IN THE CIRCUIT COURT OF THE 22nd JUDICIAL CIRCUIT McHENRY COUNTY, ILLINOIS _______________________________________ Plaintiff vs. _______________________________________ Case Number__________________________ Defendant AFFIDAVIT OF PROOF OF SERVICE OF WITHHOLDING NOTICE _________________________________________________, under penalties as provided by law pursuant to Section 1-109 of the Illinois Code of Civil Procedure states that: ON PAYOR On _____________________________________, at approximately __________ a.m./p.m. I served the attached Withholding Notice on: Name of Payor:_________________________________________________________________________ Address:_______________________________________________________________________________ in the following manner: 1. Ordinary Mail – First Class 2. Certified Mail 3. Facsimile Transmission 4. Other Electronic Means (describe):_________________________________________________ 5. Other (describe):________________________________________________________________ ON OBLIGOR On ___________________________________, at approximately __________a.m./p.m. I served the attached Withholding Notice via ordinary first class mail on: Name of Obligor:________________________________________________________________________ Address:_______________________________________________________________________________ _______________________________________________ Affiant’s Signature • • • • • Payor: Any payor of income to an obligor. Obligor: An individual who owes a duty to make support payments under an Order for Support. The Withholding Notice may be served upon the payor or its superintendent, manager or other agent by ordinary mail, certified mail return receipt requested, facsimile transmission, other electronic means, personal delivery or any other method approved by law for service of a summons. At the same time that a Withholding Notice is served on a payor, it must be served on the obligor by ordinary mail addressed to his or her last known address. A copy should also be sent to the obligor’s attorney of record if any. Proofs of Service of a Withholding Notice on the payor and the obligor shall be filed with the McHenry County Clerk of the Circuit Court, 2200 N. Seminary Avenue, Woodstock IL 60098. CS-AFF1: Revised 12/01/06 American LegalNet, Inc. www.FormsWorkflow.com