Free Income Withholding Request for Notice to Employer1.PDF - Texas


File Size: 55.3 kB
Pages: 2
Date: November 13, 2008
File Format: PDF
State: Texas
Category: Court Forms - Local
Author: HERRINT
Word Count: 184 Words, 2,206 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.hcdistrictclerk.com/common/FORMS/pdf/Request_for_Notice_to_Employer.pdf

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REQUEST FOR NOTICE TO EMPLOYER OF INCOME WITHHOLDING

PAYMENT OF $15.00 MUST BE SUBMITTED WITH THIS FORM AS FEE FOR THE FOREGOING REQUEST. WE ACCEPT PAYMENT BY CASHIER CHECKS, MONEY ORDERS OR CREDIT CARDS. IF PAYING BY CREDIT CARD, INCLUDE THE TYPE OF CREDIT CARD, CREDIT CARD NUMBER, AND EXPIRATION DATE WITH YOUR REQUEST. ***We do not accept company checks or personal checks***
TO: LOREN JACKSON, DISTRICT CLERK POST OFFICE BOX 4651 HOUSTON, TEXAS 77210 ATTENTION: FAMILY INTAKE DEPARTMENT I REQUEST THAT A NOTICE OF ASSIGNMENT OF INCOME BE ISSUED FOR: CAUSE NUMBER: ___________________________ IN THE __________ DISTRICT COURT

STYLE: _________________________________ vs. _____________________________________ NAME OF EMPLOYER WHICH ASSIGNMENT IS TO BE ISSUED TO: ____________________ ___________________________________________________________________________________ ___________________________________________________________________________________ MAILING ADDRESS FOR EMPLOYER'S PAYROLL OR HUMAN RESOURCE DEPARTMENT:
_______________________________________________________________________________________________ _______________________________________________________________________________________________

The employer of: ____________________________________________________________________
(PAYOR)

Assignment of Wage Order was signed on _______________________________________________
(DATE)

Assignment of Wage Order NOT signed; submitted to Court on ______________________________
(DATE)

************************************************************************************* Applicant's Name: ___________________________________________________________________ Telephone Number: __________________________________________________________________ Address:____________________________________________________________________________
S:\FormsLib\Civil Bureau\Civ Fam Intake & Customer Svc\Famintake\ Income Withholding, Request for Notice to Employer Revised 10/15/98

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S:\FormsLib\Civil Bureau\Civ Fam Intake & Customer Svc\Famintake\ Income Withholding, Request for Notice to Employer

Revised 10/15/98