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- 1 - STATE OF MINNESOTA DISTRICT COURTCOUNTY OF JUDICIAL DISTRICTFAMILY COURT DIVISIONIn Re the Marriage of:Court File No. ,Petitioner,NOTICE OF INCOMEWITHHOLDINGAND ,Respondent,TO : _ _____________ Y ou a re h ere b y n oti f ie d p urs u an t t o M in n. S ta t. .5 18.6 11, t h at f if te en ( 1 5) d ay s f ro m t h e d ate of t h is n otic e, y our e m plo yer o r p ay er o f f u nds w ill b e i n str u cte d t o d ed uct y our c o urt- o rd ere d c h ild su pport p ay m en ts a n d p ay m en ts f o r p ast d ue s u pport f ro m y our i n co m e.Y our c h ild s u pport p ay m en ts a re m ore t h an t h ir ty ( 3 0) d ay s i n a rre ars a n d t h e c o urt w ill b e re q ueste d t o i s su e a n o rd er f o r i n co m e w ith hold in g o n . I n a d ditio n t o w ith hold in g, $ . 0 0 p er m onth for c h ild s u pport, a n a d ditio nal s u m o f $ . 0 0 p er m onth w ill b e w ith held b y y our e m plo yer o r p ay er of f u nds u ntil p ast d ue s u ppo rt i s p aid i n f u ll.I f y ou b elie v e y our p ay m en ts a re n ot a t l e ast t h ir ty ( 3 0) d ay s i n a rre ars , o r i f o th er m is ta k es of f a ct e x is t, y ou c an d ela y i n co m e w ith hold in g b y s c h ed ulin g a m otio n w ith in f if te en ( 1 5) d ay s fro m t h e d ate o f t h is l e tte r r e q uestin g t h at t h e c o urt: 1 . Den y i n co m e w ith hold in g o n t h e g ro unds t h at a n a rre ara g e o f a t l e ast t h ir ty ( 3 0) da y s d id n ot e x is t a s o f t h e d ate o f t h is n otic e o r o n o th er g ro unds, l im ite d t o mis ta k es o f f a ct, a n d - 2 - 2. Sta y s e rv ic e o n t h e p ay er o f f u nds u ntil t h e m otio n t o d en y i n co m e w ith hold in g i s he ard . If y ou r e q uest a c o u rt h earin g, y ou m ust s e rv e n o tic e u pon _ _____________. I f y ou f a il t o serv e n otic e, y o ur e m plo yer o r p ay er o f f u nds w ill b e i n str u cte d t o b eg in w ith hold in g c h ild s u pport pa y m en ts f ro m y our i n co m e a s s o on a s t h e c o urt e n te rs a n o rd er f o r t h e w ith hold in g o f i n co m e. D ate d : _ _____ _________________________________________________________Attorney for Petitioner#1 Address#2 AddressCity, State ZipTelephone (____) __________Attorney Reg. No.: ______