FL 670 NOTICE OF MOTION FOR JUDICIAL REVIEW LICENSE DENIAL (Governmental) Fl670

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FL-670
ATTORNEY OR PARTY WITHOUT ATTORNEY OR GOVERNMENTAL AGENCY (under Family Code §§ 17400, 17406)
(Name and Address):

TELEPHONE NO.:

FOR COURT USE ONLY

To keep other people from
seeing what you entered on
your form, please press the
Clear This Form button at the
end of the form when finished.

FAX NO.:

ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:

PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT:
CASE NUMBER:

NOTICE OF MOTION FOR JUDICIAL REVIEW OF LICENSE DENIAL
See reverse for instructions.
the local child support agency of (specify county):
1. On (date):
denied a release form that would enable me to obtain the following license (specify):
Name and address of licensing agency:
2. I seek a judicial review of the local child support agency's denial on the following grounds (check all that apply):
There is no order for me to pay child support in this action.
a.

b.

I am not the person ordered to pay child support in this action.

c.

I am in compliance with the order to pay child support in this action.

d.

I am in compliance with payments on the schedule for payment of arrearages or reimbursement.

e.

Other (specify):

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)

3. A hearing on this motion will be held as follows:
Date:
Address:

Time:

Room:

Page 1 of 2
Form Adopted for Mandatory Use
Judicial Council of California
FL-670 [Rev. January 1, 2003]

NOTICE OF MOTION FOR
JUDICIAL REVIEW OF LICENSE DENIAL
(Governmental)

Family Code, § 17520
www.courtinfo.ca.gov

CASE NUMBER:

PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT:

This motion should be filed with a hearing scheduled as soon as possible after your local child support agency review.
INSTRUCTIONS
1. Complete the application on the reverse. Contact the clerk of the court for a hearing date, time, and place. Insert the information in
box 3 on the reverse.
2. File the original Notice of Motion for Judicial Review of License Denial (form FL-670) with the court and keep two copies, because
you will need them later.
3. Serve a copy of this form on the local child support agency which has certified your name for nonpayment of child support not later
than seven days after the filing in court. Service of the papers may be made by (a) personal delivery OR (b) mailing the papers
by first-class mail, postage prepaid, to the last known address of the other party. Anyone at least 18 years of age EXCEPT A PARTY
may personally serve or mail the papers. Be sure whoever serves the papers fills out and signs the proof of service below.

PROOF OF SERVICE
4. At the time of service I was at least 18 years of age and not a party to this legal proceeding.
5. I served a copy of the Notice of Motion for Judicial Review of License Denial (form FL-670) in the manner shown below.
6. Manner of service on LOCAL CHILD SUPPORT AGENCY
a.
Personal service. I personally delivered these papers to the local child support agency as follows:
(1) Local child support agency (name):
(2) Address where served:
(4) Time delivered:

(3) Date delivered:
b.

First-class mail. I deposited these papers with the United States Postal Service, in a sealed envelope with postage fully
prepaid. I am a resident of or employed in the county where the notice was mailed. The envelope was addressed and
mailed as follows:
(1) Local child support agency (name):
(2) Address on envelope:
(4) Place of mailing (city, state):

(3) Date mailed:

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date:

(SIGNATURE OF PERSON WHO SERVED THE NOTICE)

(TYPE OR PRINT NAME)

Page 2 of 2
FL-670 [Rev. January 1, 2003]

NOTICE OF MOTION FOR
JUDICIAL REVIEW OF LICENSE DENIAL

For your protection and privacy, please press the Clear This Form
button after you have printed the form.

(Governmental)

Save This Form

Print This Form

Clear This Form



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