
NOTICE REGARDING PAYMENT OF SUPPORT
(Governmental)
FL-632
PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT:
CASE NUMBER:
6.
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): Each parent must notify the local child support agency in writing within 10 days of any change in residence or employment. 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.
7. a. b.
Date:
(TYPE OR PRINT NAME)
(SIGNATURE)
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 ) )
, before me, (here insert name and title of the officer) On 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, 2008]
NOTICE REGARDING PAYMENT OF SUPPORT
(Governmental)
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