Hawaii > Local County > 1st Circuit - Oahu > Family Court > Child Support
Order Notice To Withhold Income For Child Support - Hawaii
| Order Notice To Withhold Income For Child Support Form. This is a Hawaii form and can be used in Child Support Family Court 1st Circuit - Oahu Local County . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
NAME: _____________________________________ ADDRESS: _________________________________ ___________________________________________ ___________________________________________ TEL. No.:___________________________________ [ [ ] Plaintiff/Petitioner Pro Se ] Defendant/ Respondent Pro Se IN THE FAMILY COURT OF THE _______ CIRCUIT STATE OF HAWAI`I ) _______________________________, ) [ ] Plaintiff [ ] Petitioner ) ) ) vs. ) ) ) ________________________________, ) [ ] Defendant [ ] Respondent ) ______________________________________ ) FC-___ No. ___________________ [ ] ORIGINAL [ ] AMENDED [ ] TERMINATION ORDER/NOTICE TO WITHHOLD INCOME FOR CHILD SUPPORT [ ] ORIGINAL [ ] AMENDED [ ] TERMINATION ORDER/NOTICE TO WITHHOLD INCOME FOR CHILD SUPPORT IFC 12/05 OMB0970-0154 American LegalNet, Inc. www.FormsWorkflow.com [X]ORDER/NOTICE TO W ITHHOLD INCOME FOR CHILD SUPPORT [ ]NOTICE OF AN ORDER TO W ITHHOLD INCOME FOR CHILD SUPPORT [ ]Original [ ]Amended [ ]Termination Date: [X]State/Tribe/Territory HAWAI`I - FAMILY COURT OF THE ________ CIRCUIT City/Co./Dist./Reservation CITY AND COUNTY OF HONOLULU [ ]Non-governmental entity or Individual Case Num ber FCNo. RE: Em ployer's/W ithholder's Nam e Employee's/Obligor's Nam e (Last, First, MI) Em ployee's/Obligor's Social Security Num ber FCNo. Em ployee's/Obligor's Case Identifier Obligee's Nam e (Last, First, MI) Em ployer's/W ithholder's Address Em ployer's/W ithholder's Federal EIN Num ber (if known) ORDER INFORMATION: This docum ent is based on the support or withholding order from HAW AII. You are required by law to deduct these am ounts from the em ployee's/obligor's incom e until further notice. __________ __________ __________ __________ __________ __________ __________ Per Per Per Per Per Per Per month month month month month month month current child support past-due child support current cash medical support past-due cash medical support spousal support past-due spousal support other (specify) Arrears greater than 12 weeks? [ ] yes [ ] no ________________________________________ _______________ for a total of __________ per month to be forwarded to the payee below. You do not have to vary your pay cycle to be in com pliance with the support order. If your pay cycle does not m atch the ordered paym ent cycle, withhold one of the following am ounts: __________ per weekly pay period. ______ per biweekly pay period (every two weeks). __________ per semimonthly pay period (twice a month). ____________________________ per monthly pay period. REMITTANCE INFORMATION: W hen rem itting paym ent, provide the pay date/date of withholding and the case identifier. If the em ployee's/obligor's principal place of em ploym ent is HAW AII, begin withholding no later than the first pay period occurring 7 days after the date of receiving this notice/order. Send paym ent within 5 working days of the pay date/date of withholding. The total withheld am ount, including your fee, m ay not exceed __________% of the em ployee's/obligor's aggregate disposable weekly earnings. If the em ployee's/obligor's principal place of em ploym ent is not HAW AII for lim itations on withholding, applicable tim e requirem ents, and any allowable em ployer fees, follow the laws and procedures of the em ployee's/obligor's principal place of em ploym ent (see #3 and #9, ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER W ITHHOLDERS). Make check payable to: CHILD SUPPORT ENFORCEMENT AGENCY Case ________________ Send check to: CHILD SUPPORT ENFORCEMENT AGENCY STATE DISBURSEMENT UNIT P. O. BOX 1860 HONOLULU, HI 96805-1860 . If rem itting paym ent by EFT/EDI, call (808) 692-7013 before first subm ission. Use this FIPS code: Bank account num ber: Bank routing num ber: : . 1 F C 1 2 /0 5 OMB0970-154 American LegalNet, Inc. www.FormsWorkflow.com If this is an Order/Notice to W ithhold: Print Nam e Title of Issuing Official JUDGE, FAMILY COURT, ______ CIRCUIT Signature and Date [ ]IV-D Agency [X]Court [ ]Attorney with authority under state law to issue order/notice. NOTE: Non-IV-D Attorneys, individuals, and non-governm ental entities m ust subm it a N otice of an Order to W ithhold and include a copy of the incom e withholding order unless, under a state's law, an attorney in that state m ay issue an incom e withholding order. In that case, the attorney m ay subm it an Order/Notice to W ithhold and include a copy of the state law authorizing the attorney to issue an incom e withholding order/notice. IMPORTANT: The person completing this form is advised that the information on this form may be shared with the obligor. ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS [ ]If checked, you are required to provide a copy of this form to your employee/obligor. If your employee works in a state that is different from the state that issued this order, a copy must be provided to your employee/obligor even if the box is not checked. 1. Priority: Withholding under this Order or Notice has priority over any other legal process under state law (or tribal law, if applicable) against the same income. If there are federal tax levies in effect, please notify the contact person listed below. (See 10 below.) 2. Combining Payments: You may combine withheld amounts from more than one employee's/obligor's income in a single payment to each agency/party requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 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 amount was withheld from the employee's wages. You must comply with the law of the state of employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding and forward the support payments. 4. Employee/Obligor with Multiple Support Withholdings: If there is more than one Order or Notice against this employee/obligor and you are unable to honor all support Orders or Notices due to federal, state, or tribal withholding limits, you must follow the state or tribal law/procedure of the employee's/obligor's principal place of employment. You must honor all Orders or Notices to the greatest extent possible. (See 9 below.) 5. Termination Notification: You must promptly notify the Child Support Enforcement (IV-D) Agency and/or the contact person listed below when the employee/obligor
|
|||||||
