Illinois > Local County > Lake > Family Law
Notice To Withhold Income For Support 171-60a - Illinois
| Notice To Withhold Income For Support Form. This is a Illinois form and can be used in Family Law Lake Local County . |
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IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS Petitioner, Respondent. ) ) ) ) ) Original Notice Amended Notice Termination Notice Gen. No. NOTICE TO WITHHOLD INCOME FOR SUPPORT TO: Employer/Withholder's Name Employer/Withholder's FEIN Employer/Withholder's Address RE: Employee/Obligor's Name (Last, First, MI) Employee/Obligor's Social Security Number* Custodial Parent/Obligee's Name (Last, First, MI) Custodial Parent/Obligee's Social Security Number* Child(ren)'s Name(s) Birth date Social Security Number* ORDER INFORMATION: This is a Notice to Withhold Income for Support based upon an Order for Support from the Circuit Court of Lake County, Illinois dated . By law, you are required to deduct these amounts from the above-named employee/obligor's income until even if the Notice is not Arrears 12 weeks or more? issued by your state. yes no $ per per per per per per in current support $ $ $ $ $ for a total of $ in past due support in the amount of $ in medical support in delinquent child support payments in other (specify) in other (specify) per The employee/obligor is supporting other dependents? yes no to be forwarded to the State Disbursement Unit. If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee/obligor's employment, trade or labor union. See ¶ 10 on page 3 for further instructions on your obligation to deduct for health insurance. 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 Page 1 of 4 171-60a 9/04 American LegalNet, Inc. www.USCourtForms.com support payment cycle, use the following to determine how much to withhold: $ per weekly pay period. $ per semimonthly pay period (twice a month). $ per biweekly pay period. $ per monthly pay period. * Note: Weeks/Months: To convert weeks to months, multiply the weekly amount by 4.33. To convert months to weeks, divide the monthly amount by 4.33. Weeks/Semi-monthly: To convert weeks to a semi-monthly pay period, multiply the weekly amount by 2.17. To convert a semi-monthly pay period to weeks, divide the semi-monthly amount by 2.17. Biweekly/Semi-monthly: To convert a biweekly pay period to a semi-monthly pay period multiply the biweekly amount by 1.08. To convert a semi-monthly pay period to a biweekly pay period divide the semi-monthly pay period by 1.08. REMITTANCE INFORMATION: Under Illinois law, you must begin withholding no later than the next payment of income to the employee/obligor that occurs 14 business days after the date of this Notice. You must send the amount withheld to the payee within 7 business days of the pay date. You are entitled to deduct a fee for your actual cost not to exceed $5.00 monthly to defray the cost of withholding. The total withheld amount, including your fee, cannot exceed the amount permitted under the Federal Consumer Credit Act. See ¶ 9 on page 3 for limitations on the total amount that can be withheld. When remitting payments provide: (1) the pay date/date of withholding and (2) the general number: Make check payable to: State Disbursement Unit Send check to: State Disbursement Unit, Post Office Box 5400, Carol Stream, Illinois 60197 Authorized by: Print Name: ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS: If checked you are required to provide a copy of this form to your employee. 1. Priority: Withholding under this Notice has priority over any other legal process under state law against the same income. Federal tax levies in effect before receipt of this Notice have priority. If there are federal tax levies in effect please contact the requesting agency listed below. Combining Payments: You can combine withheld amounts from more than one employee's/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. Reporting the Pay Date/Date of Withholding: You must report the pay date/date of withholding when sending the payment. The pay date/date of withholding is the date on which 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 child support payments. Employee/Obligor with Multiple Support Withholdings: If there is more than one Notice to Withhold Income for Child Support against this employee/obligor and you are unable to honor all support 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 Notices to the greatest extent possible (see ¶ 9 below). Termination Notification: You must promptly notify the State Disbursement Unit when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Notice to the agency identified below. EMPLOYEE/OBLIGOR'S NAME: CASE GENERAL NUMBER: NEW EMPLOYER'S ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions or severance pay. If you have any questions about lump sum payments, contact the person or authority below. DATE OF SEPARATION: EMPLOYEE/OBLIGOR'S LAST KNOWN HOME ADDRESS: 2. 3.** 4.** 5. Page 2 of 4 171-60a 9/04 American LegalNet, Inc. www.USCourtForms.com 7. Liability: If you fail to withhold income as this Notice directs, you are liable for both the accumulated amount you should have withheld from the employee's/obligor's income and any other penalties by state law. Under Illinois law, you may be found liable for the total amount that you fail to withhold and pay over and fines of $100 per day for each day after the 7 day grace period. (See Illinois Statutes 305 ILCS 5/10-16.2(G), 750 ILCS 15/4.1 and 750 ILCS 45/20.) Anti-discrimination: You are subject to a fine determined under state law for discharging an employee/obligor from employment, refusing to employ or taking disciplinary action against any employee/obligor because of a child support withholding. Withholding Limits: No employer/payor shall withhold income in excess of the lesser of the following amounts: (1) the maximum amount permitted by Section 303(b) of the Federal Consumer Credit Protection Act [15 USC 1673(b)]: 50% of t
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