FL-360
PETITIONER/PLAINTIFF:
CASE NUMBER:
RESPONDENT/DEFENDANT:
OTHER PARENT:
5.
FACTS IN SUPPORT of relief requested are (specify):
Contained in the attached declaration.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME)
(SIGNATURE OF DECLARANT)
NOTICE FOR CASES INVOLVING A LOCAL CHILD SUPPORT AGENCY
This case may be referred to a court commissioner for hearing. By law, court commissioners do not have the authority to issue final
orders and judgments in contested cases unless they are acting as temporary judges. The court commissioner in your case will act
as a temporary judge unless, before the hearing, you or any other party objects to the commissioner acting as a temporary judge.
The court commissioner may still hear your case to make findings and a recommended order. If you do not like the recommended
order, you must object to it within 10 court days; otherwise, the recommended order will become a final order of the court. If you
object to the recommended order, a judge will make a temporary order and set a new hearing.
Request for Accommodations
Assistive listening systems, computer-assisted real-time captioning, or sign language interpreter services are available if
you ask at least five days before the proceeding. Contact the clerk's office or go to for
Request for Accommodations by Persons With Disabilities and Response (form MC-410). (Civil Code, § 54.8)
REQUEST FOR HEARING AND APPLICATION
Page 2 of 2
FL-360 [Rev. January 1, 2007]
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