Arizona > Local County > Maricopa > Superior Court > Family Law
Employer Information Packet 412 - Arizona
| Employer Information Packet Form. This is a Arizona form and can be used in Family Law Superior Court Maricopa Local County . |
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NOTICE AND ACKNOWLEDGEMENT OF RECEIPT PLEASE FILL OUT APPROPRIATE INFORMATION AND RETURN THIS FORM I acknowledge receipt of the Order of Assignment from the Clerk of Superior Court in Maricopa County for: (Obligors Name/Case Number) According to A.R.S. 25-504 an employer or payor of funds who fails without good cause to comply with the terms of anorder of assignment is liable for amounts not paid pursuant to the order of assignment and reasonable attorney fees, costand other expenses incurred in procuring compliance and may be subject to contempt. This form must be filled out with information known to the party acknowledging receipt and returned to the Clerk ofSuperior Court immediately. I understand that if I do not return this form immediately, I may be ordered to pay the costs ofpersonal service, unless I can show good cause as to why it was not returned. EMPLOYER/PAYOR OF FUNDS: PLEASE CHECK THE APPROPRIATE BOX AND COMPLETE INFORMATION REQUIRED. This company employs/pays the employee/obligor. This company no longer employs the employee/obligor. Termination Date: SSN #: Last known address: Name and address of New Employer: There is no record of this obligor ever being employed with this company. Additional Comments: Company Name Email Address Signature (Company Representative) Date CERTIFIED MAILING (If this box is checked, this is a certified mailing.) A. If the obligor referenced above is employed with your company or you are obligated to pay this person, please complete the correct statement in the middle of the page and return this entire form. B. If the obligor referenced above is not employed with your company or you are not obligated to pay this person, please complete the correct statement in the middle of the page and return this entire form. SUBSEQUENT EMPLOYER/PAYOR OF FUNDS OF AN EX PARTE ORDER OF ASSIGNMENT (If this box is checked this is a subsequent order. Please read the following paragraph for the appropriate instruction.) This is a subsequent Ex Parte Order of Assignment. You must begin withholding payments no later than 14 days after receipt. If payment to the obligor is due sooner than the 14 days you may implement the withholding for that date. Subsequent employers do not receive an additional copy to serve on the employee.RETURN THIS ENTIRE ACKNOWLEDGMENT TO THE CLERK OF THE SUPERIOR COURT BY FAX (602) 506-1937 ORYOU MAY USE THE ENVELOPE PROVIDED. DO NOT RETURN THE ATTACHED PACKET. RETAIN A COPY OF THISNOTICE AND ACKNOWLEDGMENT OF RECEIPT FOR FUTURE REFERENCE. Page 1 of 1 Form #412 LRD 2/23/01 ALL RIGHTS RESERVED Clerk of Superior Court of Arizona in Maricopa County<<<<<<<<<********>>>>>>>>>>>>> 2 EMPLOYER/PAYOR OF FUNDS INFORMATION SHEET A.R.S. 25-504 1. An Order of Assignment and an Order Terminating the Order of Assignment shall be served on any employer or payor of funds by first class mail, electronic transmission, personal delivery or pursuant to the Arizona Rules of Civil Procedure. 2. Copies of Orders of Assignment and Orders Terminating Orders of Assignment do not need to be certified to be effective. 3. For the cost of compliance, you may also withhold and retain an additional $1 per payment sent, not to exceed $4 per month for each obligor. 4. Any employer or other payor who has received any order of assignment shall withhold the amount specified in the order of assignment, together with the handling fee as provided in section 25-510, from the income of the person obligated to pay support or spousal maintenance. Income means any form of payment owed to an individual, regardless of the source, including wages, salaries, commissions, bonuses, workers compensation, disability payments, payments pursuant to a retirement program and interest.5. The monthly fee of $2.25, to cover the cost of handling support and maintenance payments (A.R.S. 25-510), shall also be deducted from the obligors income and transmitted. This handling fee is in addition to the monthly support obligation. 6. If the obligor is ordered to pay child support for more than one family and the amount available for withholding is not sufficient to meet the total combined current child support obligations the employer or payor of funds shall allocate any monies withheld from the obligors income to each family. Attached is a Child Support Allocation Worksheet for your use in allocating the payments. (Note: disposable income is the amount paid by the employer/payor of funds after deducting from such income those amounts required by law to be withheld)7. An employer or payor of funds may combine payments withheld for more than one obligor in a single payment. When combining payments in one check be sure to include a transmittal that provides each of the payors names, Social Security Numbers, ATLAS numbers, amounts withheld for each payor, dates the funds were withheld, the date transmitted, and any handling fees withheld. Attached is a Transmittal of Payment Form for your use. Failure to provide the information on the Transmittal of Payment Form will result in a delay in processing the payment. For all Arizona withholdings refer to the address for the Support Payment Clearinghouse. For other states refer to the court order for the appropriate address to remit payments. 8. Statute requires monies withheld be transmitted within 2 business days after obligor is paid or after the payment to the obligor is due. 9. When the obligor is no longer employed or the right to receive income or other monies is terminated, within 10 days you must notify the Clerk or Support Payment Clearinghouse in writing of: the obligors Social Security Number, last known address, and the name and address of the obligors new employer, if known. You may use the attached Notice of change of obligors employment or right to receive entitlements for this purpose. Page 2 of 2 Form #412 LRD 2/23/01 ALL RIGHTS RESERVED Clerk of Superior Court of Arizona in Maricopa County<<<<<<<<<********>>>>>>>>>>>>> 3 10. If the employee terminates but is reinstated within 90 days of the last payment the employer is again obligated to withhold monies pursuant to the Order of Assignment. (This is applicable to payor of funds cases as well). 11. The first employer or payor of funds served with an Ex Parte Order of Assignment shall not withhold or deduct amounts specified in the Ex Parte Order of Assignment for 14 days. (You are the first employer if you receive two copies of an Ex Parte Order of Assignment, one copy for you and one copy f
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