Form FL-170, Declaration for Default or Uncontested Dissolution or Legal Separation Instructions

Enter the name of the person or party the attorney represents.

Enter the primary email address for contacting the attorney or party.

Enter a fax number for the attorney or party, including area code, if available.

Enter a daytime telephone number where the attorney or party can be reached, including area code and extension if any.

Enter the postal or ZIP code for the mailing or business address.

Enter the state for the mailing or business address.

Enter the city for the mailing or business address.

Enter the street address for the attorney or party, including apartment or suite number if applicable.

Enter the name of the law firm or organization the attorney is associated with, if applicable.

Enter the full name of the attorney or the party representing themselves.

Enter the attorney's state bar registration number (leave blank if the party has no attorney).

Enter the full legal name of the respondent (the person responding to the petition).

Enter the full legal name of the petitioner (the person who started the case).

Enter the court-assigned case number exactly as it appears on court documents.

Check this box if the information in the Declaration Under UCCJEA (form FL-105) has changed since it was last filed with the court (attach an updated form).

Check this box if the information in the Declaration Under UCCJEA (form FL-105) has not changed since it was last filed with the court.

Check this box to indicate you are completing subsection 6a about the Declaration Under the Uniform Child Custody Jurisdiction and Enforcement Act (FL-105) regarding whether the information has changed since it was last filed.

Enter the name of the county where the existing court order for custody/parenting time was issued. Fill only if '6b. There is an existing court order for custody/parenting time in another case (county and case number)' is 'Yes'.

Enter the docket or case number of the existing court order for custody/parenting time from the other case. Fill only if '6b. There is an existing court order for custody/parenting time in another case (county and case number)' is 'Yes'.

Check this box if there is already a court order in a different case that addresses custody or parenting time, and provide the county and that case number where requested.

Check this box when you are indicating the current custody and visitation (parenting time) that was previously ordered in this case or when you will specify the current schedule directly on this form.

Check this box when the current custody and visitation (parenting time) schedule is provided on Attachment 6c rather than being written directly on this form.

Enter the current custody and parenting-time schedule previously ordered or the current schedule for this case, including detailed days/times for regular parenting time, weekend and weekday arrangements, holiday and vacation allocations, and any pick-up/drop-off instructions or special conditions. Fill only if '6c. The current custody and visitation (parenting time) previously ordered in this case, or the current schedule is (specify)' is 'Yes'.

Check this box when you are stating the facts that support the requested custody judgment directly on this form (or will state your reasons below in a default case).

Write the facts that support your requested child custody/visitation judgment for item 6d, including specific events, dates, locations, involved persons, and reasons you want the court to grant the requested orders; attach or note any additional pages or exhibits if more space is needed. Fill only if '6d - The facts that support the requested judgment are' is 'Yes'.

Check this box when the facts that support the requested custody judgment are provided on a separate Attachment 6d rather than written on this form.

Check this box when you want the court to order child custody and visitation (parenting time) as set forth in the proposed Judgment (form FL-180).

Check this box if child support should be ordered as set forth in the proposed Judgment (form FL-180).

Check this box if child support for the minor children is currently being enforced in another case and you will provide the county and that case number.

Enter the name of the county where child support is being enforced in the other case. Fill only if '7a(1) Child support is being enforced in another case (county)' is 'Yes'.

Enter the case number of the other case in which child support is being enforced. Fill only if '7a(1) Child support is being enforced in another case (county)' is 'Yes'.

Check this box if the child support calculation attached to the proposed judgment is accurate and correct based on your personal knowledge.

Check this box if you are asking the court to base the child support order on an estimate of earning ability.

Check this box if the order should be based on the Petitioner's estimated earning ability.

Check this box if the order should be based on the Respondent's estimated earning ability.

Enter the detailed facts and explanation that support your estimate of the petitioner’s or respondent’s earning ability (specify which party), including relevant work history, education, current and potential earnings, and any attachments referenced. Fill only if '7a(3) Petitioner's', '7a(3) Respondent's' is 'Yes' (any).

Check this box if the facts supporting your estimate of earning ability are provided on Attachment 7a(3).

Check this box if you are currently receiving public assistance for the child or children listed in the proposed order.

Check this box if you are not currently receiving public assistance for the child or children listed in the proposed order.

Check this box if you are not currently receiving public assistance but intend to apply for public assistance for the child or children listed in the proposed order.

Check this box if, to the best of your knowledge, the other party is currently receiving public assistance.

