Texas > Local County > Harris
Request For Notice To Employer Of Income Withholding - Texas
| Request For Notice To Employer Of Income Withholding Form. This is a Texas form and can be used in Harris Local County . |
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REQUEST FOR NOTICE TO EMPLOYER OF INCOME WITHHOLDING MAIL TO: CHRIS DANIEL, DISTRICT CLERK POST OFFICE BOX 4651 HOUSTON, TEXAS 77210 ATTENTION: WAGE ASSIGNMENT DEPARTMENT 713-755-4359 OR FAX TO: SUBMIT $15 PER REQUEST (IF MULTIPLE ORDERS ARE INDICATED, A $15 FEE WILL APPLY PER ORDER) WE ACCEPT PAYMENT BY CASHIER'S CHECK, MONEY ORDER, OR CREDIT CARD WE DO NOT ACCEPT COMPANY CHECKS OR PERSONAL CHECKS HARRIS COUNTY CAUSE NUMBER: _____________________________ IN THE ________ DISTRICT COURT STYLE: ________________________________________ VS. ____________________________________________ DATE WAGE WITHHOLDING ORDER SUBMITTED TO COURT OR SIGNED BY JUDGE: _______________ NOTICE: IF ORDER IS NOT SIGNED WITHIN 10 BUSINESS DAYS FROM THE DATE THIS REQUEST WAS PROCESSED, NOTICE WILL BE CANCELLED AND FUNDS REFUNDED TO THE APPLICANT OR NAME ON CREDIT CARD IF DIFFERENT. SPECIFY ORDER TYPE ___ CHILD SUPPORT ___ SPOUSAL SUPPORT ___ MEDICAL SUPPORT ___ ATTORNEY FEES NOTICE OF ASSIGNMENT INFORMATION ___ TERMINATION OF GARNISHMENT EMPLOYEE NAME: ____________________________________________________________________________ (OBLIGOR'S NAME) COMPANY'S NAME: ___________________________________________________________________________________ COMPANY PAYROLL OR HUMAN RESOURCE DEPARTMENT MAILING ADDRESS: ATTN: _______________________________________________ PHONE # _________________________________ ADDRESS: _____________________________________________________________________________________ CITY: _______________________________ STATE: ___________________ ZIP: ___________________ APPLICANT'S NAME: ________________________________________ SBN/LFI# __________________________ TELEPHONE NUMBER (S): _______________________________________________________________________ ADDRESS: _____________________________________________________________________________________ CITY: _________________________________ STATE: _____________________ ZIP: ___________________ ***** EFILING Users: DO NOT include credit card information on this form. ***** ***** Payment will be processed via online provider. ***** ALL OTHERS PLEASE COMPLETE THE FOLLOWING IF PAYING BY CREDIT CARD*: NAME PRINTED ON CARD: ________________________________ CARD TYPE: Visa /MasterCard /AMEX /Discover (Circle One) CREDIT CARD # ________________________________________ EXPIRATION DATE: _____________________ BILLING ADRESS (If different from Applicant's)_______________________________________________________ BILLING PHONE (If different from Applicant's)________________________________________________________ CARDHOLDER SIGNATURE: _____________________________________________________________________ * 4% Convenience fee of total cost will be applied if received by mail or fax. American LegalNet, Inc. www.FormsWorkFlow.com
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