Fill and Sign the Of Income Withholding Order Form

INSTRUCTIONS 1. Upon issuance of a withholding order effective immediately, complete original and one copy. 2. Serve original on obligor in accordance with General Statute § 52-57 or by certified mail, return receipt requested. 3. Retain copy for file. NOTICE TO NONAPPEARING OBLIGOR OF INCOME WITHHOLDING ORDER CONNECTICUT SUPERIOR COURT JD-FM-70 Rev. 9-99 Gen. Stat. § 52-362, 15 U.S.C. 1673 P.A. 99-193 § 6 AMOUNT OF SUPPORT ORDER NAME AND ADDRESS OF COURT NAME OF CASE DOCKET NO. (Name and mailing address of obligor) TO: DATE OF SUPPORT ORDER AMOUNT OF INCOME UPON WHICH THE SUPPORT ORDER IS BASED A SUPPORT ORDER in the above amount has been issued against you. The support order is to be enforced by an INCOME WITHHOLDING ORDER. An Income Withholding Order against your earnings, EFFECTIVE IMMEDIATELY, has been issued as part of the support order. SOME OF YOUR INCOME IS EXEMPT from withholding. Only disposable income is subject to an Income Withholding Order. "Disposable income" means that part of the income of an individual remaining after deduction from that income of amounts required to be withheld for the payment of federal, state and local income taxes, employment taxes, normal retirement contributions, union dues and initiation fees and group life and health insurance premiums. The amount withheld may not exceed the maximum amount permitted under section 1673 of title 15 of the United States Code: If you are supporting a spouse or dependent child other than the spouse or child with respect to whose support the order issued, the maximum amount of your disposable income that may be withheldis 50% of such income, unless you are twelve weeks or more in arrears in which case the maximum is 55% of such income. If you are not supporting a spouse or dependent child other than the spouse or child with respect to whose support the order issued, the maximum amount of your disposable income that may be withheld is 60% of such income, unless you are twelve weeks or more in arrears in which case the maximum is 65%. In no event, however, under state law, may you be left with less than 85% of the first $145 of disposable income. YOU HAVE THE RIGHT TO A HEARING, upon motion to the court, to claim any other applicable state or federal exemption, or to offer any evidence as to why the Income Withholding Order effective immediately should not continue in effect. THE AMOUNT OF INCOME received by you which formed the basis for the support order against you is shown above. YOU HAVE A RIGHT TO MOVE TO MODIFY THE SUPPORT ORDER if your income has changed substantially or if the support order substantially deviates from the child support guidelines established pursuant to General Statute § 46b-215a. SIGNED (Dependent or attorney) PRINT NAME OF PERSON SIGNING AT LEFT DATE SIGNED