Free ADVISEMENT OF RIGHTS - Connecticut

ADVISEMENT OF RIGHTS Re: Income Withholding I. You have the right to present any evidence to the court as to why an order for withholding effective immediately should not be ordered. II. EXEMPTIONS: If your income is subject to a withholding order, a portion of your income will not be withheld. Only disposable income is subject to a withholding order. Disposable income means that part of the income of an individual remaining after deduction from that income of amounts required to be withheld for the payment of federal, state and local income taxes, employment taxes, normal retirement contributions, union dues and initiation fees and group life and health insurance premiums. The amount withheld may not exceed the maximum amount permitted under section 1673 of title 15 of the United States Code: If you are supporting a spouse or dependent child other than the spouse or child with respect to whose support the order is issued, the maximum amount of your disposable income that may be withheld is 50% of such income, unless you are twelve weeks or more in arrears in which case the maximum is 55% of such income. If you are not supporting a spouse or dependent child other than the spouse or child with respect to whose support the order is issued, the maximum amount of your disposable income that may be withheld is 60% of such income unless you are twelve weeks or more in arrears in which case the maximum is 65%. In no event, however, under state law may you be left with less than 85% of the first $145 of disposable income per week. III. You have the right to claim the exemptions listed above or any other applicable state or federal exemptions with respect to income withholding orders. IV. The computation of the amount withheld will be done by the payer of the income based on information supplied by the court. If you believe that an incorrect amount of your income is being withheld due to incorrect information being supplied to the payer of the income and you would like the amount withheld modified, you must request a court hearing. V. You have a right to seek a modification of, or raise a defense to, the support order by filing a proper motion with the court. This is to certify that this document was read to me or read by me in a language that I understand. A copy of this statement has been given to me.

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This is to attest that the above document was signed in my presence.

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Check the box below if the parties have completed the "Waiver" on the back/page 2 of this form. "Waiver of Right to Immediate Income Withholding Order" completed on back/page 2.
JD-FM-71 Rev. 6-03 C.G.S. § 52-362

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WAIVER OF RIGHT TO IMMEDIATE INCOME WITHHOLDING ORDER
NAME OF CASE DOCKET NO.

The undersigned parties agree that a contingent and not an immediate income withholding order shall issue in this case.
OBLIGOR DATE SIGNED OBLIGEE DATE SIGNED

OTHER

DATE SIGNED

OTHER

DATE SIGNED

WITNESS

DATE SIGNED

WITNESS

DATE SIGNED

JD-FM-71 (back/page 2) Rev. 6-03

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