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Itemize each expense, mark each bill or payment with an exhibit number, and group documents in chronological order for each month.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},241935,1789183392,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":126,"read_time":9},1374402739827,"https://ap-avatar.wpscdn.com/avatar/14000c97e7351f1a627?x-image-process=image/resize,m_fixed,w_180,h_180&k=1787885694763230660","|  |  | 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. |  | FL-421 |\n| --- | --- | --- | --- | --- |\n|  | PETITIONER/PLAINTIFF:\u003Cbr>RESPONDENT/DEFENDANT: |  | CASE NUMBER: |  |\n| OTHER PARENT: |  |  |  |  |\n\nPAYMENT HISTORY FOR (check one):  \n Child  Spousal  \nUnreimbursed medical  \n Family  Medical  \nOther (specify):  \nUnreimbursed child care  \nYear   Year   Year    \n\n|  | AMOUNT\u003Cbr>ORDERED | AMOUNT\u003Cbr>PAID | AMOUNT\u003Cbr>ORDERED | AMOUNT\u003Cbr>PAID | AMOUNT\u003Cbr>ORDERED | AMOUNT\u003Cbr>PAID |\n| --- | --- | --- | --- | --- | --- | --- |\n| January |  |  |  |  |  |  |\n| February |  |  |  |  |  |  |\n| March |  |  |  |  |  |  |\n| April |  |  |  |  |  |  |\n| May |  |  |  |  |  |  |\n| June |  |  |  |  |  |  |\n| July |  |  |  |  |  |  |\n| August |  |  |  |  |  |  |\n| September |  |  |  |  |  |  |\n| October |  |  |  |  |  |  |\n| November |  |  |  |  |  |  |\n| December |  |  |  |  |  |  |\n| TOTAL |  |  |  |  |  |  |\n\nYear   Year   Year    \n\n|  | AMOUNT\u003Cbr>ORDERED | AMOUNT\u003Cbr>PAID | AMOUNT\u003Cbr>ORDERED | AMOUNT\u003Cbr>PAID | AMOUNT\u003Cbr>ORDERED | AMOUNT\u003Cbr>PAID |\n| --- | --- | --- | --- | --- | --- | --- |\n| January |  |  |  |  |  |  |\n| February |  |  |  |  |  |  |\n| March |  |  |  |  |  |  |\n| April |  |  |  |  |  |  |\n| May |  |  |  |  |  |  |\n| June |  |  |  |  |  |  |\n| July |  |  |  |  |  |  |\n| August |  |  |  |  |  |  |\n| September |  |  |  |  |  |  |\n| October |  |  |  |  |  |  |\n| November |  |  |  |  |  |  |\n| December |  |  |  |  |  |  |\n| TOTAL |  |  |  |  |  |  |\n\nPage 1 of    \nForm Approved for Optional Use Judicial Council of California FL-421 [Rev. July 1, 2003]  \nPAYMENT HISTORY ATTACHMENT  \n(Family Law—Governmental—Uniform Parentage Act)  \nFamily Code, §§ 5230.5, 17524 (a), 17526(c)  \n[www.courtinfo.ca.gov](www.courtinfo.ca.gov)  \nINSTRUCTIONS FOR COMPLETING PAYMENT RECORD  \nYou must complete a separate Payment History Attachment form for each type of support paid. Enter the year, list the amount ordered, and the amount paid for each month during that year. If the amounts repeat in a column, you can use an arrow as shown in the example below. Add the amounts in each column to get the yearly totals. Enter the totals at the bottom.  \nAttach additional sheets and supporting documents (bills, receipts, and other proof of expense) as necessary.  \n|  | AMOUNT\u003Cbr>ORDERED |  | AMOUNT\u003Cbr>PAID |  | AMOUNT\u003Cbr>ORDERED |  | AMOUNT\u003Cbr>PAID |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| January | 100 |  | 0 |  | 100 |  | 100 |  |\n| February |  |  |  |  |  |  | 0 |  |\n| March |  |  |  |  |  |  | | |\n| April |  |  | 100 |  |  |  | 100 |  |\n| May |  |  | 100 |  |  |  | 0 |  |\n| June |  |  | 100 |  |  |  |  |  |\n| July |  |  | 0 |  |  |  |  |  |\n| August |  |  |  |  |  |  | 100 |  |\n| September |  |  |  |  |  |  | 100 |  |\n| October |  |  | 100 |  |  |  | 0 |  |\n| November |  |  |  |  |  |  |  |  |\n| December |  |  |  |  |  |  | | |\n| TOTAL | 1,200 |  | 600 |  | 1,200 |  | 400 |  |\n\nx  Spousal  \n\n|  | AMOUNT\u003Cbr>ORDERED |  | AMOUNT\u003Cbr>PAID |  |  |\n| --- | --- | --- | --- | --- | --- |\n| January | 100 |  | 0 |  |  |\n| February |  |  |  |  |  |\n| March |  |  | |  |  |\n| April |  |  | 100 |  |  |\n| May |  |  | 100 |  |  |\n| June |  |  | 100 |  |  |\n| July |  |  | 0 |  |  |\n| August |  |  |  |  |  |\n| September |  |  |  |  |  |\n| October |  |  | 100 |  |  |\n| November |  |  |  |  |  |\n| December |  |  |  |  |  |\n| TOTAL | 1,200 |  | 600 |  |  |\n\nUNREIMBURSED CHILD CARE, MEDICAL, OR OTHER EXPENSES:  \nYou must complete a separate Payment History Attachment form for each type of unreimbursed expense. If you have more than one bill, receipt, and other proof of expense per month use an additional declaration page (form MC-031) or separate page. 1.) Itemize each expense; 2.) attach proof of bill or payment; 3.) mark each bill or payment with an Exhibit \\#   ; 4.) group the bills, receipts, and other proof of expense in chronological order for each month; and","cbCaijuckIyv14KV","https://ap.wps.com/l/cbCaijuckIyv14KV","pdf",147368,"English","# Payment History for (check one)\n## Support types and monthly totals\n# Instructions for Completing Payment Record\n## Separate attachments and proof requirements\n# Unreimbursed child care, medical, or other expenses\n## Itemization and exhibits","[{\"question\":\"When should a separate Payment History Attachment be completed for FL-421?\",\"answer\":\"Complete a separate Payment History Attachment for each type of support paid and for each type of unreimbursed expense. Each attachment should include the applicable year and month-by-month amounts.\"},{\"question\":\"What information must be entered for each month on the payment record?\",\"answer\":\"Enter the year, list the amount ordered, and the amount paid for each month during that year. Add amounts in each column to calculate yearly totals and enter totals at the bottom.\"},{\"question\":\"What proof must be attached for unreimbursed expenses?\",\"answer\":\"Attach additional sheets and supporting documents such as bills, receipts, and other proof of expense as necessary. Itemize each expense, mark each bill or payment with an exhibit number, and group documents in chronological order for each month.\"}]","FL-421 - Payment History Attachment - Instructions for Completing Payment Record | PDF"]