Fill and Sign the Income Assignment Order Form

_____________ : _______ JUDICIAL DISTRICT COURT VS : PARISH OF _______ , LOUISIANA _____________ : DOCKET NO. ____ ______________________________________________________________________________ AMENDED INCOME ASSIGNMENT ORDER (IMMEDIATE) NOW INTO COURT comes Petitioner, _____________ , through undersigned counsel, and upon suggesting to the Court that she wishes to amend the Immediate Income Assignment which she previously filed the ____ day of _______ 20 ____ to add the following: 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, compensation as an independent contractor, shall withhold from the income of _____________ , Social Security No. _______ , the OBLIGOR herein, the total of _____________ and ____ /100 ($ _______ ), which includes the sum of _____________ and ____ /l00 ($ _______ ) for monthly child support obligation and an additional _____________ and ____ /100 ($ _______ ) per month until all arrearages are paid. Payer of income is ordered to withhold this sum until further orders of this Court. IT IS FURTHER ORDERED that this ORDER be effectuated immediately and 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