SUPERIOR COURT OF DEKALB COUNTY STATE OF GEORGIA , Civil Action Plaintiff, vs. Case Number , Defendant. INCOME DEDUCTION ORDER ON PLAINTIFF The Court has entered an order requiring the Plaintiff to pay support to the Defendant. OCGA § 19-6-32 provides for an order providing for immediate withholding from the income and earnings of the person required to pay support. The parties and children are identified as follows: Plaintiff/Obligor: Plaintiff’s SSN: DOB: Defendant/Obligee: Defendant’s SSN: DOB: Children: Name: , DOB: Name: , DOB: Name: , DOB: Name: , DOB: Name: , DOB: Name: , DOB: THEREFORE, THE COURT HEREBY ORDERS THE FOLLOWING: Income Deduction Order on Plaintiff — rev. March 9, 2006 Page 1 of 5 Provided by the DeKalb County Superior Court and the Atlanta Legal Aid Society American LegalNet, Inc. www.USCourtForms.com 1. A MOUNT OF D EDUCTION The Plaintiff’s employer, future employer, or any other person, private entity, or unit of government, that provides or administers income or earnings due the Plaintiff (whether as wages, salary, commission, bonus, workers’ compensation, payments pursuant to a disability, pension or retirement program, interest, or any other periodic form of payments, regardless of source) shall deduct from all monies due and payable to the Plaintiff the following amounts: (a) Current Child Support: $ per month (b) Current Spousal Support: $ per month (c) Support Arrearage Payment: $ per month , 200 , there is an unpaid Support As of Arrearage under a prior order in the amount of $ . The Support Arrearage Payment amount above shall be withheld each month until the amount of unpaid support has been paid in full. (d) Family Support Registry (FSR) Fee: $ ** per month ** Note: Under OCGA § 19-6-33.1(j), the amount of the FSR fee will be 5% of each payment, up to $2.00 per payment. However, the FSR fee is not required at this time; Child Support Enforcement will notify you if and when the FSR fee is to be deducted. (e) Total Amount of Deduction: $ per month. per month when all the This amount will decrease to $ Support Arrearage has been paid in full. However, if current support ends before all past due support is paid in full, then the total amount (current support plus fees) shall continue to be deducted until all past due support has been paid in full. Adjustment for Various Pay Cycles The payor is not required to vary its pay cycle to be in compliance with this order. If the pay cycle is not monthly, use the following amounts to determine how much to withhold: $ $ $ G per weekly pay period per bi-weekly pay period (every two weeks) per semi-monthly pay period (twice a month) If checked, the children listed above shall be enrolled in any health insurance coverage available through the Plaintiff’s employment. Income Deduction Order on Plaintiff — rev. March 9, 2006 Page 2 of 5 Provided by the DeKalb County Superior Court and the Atlanta Legal Aid Society American LegalNet, Inc. www.USCourtForms.com 2. T IME AND P LACE OF P AYMENT The payor shall make the amounts deducted payable to the Family Support Registry, and forward the payments within two (2) business days after each pay date to the address below, or such other address as shall be provided by Child Support Enforcement to the employer in writing: For Payments Submitted by Employers: Child Support Enforcement Family Support Registry P.O. Box 1800 Carrollton, GA 30112-1800 For Payments by the Plaintiff Directly: Child Support Enforcement Family Support Registry P.O. Box 1600 Carrollton, GA 30112-1600 The payor shall note the names of the parties, the case number, and the Plaintiff’s Social Security Number on the face of the payment. 3. C ONSUMER C REDIT P ROTECTION A CT The maximum amount to be deducted shall not exceed the amounts allowed under § 303(b) of the Consumer Credit Protection Act, 15 USCA § 1673(b) as amended. 4. S TATEMENT OF P LAINTIFF ’S R IGHTS AND R ESPONSIBILITIES Under OCGA § 19-6-32(e), the Court provides the following statement to the Plaintiff, concerning the Plaintiff’s rights, remedies and duties in regard to this income deduction order. (a) The total amount to be withheld each and every pay period is described in Paragraphs 1 and 3 above. (b) The income deduction applies to current and subsequent payors and periods of employment. (c) A copy of the income deduction order will be served on the Plaintiff’s payor or payors, if known. (d) Enforcement of the income deduction order may only be contested on the ground of mistake of fact regarding the amount of support owed pursuant to a support order, the past due support, or the identity of the Plaintiff. The Plaintiff may contest enforcement of the order as provided in OCGA § 19-6-33(c). Income Deduction Order on Plaintiff — rev. March 9, 2006 Page 3 of 5 Provided by the DeKalb County Superior Court and the Atlanta Legal Aid Society American LegalNet, Inc. www.USCourtForms.com (e) The Plaintiff is required to notify the Defendant (and the IV-D agency, if the Defendant receives IV-D services) within seven days of all changes in his/her address, payors, and the addresses of payors. 5. P LAINTIFF ’S D UTY TO E NSURE P AYMENT The Plaintiff is hereby ordered to perform all acts necessary for the proper withholding of the sums stated in this order, including delivery of the order to his/her employer, future employers and other income payors, and personally monitoring and confirming on an ongoing basis that the required payments are timely and properly deducted from his/her income and forwarded as ordered. Plaintiff remains responsible for any and all child support that is not deducted from his/her income and paid as child support or spousal support according to this order. 6. E FFECTIVE D ATE AND D URATION OF T HIS O RDER This order shall take effect: G Immediately, G Upon accrual of a delinquency equal to one month’s support. This Court finds that good cause was shown to delay the effective date of this order. The Defendant or the IV-D agency may enforce this Income Deduction Order by serving a “Notice of Delinquency” on the Plaintiff, as provided in OCGA § 19-632 (f), and shall remain in effect so long as the child support obligation continues, or until further order of the Court. This order supersedes any prior income deduction order entered in this case. 7. S ERVICE OF D OCUMENTS This order and all further papers required to be served pursuant to OCGA § 19-633, shall be served upon the payor by regular first class mail and upon the Plaintiff in person, by certified mail or statutory overnight delivery, return receipt requested, or by regular mail. A copy of this Order shall also be mailed to: Child Support Enforcement IDO Registry/FCSU P.O. Box 857 Jonesboro, GA 30237 Income Deduction Order on Plaintiff — rev. March 9, 2006 Page 4 of 5 Provided by the DeKalb County Superior Court and the Atlanta Legal Aid Society American LegalNet, Inc. www.USCourtForms.com This order was entered on , 200 . JUDGE DeKalb County Superior Court Stone M ountain Judicial Circuit F:\Home Computer\FLIC\Income Deduction Order\pro se IDO plaintiff pay 3-06.wpd Income Deduction Order on Plaintiff — rev. March 9, 2006 Page 5 of 5 Provided by the DeKalb County Superior Court and the Atlanta Legal Aid Society American LegalNet, Inc. www.USCourtForms.com