Proof Of Service Notice Withhold Income For Support {171-51}

IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS ) ) _______________________________________ ) Petitioner, ) vs. ) ) ) _______________________________________ ) Respondent. ) Gen No. Proof of Service of Notice To Withhold Income Service on Employer/Payor: On Support dated Name of employee/payor: Address: By: Ordinary mail ­ first class Certified mail Personal Delivery (insert name to whom delivery was made) Facsimile Transmission (Attach proof of transmission) Other Electronic Means (describe) (date of service), a copy of the attached Notice to Withhold Income for (date of notice) was served by ordinary mail on: (date of service), a copy of the attached Notice to Withhold Income for (date of notice) was served on: Service on Obligor: On Support dated Name of Obligor: Address: VERIFICATION BY CERTIFICATION Under penalties provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned certifies that the statements set forth in this instrument are true and correct. Served this day of , 20 By: Signature Prepared by: Attorney's Name: _ Address: City: Phone: Fax: ARDC: State: Zip Code: · The Notice to Withhold Income may be served on the employer/payor or on its superintendent, manager or other agent. · At the same time that a Notice to Withhold Income is served on a employer/payor, it must be served on the obligor by ordinary mail addressed to his/her last known address. A copy of the Notice to Withhold should also be sent to the obligor's attorney of record, if any. · Proof of Service of a Notice to Withhold Income on the employer/payor and on the obligor must be filed with the Clerk of the Circuit Court, at 18 N County Street, Waukegan, Illinois. 171-51 (Rev. 09-04) American LegalNet, Inc. www.FormsWorkflow.com