Free Child Support Forms - Illinois

ORDERINOTICE TO WITHHOLD INCOME FOR CHILD SUPPORT
State of Illinois Co.lCity/Dist. of Ogle. Oregon, Fifteenth Date of OrderDVotice Court/Case Number
) RE:

Original OrdedNotice Amended OrderMotice Terminate OrderMotice

EmployerMithholder's Federal EIN Number

EmployeeIObligor'sName (Last, First, MI)

1
EmployerMithholder's Name EmployerMithholder's Address
)

EmployeelObligor's Social Security Number

1

j
)

EmployeelObligor's* Case Identifier Custodial Parent's Narnc (Last, First, MI)

1
Child(ren)'s Names: DOB

1 1

If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the ernployeelobligor'semployment.

ORDER I N F O M T I O N : This is an OrderMotice to Withhold Income for Child Support based upon an Order for Support from Ogle County Circuit Court . You are required to deduct these amounts from the above-named employeelobligor's income until until further notice.
$ $ $ $ $

Per Per Per Per Per

for current support in past-due child support totaling $ Arrears 12 weeks or greater? yes in medical support in other (specify) in other (specify) to be forwarded to the payee below.

no

for a total of $

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 support payment cycle, use the following to determine how much to withhold:
$
$

xl

per weekly pay period per biweekly pay period (every two weeks)

$

x 2.165 x 4.33

per semimonthly pay period (twice a month) per monthly pay period

x2

$

REMITTANCE INFORMATION. Follow the laws and procedures of the employeelobligor's principal place of employment even if such laws and procedures are different from this paragraph:
You must begin withholding no later than the first pay period occurring 2working days after the date of this OrderINotice. Send payment w i t h i n 0 working days of the paydateldate of withholding. You are entitled to deduct a fee of your actual cost not to exceed $5 monthly to defray the cost of withholding. The total withheld amount, including % of the employee/obligor's aggregate disposable weekly earnings. For the purpose your fee, cannot exceed 50 of the limitation on withholding, the following INFORMATION is needed (see #9 on next page): When remitting payment provided the paydateldate of withholding and case identifier If remitting by EFTEDI, use this F P S Code: * ;bank routing code:* bank account number: Make it payable to: State Disbursement Unit (SDU) Send check to: P. 0. Box 8000, Wheaton, IL 60189-8000 Authorized by: Print Name: Attorney of Record:

ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
If checked, you are required to provide a copy of this form to your employee. If your employee works in a state that is different from the state that issued this order, a copy must be provided to your employee even if the box is not checked.

Priority: Withholding under this OrderNotice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this Order 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/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identi@ the portion of the single payment that is attributable to each employeelobligor. Reporting the Paydatemate of Withholding: You must report the paydateldate of withholding when sending the payment. The paydateldate of withholding is the date on which the 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 support payments. Employee/Obligor with Multiple Support Withholdings: If you receive more than one Order/Notice against this employee/obligorand you are unable to honor all support OrdedNotice due to Federal or State withholding limits, you must follow the law of the state of employee'slobligor's principal place of employment. You must honor all Orders/Noticesto the greatest extent possible. (See #9 below.) Termination Notification: You must promptly noti@the payee when the employeelobligor no longer works for you. Please provide the information requested and return a copy of this OrderMotice to the agency identified below: Employee/Obligor's Name: Employee's Case Identifier: Date of Separation: Last Known Home Address: New Employer's Address: 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. Liability: Ifyou fail to withhold income as the OrderINotice directs, you are liable for both the accumulated amount you should have withheld from the employee'slobligor's income and any other penalties set by State law. You may be found liable for the total amount which you fail to withhold or pay over and fines as provided by state law. Anti-discrimination: You are subject to a fine determined under the State law for discharging an employeelobligor from employment, refusing to employ, or taking disciplinary action against any employeelobligor because of child support withholding. Withholding Limits: You may not withhold more than the lesser oE I) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. $1673(b)); or 2) the amounts allowed by the State of the employeelobligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions, such as: State, Federal, local taxes; Social Security taxes, and Medicare taxes and statutory pension contnbutions. The Federal CCPA limit is 50% of the ADWE for child support and alimony, which is increased by 1) 10% if the employee does not support a second family; andlor 2) 5% if arrears are more than 12 weeks old. (See boxes on front). For the employee/obligor's rights, remedies and duties, see Illinois Statutes 305 ILCS 5110-16.2,750 ILCS 51706.1 and 750 ILCS 45/20. Requesting Agency:

