Fill and Sign the To the Payor This is a Court Order Form

             F L-4 35ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address)FOR COURT USE ONLYTELEPHONE NO.F A X N O . ( O ptio nal) :E-MAIL ADDRESS (Optional):ATTORNEY FOR (Name) :SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS:MAILING ADDRESS:CITY AND ZIP CODE:BRANCH NAME: PETIT IO NER /P LA IN TIF F:R ESPO NDEN T/D EFE N DAN T:O TH ER P AR EN TE A RNIN G S A SSIG NM EN T O RDER F O R S PO USA L O R P A RTN ER S U PPO RTCASE N UM BERM odif ic atio nTO THE PAYOR: This is a court order. You must withhold a portion of the earnings of (specify obligor’s name and birthdate):and p ay a s d ir e cte d b elo w . ( A n e xp la natio n o f t h is o rd eris p rin te d o n p age 2 o f t h is f o rm .)T H E C O URT O RDER S 1. Y ou m ust p ay p art o f t h e e arn in gs o f t h e e m plo ye e o r o th er p ers o n w ho h as b een o rd ere d t o p ay s u pport, a s f o llo w s:a.$b.$p er m onth c u rre n t s p ousal o r p artn er s u pport pe r m onth s p ousal o r p artn er s u pport a rre ara g esc. Total deductions per month:$2.T he p aym ents o rd ere d u nder it e m 1 a m ust b e p aid t o ( n am e, a ddre ss):3 .T he p aym ents o rd ere d u nder it e m 1 b m ust b e p aid t o ( n am e, a ddre ss):4 . T he p aym ents o rd ere d u nder it e m 1 m ust c o ntin ue u ntil f u rth er w rit te n n otic e f r o m t h e p aye e o r t h e c o urt.5 .T his o rd er m odif ie s a n e xis tin g o rd er T he a m ount y o u m ust w it h ho ld m ay h ave c h an ged . T he e xis tin g o rd er c o ntin ues in ef fe ct u n til t h is m odif ic a tio n is e ffe ctiv e .6. T his o rd er a ffe cts a ll e arn in gs t h at a re p aya ble b egin nin g a s s o on a s p ossib le b ut n ot la te r t h an 1 0 d ays a fte r y o u r e ce iv e it .7 . Y ou m ust g iv e t h e o blig or a c o py o f t h is o rd er a nd t h e b la nk R equest f o r H earin g R egard in g E arn in gs A ssig nm ent ( fo rm F L-4 50) wit h in 1 0 d ays.8.O th er ( s p ecif y ):9 . F or t h e p urp ose s o f t h is o rd er, s p ousa l o r p artn er s u pport a rre ara ges a re s e t a t: $a s o f ( d a te ):D ate :OFFIC ERPage 1 o f 2F orm A dopte d fo r M andato ry U se Ju dic ia l C ouncil o f C alif o rn ia FL -4 35 [R ev. J a nuary 1 , 2 005]EARNINGS ASSIGNMENT ORDER FOR SPOUSAL OR PARTNER SUPPORT (Family Law)Fam ily C ode, § § 2 99(d ) 5 208,C ode o f C iv il P ro ce dure , § 7 66 0 3115 U.S.C. §§ 1672-167ie le ctr o nic f o rm  2 005 WWW.LawCA.com La w P ublis h ers security, (3) state income tax, (4) state disability insurance,and (5) payments to public employees’ retirementsystems. After the obligor’s disposable earnings are known, withhold the amount required by the order, but neverwithhold more than 50 percent of the disposableearnings unless the court order specifies a higherpercentage. Federal law prohibits withholding more than65 percent of disposable earnings of an employee in anycase. If the obligor has more than one assignment forsupport, add together the amounts of support due forall the assignments. If 50 percent of the obligor’s netdisposable earnings will not pay in full all of theassignments for support, prorate it first among all ofthe current support assignments in the sameproportion that each assignment bears to the totalcurrent support owed. Apply any remainder to theassignments for arrearage support in the sameproportion that each assignment bears to the totalarrearage owed. If you have any questions, pleasecontact the office or person who sent this form to you.This office or person's name appears in the upperleft-hand corner of the order.If the employee's pay period differs from the periodspecified in the order, prorate the amount ordered withheldso that part of it is withheld from each of the obligor’spaychecks.If the obligor stops working for you, notify the office thatsent you this form of that, no later than the date of the nextpayment, by first-class mail. Give the obligor’s last knownaddress and, if known, the name and address of any newemployer.California law prohibits you from firing, refusing to hire, ortaking any disciplinary action against any employeeordered to pay support through an earnings assignment.Such action can lead to a $500 civil penalty per employee.b.c.d.4.5.I N STR UCTIO NS F O R E A RNIN G S A SSIG NM EN T O RDER1. D EFIN IT IO N O F I M PO RTA NT W ORDS I N T H E E A RNIN G S ASSIG NM EN T O RDERa. Earnings:(1 ) W ages, s a la ry , b onuse