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FL-600PETITIONER/PLAINTIFF: COUNTY OF MADERA

RESPONDENT/DEFENDANT: JESUS RIVERAOTHER PARENT: ANGELA RIVERA

C AS E N U MBE R :

4. a. | X I Some or all of the children named in item 1 are receiving or have received public assistance from thefollowing counties (specify):MA D E R A

b. | X I Date public assistance first paid: 02/01/20095. Other (specify):THE LOCAL CHILD SUPPORT AGE NCY REQUESTS HAT:6. | | The court determine that the persons listed in item 2 are the parents of the children listed in item 1 for whom the "EstablishParentage" boxes have been checked.7. | X I Based on the California support guideline, the court order the obligor to pay:

a. I X I $536.00 current monthly child support based on the obligor's known income of: $ 2313.00per month, and, f applicable, the obligee's known income of: $ 1387.00 per month.

b. [ 1$ current monthly child support based on the obligor's presumed income, as provided by law.c. | | $ additional monthly child support for the following reasons (specify):

d. | X 1 The court issue appropriate orders for sharing the costs ofchild care and/or uninsured health care (specify):Ob ligor be required to pay fifty percent (50%) of the reasonable uninsured health care costs for the children asprovided by Family Code section 4062.

e. | ~] Other (specify):

8. |X I The court order the obligor to provide health insurance for each child named in item 1 if available at no or reasonable cost; to keepthe local child support agency informed of the availability of the coverage; to complete and return, within 20 days of the local childsupport agency's request, a health insurance form and that a National Medical Support Notice be issued. If health insurance is notavailable at no or reasonable cost, that the court orders obligor to provide coverage when it becomes available. NOTICE: Th eobligor's em ployer or other person providing health insurance will be ordered to enroll the children in an appropriate healthinsurance plan if the obligor is found to be the parent.

9. A wage and earnings assignment be issued.10. The court order the parents toadvise the local child support agency within 10 days inwritingof any change in residence or employment.11. Th e court order the obligor to make all payments to (specify): CALIFORNIA STATE DISBURSEMENT UNITPO BOX 989067WEST SACRAMENTO C A 95798-906712. [xI The other parent be added as a party to this case.13. Number of pages attached :

NOTICE Child support: The court will make orders for thesupport of the children upon request and submission of financial forms by herequesting party.f you want legal advice, contact a lawyer imm ediately.A Statement of Rights and Responsibilities is attached to this document. Please read itcarefully.

Date: 05/11/2009VICTORIA A. MILLER

(TYPE OR PRINT NA ME) (ATTORNEY FOR LOCAL CHILD SUPPO RT AGENCY)

FL-600 [Rov. January 1, 2007] SUMMONS AND COMPLAINT OR SUPPLEMENTALCOMPLAINT REGARDING PARENTA L OBLIGATIONS(Governmental)