Kansas > Local District Court > 7th Judicial District (Douglas County) > Trustee - Pro-Se
Voluntary Application For Income Withholding Order - Kansas
| Voluntary Application For Income Withholding Order Form. This is a Kansas form and can be used in Trustee - Pro-Se 7th Judicial District (Douglas County) Local District Court . |
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DISTRICT COURT TRUSTEE SEVENTH JUDICIAL DISTRICT JUDICIAL CENTER, 111 E. 11TH LAWRENCE, KANSAS 66044-2966 785-832-5315 Fax: 785-838-2408 Pro Se Voluntary Application for Income Withholding Order 1. Fill out completely using typewriter or printed in black ink: a) Voluntary application b) Income withholding order c) Request for service 2. File the original and 5 copies of the above documents with the Clerk of the District Courts Office. Write District Judge Pro Tem across the top of one copy of the voluntary application document. 3. The Clerk of the District Court will file stamp all copies and give you back the additional copies. You must send by first class mail a file-stamped copy of the Voluntary Application to the Petitioner/Respondent and his/her attorney of record. You must then complete the certificate of mailing section on the original voluntary application form. 4. IT IS UP TO YOU to get the correct papers filed in order for your income withholding order to be served and put into effect. <<<<<<<<<********>>>>>>>>>>>>> 2IN THE DISTRICT COURT OF DOUGLAS COUNTY, KANSAS In the Matter of ) ) ,) Petitioner, ) Case No. DG vs. ) Division 3 ) ,) Respondent. ) VOLUNTARY APPLICATION FOR INCOME WITHHOLDING ORDER I, , the judgment debtor in the above-named case, request that an income withholding order be issued to the following (check one): Employer Payor (other than employer)Name of Employer/Payor: Address: Income is to be withheld as follows: $ per month, to be applied: $ per month for current support $ per month for past due support (Your signature) ACKNOWLEDGMENT State of Kansas ) ) ss. County of ) T his instrument was acknowledged to before me on , 20 . Notary PublicMy term expires: CERTIFICATE OF MAILING I hereby certify that on the day of , 20 , I m ailed a copyof this application by first-class mail, postage prepaid, addressed to all interested parties asfollows: (Your signature)
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