s, v a ca tio n p ay, r e tir e m ent pay, a nd c o m mis sio ns p aid b y a n e m plo ye r; (2 ) P aym ents f o r s e rv ic e s o f in depe ndent c o ntr a cto rs ; (3 ) D iv id ends, in te re st, r e nts , r o ya lt ie s, a nd r e sid uals ; (4 ) P ate nt r ig hts a nd m in era l o r o th e r n atu ra l r e so urc erights;(5 ) A ny p aym ents d ue a s a r e su lt o f w rit te n o r o ra l co ntr a cts f o r s e rv ic e s o r s a le s, r e gard le ss o f t it le ; (6) P aym ents d ue f o r w ork e rs ' c o m pensa tio n t e m pora ry be ne fit s , o r p aym ents f r o m a d is a bilit y o r h ealt h in su ra nce p olic y o r p ro gra m ; a nd(7 ) A ny o th er p aym ents o r c re dit s d u e, r e gard le ss o fso urc eb. Earnings assignment order: a c o urt o rd er is su ed ine ve ry c o urt c a se in w hic h o ne p ers o n is o rd ere d t o p ayfo r t h e s u pport o f a noth er p ers o n.T his o rd er h as p rio rit yo ve r a ny o th er o rd ers s u ch a s g arn is h m ents o r e arn in gsw it h hold in g o rd ers . E arn in gs s h ould n ot b e w it h held f o r a ny o th er o rd er until t h e a m ounts n ece ssa ry t o s a tis fy t h is o rd er h ave be en w it h held in f u ll. H ow eve r, a n O rd er/N otic e t o WIth hold I n co m e f o r C hild S upport f o r c h ild s u pport o r fam ily s u p port h as p rio rit y o ve r t h is o rd er f o r s p ousa l o r partn er s u pport. c. Obligor: any person ordered by a court to pay support. The o blig or is n am ed b efo re it e m 1 in t h e o rd er.d. Obligee: the person or governmental agency to whom the s u pport is t o b e p aid .e. Payor: the person or entity, including an employer, that pays earnings to a n o blig or.2. INFORMATION FOR ALL PAYORS. Withhold money fromth e e arn in gs p aya b le t o t h e o blig or a s s o on a s p ossib le b ut no la te r t h an 1 0 d a ys a fte r y o u r e ce iv e t h e E arn in gs Assig nm ent O rd er f o r S pousa l o r P artn er S upport. S end t h e wit h held m oney t o t h e p aye e(s ) n am ed in it e m s 2 a nd 3 o f the o rd er w it h in 1 0 d ays o f t h e p ay d ate . Y ou m ay d educt $ 1fr o m t h e o blig or's e arn in gs f o r e ach p aym ent y o u m ake . W hen s e ndin g t h e w it h held e arn in gs t o t h e p aye e, s ta te th e d ate o n w hic h t h e e arn in gs w ere w it h held . Y ou m ay com bin e a m ounts w it h held f o r t w o o r m ore o blig ors in a sin gle p aym ent t o e ach p aye e, a nd id entif y w hat p ortio n o f th at p aym ent is f o r e ach o blig or Y ou w ill b e l ia b le f o r a n y a m ount y o u f a il t o w it h hold an d c an b e c it e d f o r c o nte m pt o f INFORMATION FOR ALL OBLIGORS. You should have received a Request for Hearing Regarding Earnings Assignment (form FL-450) with this Earnings Assignment Order for Spousal or Partner Support. If not, you may get one from either the court clerk or the family law facilitator. If you want the court to stop or modify your earnings assignment, you must file (by hand delivery or mail) an original copy of the form with the court clerk within 10 days of the date you received this order. Keep a copy of the form for your records. If you think your support order is wrong, you can ask for a modification of the order or, in some cases, you can have the order set aside and have a new order issued. You can talk to an attorney or get information from the family law facilitator about this.SPEC IA L I N STR U CTIO NS F O R P A YO RS W HO A RE EM PLO YER Sa. S ta te a nd f e de ra l la w s lim it t h e a m ount y o u c a nw it h hold a nd p ay a s d ir e cte d b y t h is o rd er. T his lim it a tio n applie s o nly t o e a rn in gs d efin ed a b ove in it e m 1 a (l) a ndare u su ally h alf t h e o blig or's d is p osa ble e arn in gs D is p osab le e a rn in gs a re d if fe re n t f r o m g ro ss p ay or t a ke-h om e p ay. D is p osa ble e arn in gs a re e arn in gs le ft afte r s u b tr a ctin g t h e m oney t h at s ta te o r f e dera l la w requir e s a n e m plo ye r t o w it h hold . G enera lly t h ese re quir e d d eductio n s a re ( 1 ) f e dera l in co m e t a x, ( 2 ) s o cia l SPECIAL INFORMATION FOR THE OBLIGOR WHO IS AN EMPLOYEE. State law requires you to notify the payees named in items 2 and 3 of the order if you change your employment. You must provide the name and address of your new employer.F L-4 35 [R ev. J a nuary 1 , 2 0 05]EARNINGS ASSIGNMENT ORDER FOR SPOUSAL OR PARTNER SUPPORT (Family Law)Page 2 o f 2