Income Withholding Order {FOC 5}

2nd copy - Plaintiff Original - Court 3rd copy - Defendant Approved, SCAO 1st copy - Friend of the Court Additional copies to all sources of income STATE OF MICHIGAN CASE NO. JUDICIAL CIRCUIT INCOME WITHHOLDING ORDER COUNTY Court ordered Consent Friend of the Court address Court telephone no. Plaintiffs name and address Regarding: Payer Social security number v Defendants name and address Date of order: Judge: 1. The court finds that the above payer owes current support, statutory fees, and/or arrearages in the above case, and notice has been given as required by law. 2. Income is defined as: commissions, earnings, salaries, wages, and other income due now or in the future from an employer and successor employers; any payment due now or in the future from a profit-sharing plan, pension plan, insurance contract, annuity, unemployment compensation, supplemental unemployment benefits, and workers compensation; any amount of money due the payer under a support order as a debt of any other individual, partnership, association, private or public corporation, the United States or any Federal agency, any state or political subdivision of any state, or any other legal entity indebted to the payer. IT IS ORDERED: 3. The source of income shall withhold payers income as specified in the attached notice of income withholding and in any subsequent notices. 4. The State Disbursement Unit shall receive and disburse these funds for the purpose of collecting support, statutory fees, and the payment of all arrearages. 5. Any income withheld under this order shall be paid to the State Disbursement Unit within 3 days after the date of withholding. 6. If the payers existing support order is modified by an order of the court, the office of the friend of the court shall send a notice of modification to the source of income by ordinary mail. The amount assigned or withheld shall be changed to conform with the court modification within 7 days after receipt of the notice of modification. Signature of preparer Judge Bar no. I consent to the terms of this order. Payers signature CERTIFICATE OF MAILING I certify that on this date I mailed a copy of this order to the parties and sources of income by ordinary mail addressed to their last known addresses. Date Signature FOC 5 (4/01) INCOME WITHHOLDING ORDER MCL 552.601 et seq.; MSA 25.164(1) et seq.