GF-161B, 08/12 Notice to Court that Another Income Assignment Order has been Received Federal Consumer Protection Act, 15 USC 1973; 247247778.30, 812.30(6), 973.05(4)(b), 973.05(5)(c), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF THE OUTSTANDING OBLIGATIONS OF Debtor Date of Birth Notice to Court t hat Another Income Assignment Order h as been Received Case No(s). 1. The address of the debtor is Address: City/State/Zip Code: Telephone Number: 2. The name and address of the d Name(s): Address: City/State/Zip Code: Telephone Number: Notice to court that another assignment(s) has been received. I am the employer of the debtor and have received and am now paying on another assignment for fines and other court obligations of the debtor; understand that I am to return a copy of this form to the clerk of court of this county within ten ( 10 ) days of receiving this assignment; and understand that I will retain this assignment and once any other earlier assignment(s) is paid in ful l, I will then pay this assignment. Employer Date NOTICE TO DEBTOR: If you believe the balance is incorrect or the income assignment will cause irreparable harm, you must file a written objection with the court. DISTRIBUTION: 1. Clerk of C ourt 2. Debtor American LegalNet, Inc. www.FormsWorkFlow.com