Request For Hearing Regarding Earnings Assignment Page 2
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3FL-450
CASE NUMBER:
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT:
I request that the earnings assignment be modified because
3.
a.
the total amount of arrearages claimed as owing is incorrect. (Check one or more of the following reasons.)
(1)
I did not receive credit for all of the payments I have made. (Check (a), (b), or both.)
(a)
I have attached my statement of the payment history, which includes a monthly breakdown of
amounts ordered and amounts paid.
(b)
I made the following payments that were not credited (for each payment, specify the date, the
amount, and the name of the person or agency paid):
(2)
Child support was terminated (specify name of child, child’s date of birth, date of termination, and reason
support was terminated):
(3)
Other (specify):
b.
the monthly payment specified in the earnings assignment is more than half of my total net income each month from
all sources.
c.
the monthly arrearage payment stated in the earnings assignment creates an undue hardship because (describe the
hardship and state the amount you are able to pay on your arrearage):
(NOTE: If you want to change the amount of money being deducted for arrearage because it creates a
hardship, please attach a completed Financial Statement (Simplified) (form FL-155) or Income and Expense
Declaration (form FL-150).)
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 OF PERSON REQUESTING HEARING)
(SIGNATURE OF PERSON REQUESTING HEARING)
CLERK’S CERTIFICATE OF MAILING
I certify that I am not a party to this action and that a true copy of the Request for Hearing Regarding Earnings Assignment (form
FL-450) was mailed, with postage fully prepaid, in a sealed envelope addressed as shown below, and that the request was mailed
at (place):
on (date):
Date:
, Deputy
Clerk, by
Page 2 of 3
REQUEST FOR HEARING REGARDING EARNINGS ASSIGNMENT
FL-450 [Rev. July 1, 2008]
(Family Law—Governmental—UIFSA)
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