NOTICE: THIS DOCUMENT
CONTAINS SENSITIVE DATA
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See § 6 of the Introduction in volume 1 of this manual concerning protection of sensitive data in filed documents. |
[Caption. See § 3 of the Introduction in volume 1 of this manual.]
Notice of Application for Income Withholding for Support (Judicial Writ of Withholding)
You, the obligor named below, are given notice in accordance with subchapter D, chapter 158, of the Texas Family Code that your employer will be required to withhold the amounts specified below for payment of both your current support obligation for the child[ren] named below and for any overdue support (arrearage) as follows:
Obligor
Name:
Social Security number:
Obligee
Name:
Social Security number:
Child[ren]
Name:
Sex:
Birth date:
Social Security number:
Date child will become eighteen:
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Repeat above information for each additional child. |
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Monthly child support due: |
$[amount] |
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Monthly medical support due: |
$[amount] |
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Total arrearage, including accrued interest: |
$[amount] |
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As of: [date of this order] |
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Monthly amounts to be withheld from your wages on service of the withholding: |
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On current child support: |
$[amount] |
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On current medical support: |
$[amount] |
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On child support arrearage owed: |
$[amount] |
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On medical support arrearage owed: |
$[amount] |
Monthly amounts to be withheld from your wages after [date]:
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On current child support: |
$[amount] |
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On current medical support: |
$[amount] |
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On child support arrearage owed: |
$[amount] |
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On medical support arrearage owed: |
$[amount] |
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Continue as required for further reductions. |
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Include the following if applicable. |
You have repeatedly failed to pay support in accordance with your order of support. The Income Withholding for Support may include arrearages that accrue between the filing of this notice and the issuance of the Income Withholding for Support.
The order to withhold from your wages applies to each current or subsequent employer and period of employment.
If you do not contest this withholding within ten days after the receipt of this Notice of Withholding, your employer will be notified to begin deducting from your pay the amounts specified above.
Your sole ground for successfully contesting the issuance of an Income Withholding for Support is a mistake of fact. If you claim that you are not the person who owes the child support, or that you are not in arrears, or that the arrearage listed on the notice is incorrect, you can request a hearing by completing a Motion to Stay Issuance and Delivery of Income Withholding for Support (Judicial Writ of Withholding) and filing the motion within ten days of receipt of this notice with the clerk of the Court listed on the top of this notice.
Filing the attached motion will stay issuance and delivery of the Income Withholding for Support to your employer until a hearing is held.
If you contest this withholding, you will be afforded an opportunity to present your case to the court within thirty days of receipt of your notice of contest. The hearing will be limited to the disputed issues as stated on the Motion to Stay Issuance and Delivery of Income Withholding for Support (Judicial Writ of Withholding).
At the hearing the court will decide the contested delinquency and will either enter an order for income withholding or decide that an order for income withholding should not be entered. It is anticipated that additional arrearages will accrue, and on hearing the court will be requested to confirm all amounts then due.
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An unsworn declaration may be used in place of a verification. See form 8-27. |
Verification
I, [name of affiant], swear under oath that the above Notice of Application for Income Withholding for Support (Judicial Writ of Withholding) is true and correct.
Affiant
SIGNED under oath before me on ______________________________.
Notary Public, State of Texas