FL-400 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and address): TELEPHONE NO.: FOR COURT USE ONLY ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: CASE NUMBER: ORDER FOR CHILD SUPPORT SECURITY DEPOSIT AND EVIDENCE OF DEPOSIT ORDER FOR CHILD SUPPORT SECURITY DEPOSIT is ordered to deposit the sum 1. Obligor (name): of (specify): $ as security for the payment of child support. The money must be deposited in an interest-bearing account with a state or federally chartered commercial bank, a trust company authorized to transact trust business in California, or a savings and loan association, or in shares of a federally insured credit union doing business in California and having a trust department. The money may be withdrawn only upon order of this court. 2. Evidence of the deposit must be filed with this court by the obligor and served upon the person to whom support is to be paid not later than (date): Date: JUDICIAL OFFICER OF THE SUPERIOR COURT EVIDENCE OF DEPOSIT 3. The child support obligor has deposited (specify): $ of child support on (date): in an interest-bearing account as security for payment The deposit account is blocked so the sums may be withdrawn only upon presentation of a certified copy of a court order specifying the amount to be withdrawn and the person to whom the money should be paid. 4. The child support obligor has replenished the child support security deposit by depositing (specify): $ on (date): 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) Title: Name of financial institution: Address: Telephone No.: Account No.: The original signed Evidence of Deposit should be filed with the court and a copy mailed to the person entitled to receive payment. Page 1 of 1 Form Adopted for Mandatory Use Judicial Council of California FL-400 [Rev. January 1, 2003] ORDER FOR CHILD SUPPORT SECURITY DEPOSIT AND EVIDENCE OF DEPOSIT Family Code, §§ 4560-4562 www.courtinfo.ca.gov 2002 © American LegalNet, Inc.