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Order to Establish Account and Authorize Transfer Wisconsin Form

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STATE OF WISCONSIN, CIRCUIT COURT, COUNTY For Official Use Petitioner: -vs- Respondent: Order to Establish Account and Authorize Transfers Case No. THE COURT FINDS: 1. Income withholding is inapplicable, ineffective or insufficient to ensure payment pursuant to an order of support or for payment of a child's health care expenses. 2. It is necessary to require the payer to identify or establish a deposit account in a financial institution to allow for periodic transfers of funds. IT IS ORDERED: The petitioner: respondent: 1. Immediately authorize the periodic transfer of funds from an account at a financial institution. The payer shall establish such an account if none exists. 2. Execute the Depositor's Authorization to Transfer Funds for Support form provided by the Department of Workforce Development. BY THE COURT: Signature of Circuit Judge/Court Commissioner Name Printed or Typed Date Distributon: 1. Court - Original 2. Petitioner/Petitioner's Attorney 3. Respondent/Respondet's Attorney FA-606, 06/00 Order to Establish Account and Authorize Transfers §§767.25(4m)(c), 767.265, 767.51(3m)(c), Wisconsin Statutes . This form shall not be modified. It may be supplemented with additional material. Page 1 of 1

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