Illinois > Local County > 2nd Judicial Circuit
Order Notice To Withhold Income For Child Support - Illinois
| Order Notice To Withhold Income For Child Support Form. This is a Illinois form and can be used in 2nd Judicial Circuit Local County . |
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State of ILLINOIS County of _________________, City of _________________ Court/Case Number__________________________________ _____________________________________ Employer's/Withholder's Name ORDER/NOTICE TO WITHHOLD INCOME FOR CHILD SUPPORT 9 Original 9 Amended 9 Termination _____________________________________ Employer's/Withholder's Address _____________________________________ _____________________________________ _____________________________________ ____________________________________________ Child(ren)'s Name(s): DOB Employer's/Withholder's Federal EIN Number (if known) RE:_________________________________________ Employee's/Obligor's Name (Last, First, MI) ____________________________________________ Employee's/Obligor's Social Security Number ____________________________________________ Employee's/Obligor's Case Identifier ____________________________________________ Obligee's Name (Last, First, MI) 9 If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available to the employee's/ obligor's through his/her employment. ORDER INFORMATION: This Order/Notice is based on the support order from _______________________________________. You are required by law to deduct these amounts from the employee's/obligor's income until further notice. $____________________ per ____________________ current child support 9 Yes 9 No $____________________ per ____________________ past-due child support -- Arrears 12 weeks or greater? $____________________ per ____________________ current medical support $____________________ per ____________________ past-due medical support $____________________ per ____________________ spousal support $____________________ per _____________________other (specify) _____________________________________________________ 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 support order. If your pay cycle does not match the ordered payment cycle, withhold one of the following amounts: $_______________ per weekly pay period. $_______________ per biweekly pay period (every 2 weeks). $_______________ per semimonthly pay period (twice a month) $_______________ per monthly pay period REMITTANCE INFORMATION: When remitting payment, provide the pay date/date of withholding and the case identifier. If the employee's/obligor's principal place of employment is _________________________________, begin withholding no later than the first pay period occurring ________ days after the date of ________________. Send payment within _________ working days of the pay date/date of withholding. The total withheld amount, including your fee, cannot exceed __________% of the employee's/obligor's aggregate disposable weekly earnings. If the employee's/obligor's principal place of employment is not __________________, for limitation on withholding, applicable time requirements, and any allowable employer fees, follow the laws and procedures of the employee's/obligor's principal place of employment (see #4 and #10, ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS). If remitting payment by EFT/EDI, call _____________________________ before first submission. Use this FIPS code:________________: Bank routing code: __________________ Bank account number: ________________________________________________________. Make check payable to:__________________________________________________________________________________________ (Payee and Case identifier) Send check to: ______________________________________________________________________________________________ Authorized by____________________________________________________________________ Date:_________________________ _____________________________________________________________________ Date:_________________________ Print name and Title_____________________________________________________________________________________________ of Authorized Official(s)__________________________________________________________________________________________ IMPORTANT: The person completing this form is advised that the information on this form may be shared with the obligor. Rev. 5/15/01 Page 1 of 2 2002 © American LegalNet, Inc. ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS If checked, you are required to provide a copy of this form to your employee. 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 even if the box is not checked. 1. 2. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. Priority: Withholding under this Order/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 State Child Support Enforcement Agency or party listed in number 12 below. Combining Payments: You can combine withheld amounts from more than one employe'se/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. 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 order and forward the support payments. Employee/Obligor with Multiple Support Withholdings: If there is more than one Order/Notice to Withhold Income for Child Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Order/Notices to the greatest extent possible. (See #10 below) Termination Notification: You must promptly notify the Child Support Enforcement Agency or payee when the employee/obligor no longer works for you. Please provide the information request
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