Fill and Sign the Appendix 251 Court Specific Rules Concerning Income Form

____________ : ____ JUDICIAL DISTRICT COURT VS : PARISH OF _______, LOUISIANA ____________ : DOCKET NO. ____ _________________________________________________________________ INCOME ASSIGNMENT ORDER (IMMEDIATE) Pursuant to R.S. 46:236.3, A and B, on motion of the Plaintiff, through her undersigned attorney, to order an immediate income assignment if there is not a written agreement between the parties for an alternate arrangement, or if the Court does not find good cause to issue an immediate income assignment order: IT IS ORDERED that there be an immediate income assignment under the provisions of R.S. 46:236.3, A and B, since there is no written agreement between the parties for an alternate arrangement and the court does not find good cause not to issue the order requiring the defendant's present and/or future payers of any income, including but not limited to, wages, salary, commission, compensa tion as an independent contractor, withholding from the income of ____________ , Social Security No. ____-____ -____, the OBLIGOR herein, a sum certain per week to be calculated by the payer of income, to pay the amount of ____________ AND ____/100 ($_______) DOLLARS per month. IT IS FURTHER ORDERED that this ORDER be effectuated immediately an d served upon the Payer of any income. IT IS FURTHER ORDERED that the Defendant is to notify the Court as to any change in circumstance, including change of residence or place of employment. THUS DONE AND SIGNED this ______ day of ___________ _______, 20____, at _______________, Louisiana. ____________________________ DISTRICT JUDGE