Free STATE OF WYOMING - Wyoming

STATE OF WYOMING

) ) ss. COUNTY OF ____________ )

IN THE DISTRICT COURT _________________ JUDICIAL DISTRICT

________________________________ Petitioner, vs. _______________________________ Respondent.

) ) ) ) ) ) ) ) )

Civil Action No. ____________________

INCOME WITHHOLDING ORDER

THE COURT ORDERS any payor of the ___________________________________ (name of Obligor, person owing child support), to pay child support to _______________________ (name of Obligee, person owed child support) commencing on __________________(date). Payments are due on the __________ day of every _________________(specify time period, i.e. monthly). Total arrears (past due support) owed as of ________________(date) for child support is $_____________. The Court orders the immediate activation of an Income Withholding Order against the obligor, pursuant to Wyo. Stat. § 20-6-204. Income withheld must be paid through the Clerk of the District Court or the State Child Support Disbursement Unit at the following address for forwarding to the obligee: OR Pursuant to Wyo. Stat. § 20-6-204, this Income Withholding Order is not subject to immediate activation because either:

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Both parties have agreed in writing to an alternative arrangement. (When the parties agree to an alternative arrangement, the arrangement shall be in writing, signed by the parties and reviewed and entered in the record by the court.) OR The Court finds there is good cause not to require the immediate activation of an Income Withholding Order because: (The court shall include in the record its findings of good cause, including a statement explaining why implementation of immediate income withholding would not be in the best interests of the child and, in cases involving modification of child support, proof of timely payments.)

Any income withholding order not subject to immediate activation shall become effective upon the date the obligor requests withholding commence; or the date the obligor becomes delinquent in payment of an amount equal to one (1) month's support obligation under the support order as set forth in Wyo. Stat. § 20-6-205. IT IS FURTHER ORDERED that upon receipt of a Notice to Payor from the Clerk of District Court, every employer or other person now or in the future owing income to the obligor shall comply with all terms of the notice and shall withhold a portion of the obligor's income and remit it to the Clerk of District Court or as otherwise noted in accordance with the terms of the notice. For purposes of this order: "INCOME" means any form of periodic payment or return in money to an individual, regardless of source. Income includes, but is not limited to wages, earnings, salary, commission, compensation as an independent contractor, temporary total disability and permanent partial disability worker's compensation payments, unemployment compensation, disability, annuity and retirement benefits, and any other payment made by any payor. Furthermore, no employer may discharge, discipline, refuse employment to, or otherwise penalize an obligor because of this Income Withholding Order.

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IT IS FURTHER ORDERED that the payor comply with all the terms of the Notice to Payor and all subsequent notices from the Clerk served upon the payor; The last known addresses of the obligor and obligee are as follows * : Obligor (person owing child support): Address: __________________________ __________________________ __________________________ Obligee (person to receive child support): __________________________ Address: __________________________ __________________________ IT IS, FURTHER, ORDERED that each party shall notify the Clerk of District Court, in writing, on forms available from the Clerk, within fifteen (15) days of any changes in address or employment status. At the time an Income Withholding Order is entered, the Clerk shall mail a copy of the income withholding order and the support order to the last known address of the obligor and the obligee. DATED this ______ day of _______________________, 20______. BY THE COURT: ___________________________________ District Court Judge

Approved as to Form: ___________________________________ Petitioner's Attorney or Petitioner, if pro se ___________________________________ Respondent's Attorney or Respondent, if pro se

*

The parties' social security numbers are included in a separate Confidential Statement of the Parties. Include addressed and stamped envelopes for copies when filing Income Withholding Order with the clerk. CSMod 19 Income Withholding Order Revised July 2006 Page 3 of 3