Fill and Sign the Motion and Notice of Proposed Form

MOTION AND NOTICE OF PROPOSED Case No. ...................................................................... INCOME DEDUCTION ORDER FOR SUPPORT DCSE ID No. ............................................................ Commonwealth of Virginia VA. CODE § 20-79.1 ................................................................................................................................................................... Juvenile and Domestic Relations District Court ................................................................................................................................................................................................................................................................... ADDRESS ........................................................................................................................... v. ..................................................................................................................... PETITIONER RESPONDENT ........................................................................................................................... ... .................................................................................................................. SOCIAL SECURITY NUMBER ADDRESS ..................................................................................................................... MOTION: ..................................................................................................................... I request the court to enter an income deduction order which SOCIAL SECURITY NUMBER contains the following terms: 1. Proposed Inco me Deduction Terms: Pay interval: [ ] weekly ............................................................................................... [ ] bi-weekly ......................................................................................... [ ] semi-monthly ................................................................................. regular pay dates [ ] monthly ............................................................................................ [ ] ................................................................................................................ OTHER PAY INTERVAL AND REGULAR PAY DATES The Respondent has also been ordered to provide health care coverage for the following persons: STATUS (check applicable box) NAME Payment Priority [ ] Support [ ] Health care coverage Dependent Current Former Child Spouse Spouse 1. ......................................................................................... 2. ......................................................................................... 3. ......................................................................................... 4. ......................................................................................... 5. ......................................................................................... 6. ......................................................................................... 2. Proposed amount to be deducted each pay period: $ ........................................... or ......................................... % of disposable income, whichever is less based on court-ordered payments of $ ........................................ per ................................... with $ ....................................... total unpaid payments. 3. Reason for proposed support income deduction order: [ ] receipt of notice of arr earage in support payments [ ] court has found that there is an arrearage of an amount equal to one month’s support obligation [ ] facts relevant in determining the likelihood of [ ] request of the obligor payments in accordance with the support order [ ] Other: ............................................................................................................. 4. .......................................................................................................................................................................................................................................................... EMPLOYER’S NAME .............................................................................................................................. ............................................................................................................................ EMPLOYER’S ADDRESS .............................................................................. _______________________________________________ ___________________ DATE PETITIONER NOTICE TO THE RESPONDENT/OBLIGOR: Read this entire Notice (pages one and two) carefully. This motion is made pursuant to Virginia Code § 20-79.1. If you wish to contest this Motion, written notice must be filed in the clerk’s office by .................................................................................................................................... for a hearing on ........................................................................................... FILING DEADLINE HEARING DATE ....................................................................................... ___________________________________________________________________________ DATE [ ] CLERK [ ] DEPUTY CLERK FORM DC-617 (MASTER, PAGE ONE OF TWO) 12/98 PC TO THE RESPONDENT/OBLIGOR: This notice is to advise you that this Court has been requeste d for the reason stated above to enter an order requiring all of your present and future employers to deduct support payments as described above from your income. This deduction will begin with the next regular pay interval for your income after your employers are served with an order. You have ten (10) days from the date of issuance of this Notice to file in the clerk’s office of this court a written notice o f contest of such proposed order. If no wr itten notice of contest is filed, the court w ill enter such an order at the end of the ten (10) day filing period. If you file a written notice of contest, — a hearing will be held and a decision made regarding the issuan ce of the Order and its contents within ten (10) days from the date that the Court receives your wr itten notice of contest, unless good cause is shown for additional time, but not to exceed forty-five (45) days from y our receipt of this notice, and — only disputes as to mistakes of fact (e rror in the identity of the payor or the amount of current support or arrearage) will be heard. Alleged inability to pay is not a grounds for contest. — payment of overdue sup port upon receipt of the notice shall not be the sole basis for not implementing withholding. The order will state that the deduction will start with the regular pay period for your income after you employer is served with an order. Your employer will be told the names of the petitioner, the court file number, the DCSE ID number (if any), you r name, address, and social security number, and the terms of th e periodic support payment, and where to send payments. The employer will also be told: — the maximum amount which can be withheld from your income, — that the order is binding on the employer until furthe r notice sent by the court is received by the employer, — that the order requires income deductions for support to be paid before any other liens creat ed under state law except that, when judicial or administrative income deduction orders for support have been previous ly served on the employer, the employer must prorate the amount withheld from your check among all income deduction ord ers of support based upon the current amounts due, with any remaining income pror ated among the orders for accrued arrearages, if any, — that deductions are to be made on your regular payday and sent that date to the Virginia Departme nt of Social Services and how to send such payments, — of his liability for failing to honor the order or for taki ng retaliatory action against you because of such order, — that the employer and respondent must notify the Virginia Department of Social Services when your employment terminates, and give your home address and the name and address of your new employer, — that the employer may deduct an additional fee of $5.00 for each time that the employer deducts money or answers in writing that the employer was legally unable to makes such deductions, — how the employer should respond if the order contains erroneous information, and — the statutory authorization for such order. SERVICE OF PROCESS ON RESPONDENT: [ ] Personal service Being unable to make personal service, a copy was delivered in the following manner: [ ] Delivered to family member (not temporary sojourner or gue st) age 16 or older at usual place of abode or party named above after giving information of its purport. (List name, age of recipient and relation to party named above.) ........................................................................................................................................................................................................................................................... [ ] Posted on front door or such other door as appears to be the main entrance of usual place of abode, address listed above. (Other authorized recipient not found.) [ ] Certified mail. [ ] Facsimile service on employer to deliver to respondent. [ ] Not found. ................................................ _____________________________________________ for ____________________________________________ DATE SERVING OFFICER FORM DC-617 (MASTER, PAGE TWO OF TWO) 4/06