Fill and Sign the Order of Assignment Arizona Form

THE SUPERIOR COURT OF ARIZONA IN       COUNTY ) (1) ) Petitioner ) ) (3) Case Number: vs. ) (4) ATLAS Number: ___ (2) ) ORDER OF ASSIGNMENT Respondent TO: Current and future employers or other payors of: (5) Name: SSN: This order modifies and replaces any previous “Order of Assignment” with the same case number. You shall withhold court-ordered payments as follows: Current Child Support $ Current Spousal Maintenance/Support $ Payments on Arrears / Interest $ Clearinghouse Handling Fee $ 2.25 per month * TOTAL AMOUNT per month $ , but no more than 50% of disposable earnings (A.R.S. § 33-1131). * The Clearinghouse handling fee is set by statute and subject to change (A.R.S. § 25-510). This “Order of Assignment” is effective immediately upon receipt by an employer or other payor, including self-employed persons, and continues until further Order, or until a period of 90 continuous days from the last payment to the Obligor. If you are again obligated to pay monies to the Obligor within 90 days, you are again bound by this “Order of Assignment.” Payment must be sent to the Support Payment Clearinghouse within two (2) business days of the date the monies were withheld. This Order of Assignment terminates on the last day of , unless it includes an arrearage payment, in which case the total amount listed above shall continue to be withheld until further order. You shall NOT discharge or otherwise discipline the person named in this assignment, because of service of this “Order of Assignment.” The above ATLAS number and employee's name must appear on the Transmittal Form or check . Make payments payable and send to: Support Payment Clearinghouse, P.O. Box 52107, Phoenix, AZ 85072-2107 © Superior Court of Arizona For Clerk’s Use Only Page 1 of 1 Dated this day of , 20 . Judicial Officer or Clerk of Superior Court © Superior Court of Arizona Page 2 of 1