Fill and Sign the Minnesota Statute Form

STATE OF MINNESOTA DISTRICT COURT COUNTY OF JUDICIAL DISTRICT FAMILY COURT DIVISION In Re the Marriage of: Court File No. , Petitioner, NOTICE OF DETERMINATION OF ARREARAGE AND INTENT AND TO WITHHOLD INCOME , Respondent, TO: You are hereby notified, pursuant to Minn. Stat. §518.611 and §518.645,that _______________ , the above-named Petitioner, has determined: 1. That you, , are obligated under the Court's Order dated _______________ (and under subsequent Orders dated ), filed in _______________ County District Court, File No. _______________ a copy (copies) of which are attached hereto as Exhibit(s) _______________ , to pay to _______________ the sum of $ _______________ per month as and for spousal maintenance. 2. That you, , are delinquent in the payment of said spousal maintenance and that the total spousal maintenance arrearages of $ _______________ has accumulated since Date of Last Payment , as shown by the table of payments due and payments made attached hereto as Exhibit       . 3. That as of , the date of t his Notice, you are at least thirty (30) days inn arrears in the payment of spousal maintenance. 4. You are further notified that , the above-named - 1 - Petitioner/Respondent, intends, through her attorney, and , to serve upon your employer a copy of this Notice of Determination of Arrearages and a copy of the Order setting spousal maintenance and Minn. Stat. §518.611 not less than fifteen (15) days after service of this Notice and a copy of the Order upon you. 5. You are further notified that, if, within said fifteen (15) day period, you fail to move the court to deny withholding on the grounds that an arrearage of at least thirty (30) days does not exist as of the date of the Notice of Income Withholding or on other grounds limited to mistakes of fact, and exparte, to stay service on the payer of funds until the motion to deny withholding is heard, your employer, upon receipt of Notice and a copy of the Order, will commence withholding the amount of spousal maintenance you are obligated to pay from your wages and an additional amount equal to twenty percent ( ____ %) of the monthly spousal maintenance obligation until the arrearage is paid. 6. Forms in support of a motion to deny income withholding may be obtain from the _______________ , (wherever the case is venued) County Clerk of Court. 7. If you request a court hearing, you must serve notice upon , , , MN . If you fail to serve notice, your employer or payer of funds will be instructed to begin withholding spousal maintenance payments from your income. 8. a copy of this Notice and a copy of the Order shall be submitted to the Support and Collection Division of County where venued County. DATED: _______________________________ Attorney for (Address) (Address) (City, State, Zip) (Telephone Number) (Attorney Reg. No.:) STATE OF MINNESOTA DISTRICT COURT COUNTY JUDICIAL DISTRICT - 2 - OF FAMILY COURT DIVISION In Re the Marriage of: Court File No. , Petitioner, ORDER TO WITHHOLD INCOME AND , Respondent, This matter was brought on by service, duly made, upon the Respondent of the Petitioner's Notice of Determination of Arrearage and Intent To Withhold Income Pursuant to Minn. Stat. 518.611 and 518.645. Based on all of the files, records and proceedings herein, the Court makes the following: FINDINGS OF FACT I. That on ______________ , __________ Petitioner duly served Respondent with Notice of Determination of Arrearage and Intent To Withhold Income Pursuant to Minn. Stat. 518.611 and 518.645. II. That at least fifteen days have elapsed since the Notice was served on the Respondent and that Respondent has not brought a motion to deny wage withholding. III. That Respondent was ordered to pay to the Petitioner spousal maintenance/child support in the sum of $ ______________ per month by Order of the Court dated ______________ . - 3 - ______________ IV. That Respondent is delinquent in the payment of said spousal maintenance/child support and that the total spousal maintenance arrearages of $ ______________ has accumulated since date of last payment . ORDER 1. The employer of the Respondent, ______________ , is ordered to begin wage withholding no later than the first pay period that occurs after fourteen days of the notice served with this Order. 2. The employer shall withhold the sum of $       representing monthly spousal maintenance/child support from Respondent's earnings each month until ______________ or further order of the Court. 3. The employer shall, in addition to the sum to be withheld pursuant to paragraph No. 2 of this Order, withhold from Respondent's earnings an amount equal to twenty percent ( ____ %) of the monthly maintenance/child support obligation until the arrearage found to be due herein is paid. Dated: BY THE COURT ______________________________________ Judge of the District Court - 4 -