Fill and Sign the Earnings Child Support Form

NO. ______________________ IN THE MATTER OF § IN THE DISTRICT COURT THE MARRIAGE OF § § ______________________________ § AND § __________ JUDICIAL DISTRICT ______________________________ § § AND IN THE INTEREST OF § ______________________________ , § _______________ COUNTY, TEXAS CHILDREN § EMPLOYER'S ORDER TO WITHHOLD FROM EARNINGS FOR CHILD SUPPORT The Court ORDERS you, the employer of ____________________ , Obligor, to withhold income from his disposable earnings from this employment as follows: Obligor Name: ______________________________ Address: ________________________________________ Social Security number: ____________________ Obligee Name: ______________________________ Address: ________________________________________ Social Security number: ____________________ Children Name: ______________________________ Sex: ________________________________________ Birth date _______________ Social Security number: ____________________ Date child will become eighteen: _______________ Birthplace: _______________ Reference to the Income Withholding Law Attached to this order is a copy of subchapter C, chapter 158, of the Texas Family Code, which sets forth rights, duties, and potential liabilities of employers in addition to the provisions of this order. EMPLOYER’S ORDER TO WITHHOLD FROM EARNINGS FOR CHILD SUPPORT – PAGE 1 Withholding Earnings for Child Support The Court ORDERS that any employer of ____________________ shall begin withholding from his disposable earnings no later than the first pay period following the date this order is served on that employer. Method of Payment The Court ORDERS the employer to pay all amounts withheld on each payday through Guardian Ad Litem or his duly qualified successor at ______________________________ , _______________ , Texas _____ for distribution according to law. All payments shall identify the obligor, the obligee, the date of withholding, and the cause number, which is __________ . Maximum Amount Withheld The maximum amount to be withheld shall not exceed 50 percent of ____________________ disposable earnings. "Arrearage" Defined As used in this order, the term "arrearage" means the sum of: 1. all past-due child-support payments; and 2. all unpaid interest accrued on child-support obligations; and 3. all unpaid child-support judgment amounts. Order to Withhold The Court ORDERS the employer to withhold the following amounts from the earnings of ____________________ : $ __________ if Obligor is PAID TWICE MONTHLY: $ __________ on current support and $ __________ on the arrearage owed. EMPLOYER’S ORDER TO WITHHOLD FROM EARNINGS FOR CHILD SUPPORT – PAGE 2 $ __________ if Obligor is PAID TWICE MONTHLY: $ __________ on current support and $ __________ on the arrearage owed. $ __________ if Obligor is PAID EVERY OTHER WEEK: $ __________ on current support and $ __________ on the arrearage owed. $ __________ if Obligor is PAID EVERY WEEK: $ __________ on current support and $ __________ on the arrearage owed. The Court ORDERS the employer to withhold the above amount until _______________ _____ , __________ . Calculating Disposable Earnings The employer shall calculate ____________________ disposable earnings, which are subject to withholding for child support, as follows: 1. Determine the "earnings" of ____________________ , which means compensation paid or payable for personal services, whether called wages, salary, compensation received as an independent contractor, overtime pay, severance pay, commission, bonus, or otherwise, including periodic payments pursuant to a pension, an annuity, workers' compensation, a disability and retirement program, and unemployment benefits; 2. Subtract the following sums to calculate ____________________ "disposable earnings": EMPLOYER’S ORDER TO WITHHOLD FROM EARNINGS FOR CHILD SUPPORT – PAGE 3 a. any amounts required by law to be withheld, that is, federal income tax and federal FICA or OASI tax (Social Security) and Railroad Retirement Act contributions; b. union dues; c. nondiscretionary retirement contributions by ____________________ ; and d. medical, hospitalization, and disability insurance coverage for ____________________ and his child. More Than One Order Withholding If you receive more than one "Writ of Withholding" or "Employer's Order to Withhold Earnings for Child Support" for ____________________ , you shall pay an equal amount towards the current support portion of all orders or writs until each is individually complied with, and thereafter pay equal amounts on the arrearage portion of all orders or writs until each is complied with, or until the maximum total amount of allowable withholding, 50 percent of ____________________ disposable earnings, is reached, whichever occurs first. Termination of Withholding For as long as ____________________ is employed by you, you, the employer of ____________________ , shall continue to withhold income in accordance with this order until the youngest child reaches eighteen years of age or graduates from high school, whichever occurs last. This order indicates when the child reaches eighteen years of age. Written notice from the child's school of the child's high-school graduation will constitute notice of graduation to you. Notice of Change of Employment The Court ORDERS the employer to notify the Court and ____________________ within seven days of the date that ____________________ terminates employment. EMPLOYER’S ORDER TO WITHHOLD FROM EARNINGS FOR CHILD SUPPORT – PAGE 4 The Court ORDERS the employer to provide ____________________ last known address and the name and address of his new employer, if known. SIGNED on _______________ ______________________________________ JUDGE PRESIDING EMPLOYER’S ORDER TO WITHHOLD FROM EARNINGS FOR CHILD SUPPORT – PAGE 5