SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY DRS88f-041712 All Rights ReservedPage 1 of 1CEI CURRENT EMPLOYER* INFORMATION You may also fill out this form online at the Family Support Center Website THIS FORM MUST BE COMPLETED FOR: AN INCOME WITHHOLDING ORDER ORDER TO STOP AN INCOME WITHHOLDING ORDER NOTIFICATION OF A CHANGE OF EMPLOYER (or OTHER PAYOR) CASE NUMBER: ATLAS NUMBER: NAME OF PERSON ORDERED TO MAKE PAYMENTS: LIST THE NAME OF THE EMPLOYER* AND THE ADDRESS OF THE PAYROLL OR FINANCIALDEPARTMENT (for the person named above) WHERE THE INCOME WITHHOLDING ORDER OR STOP ORDER SHOULD BE MAILED. EMPLOYER* NAME: PAYROLL ADDRESS: CITY: STATE: ZIP: EMPLOYER* TELEPHONE: EMPLOYER* FAX: *or other payor or source of funds FOR COURT USE ONLY. DO NOT WRITE BELOW THIS LINE. WA/FSC WA/LOG ID: TYPE OF W/A DATE AMOUNT OF ORDER EMPLOYER STATUS ENTERED BY NEW W/A SUB AGDCSE For Clerk222s Use Only American LegalNet, Inc. www.FormsWorkFlow.com