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FL-421Optional

Payment History Attachment (Governmental—Uniform Parentage Act)

California · Judicial Council of California · Effective July 1, 2003

This form is used to give a detailed monthly breakdown of how much support has been paid for different types of support. It requires filling out separate forms for each type of support paid.

The court describes it as: Gives a monthly breakdown about how much support has been paid and attach to Declaration of Payment History (form FL-420).

Open the official PDFfrom Judicial Council of California

Where this fits in a case

General & info

Information / general use — not tied to one step of a case

This form is used when someone needs to show the court a record of payments made for support, such as spousal support or child support. It must be attached to a Declaration of Payment History (form FL-420).

Either party may file.

Common questions

What does this form track payments for?
It tracks payments for spousal support, child support, and unreimbursed expenses like child care or medical costs.
Do I need to fill out this form for every type of support?
The instructions state that you must complete a separate Payment History Attachment form for each type of support paid.

Revision history

No changes recorded since we started tracking this form on October 9, 2026. The current version took effect July 1, 2003.

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