Form 33-23

NOTICE: THIS DOCUMENT
CONTAINS SENSITIVE DATA

[Caption. See § 3 of the Introduction in volume 1 of this manual.]

Order to Withhold Income for Costs and Fees

The Court ORDERS you, the employer of Obligor, to withhold income from Obligor’s disposable earnings from this employment as follows:

Obligor:

Name:

Address:

City, state, zip:

Social Security number:

Attorney for Obligee:

Name:

Address:

City, state, zip:

Social Security number:

Child[ren]:

Name:

Date of birth:

Social Security number:

Withholding from Earnings for Attorney’s Fees and Costs

The Court ORDERS that any employer of Obligor shall begin withholding from Obli­gor’s disposable earnings not later than the first pay period following the date this order is delivered to the employer.

IT IS ORDERED that the amount of earnings to be withheld by the employer is:

1.[number] dollars ($[amount]) if Obligor is paid monthly.

2.[number] dollars ($[amount]) if Obligor is paid twice monthly.

3.[number] dollars ($[amount]) if Obligor is paid every other week.

4.[number] dollars ($[amount]) if Obligor is paid every week.

The employer shall withhold earnings in the above amount for as long as Obligor is employed by the employer or until the full amount of [number] dollars ($[amount]) assessed as attorney’s fees and costs has been fully paid.

Maximum Amount Withheld

The maximum amount to be withheld shall not exceed 50 percent of Obligor’s dispos­able earnings.

Method of Payment

The Court ORDERS the employer to pay all amounts withheld on each regular pay day through Obligee’s attorney.

All payments shall be made payable to [name of obligee’s attorney].

All payments shall identify the names of Obligor and Obligee’s attorney and the cause number of this suit.

Calculating Disposable Earnings

The employer shall calculate Obligor’s disposable earnings, which are subject to with­holding for child support, as follows:

1.Determine the “earnings” of the Obligor, which means compensation paid or pay­able for personal services, whether denominated as wages, salary, compensation received as an independent contractor, overtime pay, severance pay, commission, bonus, or otherwise, including periodic payments pursuant to a pension, an annuity, workers’ compensation, and a disability or retirement program, and unemployment benefits.

2.Subtract the following sums to calculate Obligor’s “disposable earnings”:

a.any amounts required by law to be withheld (e.g., federal income tax and fed­eral FICA or OASI tax (Social Security), Railroad Retirement Act contribu­tions);

b.union dues;

c.nondiscretionary retirement contributions by Obligor; and

d.medical, hospitalization, and disability insurance coverage for Obligor and Obligor’s child[ren].

More Than One Order Withholding

An employer receiving two or more orders or writs for Obligor shall comply with each order or writ to the extent possible.

If the total amount due under the orders or writs exceeds the maximum amount allowed to be withheld, the employer shall pay, until that maximum is reached, in the following order of priority:

1.an equal amount toward the current support in each order or writ until the employer has complied fully with each current support obligation;

2.an equal amount toward current spousal maintenance in each order or writ until the employer has complied fully with each current spousal maintenance obligation;

3.an equal amount toward the child support arrearages in each order or writ until the employer has complied fully with each order or writ for child support arrearages;

4.an equal amount toward the maintenance arrearages in each order or writ until the employer has complied fully with each order or writ for spousal maintenance arrearages; and

5.an amount toward the attorney’s fees and costs.

Notice of Change of Employment

The Court ORDERS an employer to notify this Court and Obligee’s attorney within seven days of the date Obligor terminates employment. The employer is ORDERED to pro­vide Obligor’s last known address and the name and address of Obligor’s new employer, if known.

SIGNED on ________________________________.

   
JUDGE PRESIDING