Income Withholding For Support {CS-ORD1}

IN THE CIRCUIT COURT OF THE 22ND JUDICIAL CIRCUIT McHENRY COUNTY, ILLINOIS ________________________________ Plaintiff vs. ______________________________________ Defendant CASE NO: _____________________________________ INCOME WITHHOLDING FOR SUPPORT ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) AMENDED IWO ONE-TIME ORDER/NOTICE FOR LUMP SUM PAYMENT TERMINATION OF IWO DATE: _________________ Child Support Enforcement (CSE) Agency NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions www.acf.hhs.gov/programs/cse/forms/OMB-0970-0154/instructions.pdf). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. State/Tribe/Territory: Illinois ____________ Remittance Identifier (include w/payment) __________________ City/County/Dist./Tribe _________________ Order Identifier _______________________________________ Private Individual/Entity ________________ CSE Agency Case Identifier _____________________________ Date of Entry of the Order on which this IWO is based _____________________________________________ _________________________________________ RE: __________________________________________ Employer/Income Withholder's Name Employee/Obligor's Name (Last,First,Middle) ________________________________________ Employer/Income Withholder's Address ________________________________________ ________________________________________ Employer/Income Withholder's FEIN ______________________ Child(ren)'s Name(s) (Last, First, Middle) ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ Child(ren)'s Birth Date(s) ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ___________________________________________ Employee/Obligor's Social Security Number ___________________________________________ Custodial Party/Obligee Name (Last, First Middle) OMB 0970-0154. OMB Expiration Date ­ 5/31/2014. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version of the form currently in use. CS-ORD1: Revised 12/13/13 Page 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com ORDER INFORMATION: This document is based on the support or withholding order from Illinois. You are required by law to deduct these amounts from the employee/obligor's income until further notice. (*See Additional Information, below.) $_________________ Per ______________ current child support $_________________ Per ______________ current cash medical support $_________________ Per ______________ past-due cash medical support $_________________ Per ______________ current spousal support $_________________ Per ______________ past-due spousal support $_________________ Per ______________ for child support delinquency of $___________ as of ________________ per 750 ILCS 28/20(a)(2) $_________________ Per ______________ for post-majority enforcement of $________________ per 750 ILCS 28/32 $_________________ Per ______________ other (must specify) ___________________________________________. For a Total Amount to Withhold of $_____________ per ______________. AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information. If your pay cycle does not match the order payment cycle, withhold one of the following amounts: $ _______________ per weekly pay period $ ___________ per semimonthly pay period (twice a month) $ _______________ per biweekly pay period (every two weeks) $ ___________ per monthly pay period $ ______________ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. WEEKLY/MONTHS: To convert weekly to months, multiply the weekly amount by 4.33. To convert months to weeks, divide the monthly amount by 4.33. Weekly/Semi-monthly: To convert weekly to a semi-monthly pay period, multiply the weekly amount by 2.17. To convert a semi-monthly pay period to weeks, divide the semi-monthly amount by 2.17. Biweekly/Semi-Monthly: To convert a bi-weekly pay period to a semi-monthly pay period, multiply the bi-weekly amount by 1.08. To convert a semi-monthly pay period to a bi-weekly pay period divide the semi-monthly pay period by 1.08. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within Illinois, you must begin withholding no later than the first pay period that occurs 14 days after the date this document is received. Send payment within 7 working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 65% of disposable income for all others. (See WITHHOLDING LIMITS). If the employee/obligor's principal place of employment is not Illinois, obtain withholding limitations, time requirements, and any allowable employer fees at www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contact.map.htm for the employee/obligor's principal place of employment. For electronic payment requirements and centralized payment collection and disbursement facility information (State Disbursement Unit [SDU], see www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contact map.htm. Include the Remittance Identifier with the payment and this FIPS code: ___________________________________. [The remittance identifier for the Illinois State Disbursement Unit is the FIPS code followed by the county case number.] Remit payment to Illinois State Disbursement Unit (SDU), at P. O. Box 5400 Carol Stream, IL 60197-5400 or to: _________________________________________________________________________ (SDU/Tribal Payee Address) Return to Sender [Completed by Employer/Income Withholder]. Payment must be directed to an SDU in accordance with 42 USC §666(b)(6) or Tribal Payee (see Payments to SDU below). If payment is not directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender. Signature of Judge/Issuing Official (if required by State or Tribal Law) ­ Note: *Not required by Illinois law if Child Support Order is attached: _______________________________________ Print Name of Judge/Issuing Official: ______________________________________________ Title of Ju