Notice To Withhold Income For Child Support

NOTICE TO WITHHOLD INCOME FOR CHILD SUPPORT State of Illinois County of :____________________ ( ) Original Notice Case Number:_________________ ( ) Amended Notice Date: ________________________ ( ) Terminate Notice ______________________________ ____________________________ Employer/Withholders Fed. EIN No. Employee/Obligors (Last, First, MI) ______________________________ ____________________________ Employer/Withholders Name Employee/Obligors Soc. Sec. No. ______________________________ ____________________________ Employer/Withholders Address Court Case Number ______________________________ ____________________________ AND ANY SUBSEQUENT EMPLOYER Custodial Parents (Last, First, MI) Child(ren)s name (s): date of birth: Child(ren)s name(s) date of birth: ___________________ ___________ ________________ __________ ___________________ ___________ ________________ __________ ___________________ ___________ ________________ __________ ORDER INFORMATION: This is a Notice to Withhold Income for Child Support based upon an order for support entered by the Honorable _____________________ ______, Circuit Court of _________________ County, IL on _____________________, 20 ___. By law, you are required to deduct these amounts from the above -named e mployee or obligors income until ________ , 20___ even if the Notice is not iss ued by your State. American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2(___) If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employees/obligators employme nt. $______ per _____ in current support $______ per _____ in past due support totaling $______ Arrears 12 weeks or greater? (__)yes (__) no $______ per _____ in medical support $______ per _____ in ______ for a total of $______ per ______ to be forwarded to the payee below. You do not have to vary your pay cycle to be in compliance with the supp ort order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $_____ per weekly pay period. $______ per semimonthly pay period (twice a month). $_____ per monthly pay period. $______ per biweekly pay period (every two weeks). REMITTANCE INFORMATION: Follow the laws and procedures of the employees/obligators principal place of employment even if such laws a nd procedures are different from this paragraph: You must begin withholding no later than the first pay period occurring 14 working days after the date of this Notice. Send payment within 7 working days of the paydate/date of withholding. You are entitled to deduct a fee of your actual cost not to exceed $5 monthly to defray the cost of withholding. The total withheld amount, including your fee, cannot exceed FCCPA % of the employee/obligators aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (see #9 below): When remitting payment, provide the paydate that you withheld support an d the case number: ________________. Make it payable to :____________________________________________________ __ Send check to :_________________________________________________________  American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 3ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS (____) If checked, you are required to provide a copy of this form to your employee. 1. Priority: Withholding under this Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect, please contact the requesting person/agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligators income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligator. 3.  Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which the employee is paid and controls the income, i.e., the date the income chec k or cash is given to the employee, or the date on which the income is deposited directly in his/her account. 4.  Employee/Obligor with Multiple Support Withholdings: If you receive more than one Notice against this employee/obligor and you are unable to honor them all in full because together they exceed th e withholding limit of the State of the employees principal place of employment (see #9 below), you must allocate the withholding based on the law of the State of the employees principal place of employment. If you are unsure of that States allocation law, you must honor all Notice s current support withholdings before you withhold for any arrearages, to the greatest extent possible under the withholding limit. You should immediately contact the last agency that sent you a notice to find the allocation law of the state of the employees principal place of employment. 5. Termination Notification: You must promptly notify the payee when the employee/obligor is no longer working for you. Please provide the information requested on the following page and return a copy of this order/notice to the person/agency. American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 4Information Requested: EMPLOYEES/OBLIGORS NAME:________________________________________ DATE OF SEPARATION/TERMINATION OF EMPLOYMENT:___________________ LAST KNOWN HOME ADDRESS:_________________________________________ _____________________________________________________________________ _____________________________________________________________________ NEW EMPLOYERS NAME AND ADDRESS:_________________________________ _____________________________________________________________________ Return Copy to: _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ 6. Lump Sum Payments: You may required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Notice directs, yo