Check this box if, to the best of your knowledge, the other party is not receiving public assistance.

Check this box if the Petitioner is currently receiving public assistance and you request that all support be made payable to the local child support agency.

Check this box if the Respondent is currently receiving public assistance and you request that all support be made payable to the local child support agency.

Check this box if the case is uncontested and service of the final Declaration of Disclosure (FL-140) is mutually waived by both parties or a waiver is contained in a stipulation/settlement (for example, on FL-144 or in the judgment/proposed judgment).

Check this box when both parties have filed (or are filing concurrently) a Declaration Regarding Service of Declaration of Disclosure and an Income and Expense Declaration.

Check this box when the case is proceeding by default, you are the petitioner, and service of the summons on the respondent was done by publication or posting so service of the preliminary Declaration of Disclosure is not required.

Check this box when the case is proceeding by default and you (the petitioner) have filed proof of service of the preliminary Declaration of Disclosure with the court and received the respondent’s final Declaration of Disclosure.

Check this box if this declaration is being filed in a legal separation proceeding.

Check this box if this declaration is being filed in a dissolution (marriage divorce) proceeding.

Enter the court-assigned case number for this dissolution or legal separation proceeding.

Check this box when you are declaring that the Petition (original filing) is true and correct.

Check this box when you are declaring that the Response is true and correct.

Check this box when the information on this form has been amended and you are indicating the statement is true and correct as amended.

Enter the full name of the petitioner (person or entity filing the case) exactly as it should appear on court records.

Enter the full legal name of the respondent (person or entity) in this case.

Check this box if you are knowingly and voluntarily giving up forever any right to receive spousal or partner support.

Check this box when you are asking the court to reserve jurisdiction to award spousal or partner support at some future time.

Check this box when you want the court's reserved jurisdiction to be able to award spousal or partner support to the Petitioner in the future. Fill only if '8b - Request to reserve jurisdiction to award spousal or partner support' is 'Yes'.

Check this box when you want the court's reserved jurisdiction to be able to award spousal or partner support to the Respondent in the future. Fill only if '8b - Request to reserve jurisdiction to award spousal or partner support' is 'Yes'.

Check this box when you are asking the court to permanently terminate spousal or partner support; then also check which party (Petitioner or Respondent) the request applies to.

Check this box when the request to terminate spousal or partner support applies to the Petitioner. Fill only if '8c. I ask the court to terminate forever spousal or partner support' is 'Yes'.

Check this box when the request to terminate spousal or partner support applies to the Respondent. Fill only if '8c. I ask the court to terminate forever spousal or partner support' is 'Yes'.

Check this box when you are requesting that spousal or domestic partner support be ordered in the proposed Judgment (form FL-180).

Check this box when you have completed and attached form FL-157 (Spousal or Partner Support Declaration) to support the request for spousal/partner support.

Check this box when you have attached a separate declaration (Attachment 8d) describing the factors that support ordering spousal or partner support.

Check this box when the request for spousal/partner support is based on a written agreement between the parties and you are relying on that agreement.

Check this box when you are requesting or indicating a spousal/partner support option that is not listed in items 8a–8e and you will specify the alternative arrangement in the space provided or on an attached sheet.

Enter a brief description of the other spousal/partner or family support you are requesting or specifying for item 8f. Fill only if '8f. Other (specify)' is 'Yes'.

Enter the name of the county where the Superior Court is located (for example, "Los Angeles").

Enter the name or designation of the specific court branch or division (for example, "Central Branch" or "Family Law Division").

Enter the city and full ZIP code for the court's location (for example, "San Francisco, CA 94102").

Enter the street address of the Superior Court, including building number and street name.

Enter the court's mailing address or P.O. Box if different from the street address.

Check this box when you are selecting the 'Default with agreement' type of case because no responsive pleading was filed and the parties have agreed the matter may proceed as a default and have a written agreement about property, support, or other rights.

Check this box when no response has been filed, there is no written agreement or stipulated judgment between the parties, the default of the respondent has been entered or is being requested, and you are not seeking any relief not requested in the petition.

Check this box when there are no community, quasi‑community, or separate assets or debts that need to be divided or otherwise disposed of by the court. Fill only if 'a. Default without agreement' is 'Yes'.

Check this box when the community and quasi‑community assets and debts are listed on a completed Property Declaration (form FL‑160) and the proposed division in the judgment (form FL‑180) fairly and equally assigns property and debts (or assigns debts if there is negative estate). Fill only if 'a. Default without agreement' is 'Yes'.