If you or your employee/obligor have any questions, contact
--

by telephone at: by FAX at. or by Internet:

STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE FIFTEENTH JUDICIAL CIRCUIT OGLE COUNTY

In re the Marriage o f

Petitioner, and

> >
Respondent.

1
)

STATEMENT OF SERVICE METHOD FOR INCOME WITHHOLDING Copies of the attached OrderNotice to Withhold Income for Child Support hashave been delivered to:

by: Regular U.S. Mail Certified Mail, Return Receipt Requested Facsimile Transmission or Other Electronic Means Personal Delivery Other Method Provided by Law for Service of a Summons That service was made on

CERTIFICATION
Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned certifies that the statements set forth in this instrument are true and correct, except as to matters therein stated to be on information and belief, and as to such matters the undersigned certifies as aforesaid that helshe verily believes the same to be true.

IN THE CIRCUIT COURT OF THE FIFTEENTH JUDICIAL CIRCUIT
OGLE COUNTY, ILLINOIS ILLINOIS DEPARTMENT OF PUBLIC AID, ex. rel.
9

PLAINTIFF, vs.
3

1
)

)

CASENO.

1
DEFENDANT.

MITTIMUS ORDER FOR INDIRECT CIVIL CONTEMPT FOR FAILURE TO PAY CHILD SUPPORT
THIS CAUSE coming for hearing on the PETITION FOR ADJUDICATION OF CONTEMPT, the Defendant having failed to pay previously ordered child support, and the Court being fully advised in the premises, hereby orders as follows: A) The Defendant is found to be in indirect civil contempt for willful failure to pay child support as previously ordered and is sentenced upon said contempt to imprisonment in the Ogle County Jail, stayed until Defendant shall not receive day for day credit on this sentence. days

, 2 0 0 @ 6:00 p.m. The

B) The Defendant may purge said jail term by the payment of $

O prior to .O

,2004 @ 9:00 a.m., at which time this matter is set for compliance hearing.
C) Upon either purging or serving said term, the Defendant shall be released on a
$1 000.00 recognizance bond, returnable

,2004 at 9:00 a.m. for further

hearing on compliance and/or sanctions, at which time Defendant is ordered to appear.

Dated this

day of

,200-.

JUDGE

IN THE CIRCUIT COURT OF THE FIFTEENTH JUDICIAL CIRCUIT OGLE COUNTY, ILLINOIS ILLINOIS DEPARTMENT OF PUBLIC AID, ex. rel. 1
Y

PLAINTIFF,
VS.

1
)

CASENO.

1
,
DEFENDANT.

COMPLIANCE ORDER
THIS CAUSE coming for hearing on the (Plaintiff s1Defendant's) compliance with the previous order of this Court sentencing the (PlaintiffIDefendant) to a term of imprisonment upon the Court's finding of contempt, and upon the compliance of the (PlaintiffIDefendant) with the Court's order by the payment of the purge amount as previously set forth, it is hereby ordered as follows: The (Plaintiff/Defendant) has purged (himself/herself) of the jail sentence previously ordered herein, and the Mittimus stayed until
be vacated.

,200- @ 6:00 p.m. shall

The (PlaintifflDefendant) is ordered to appear on
further hearing on compliance and/or sanctions.

,2004 at 9:00 a.m. for

Dated this

day of

,200-.

JUDGE