COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. NOTICE AND ACKNOWLEDGEMENT OF No. RECEIPT : Calendar PLEASE FILL OUT APPROPRIATE INFORMATION : JUDICIAL SUBPOENA Plaintiff(s) AND RETURN THIS FORM -against- : I acknowledge receipt of the Order of Assignment from the Clerk of Superior Court in Maricopa County for: : : Defendant(s) : ...................................................... (Obligor's Name/Case Number) According to A.R.S. §25-504 an employer or payor of funds who fails without good cause to comply with the terms of an order of assignment is liableTHE STATE not paid pursuant to the order of assignment and reasonable attorney fees, cost THE PEOPLE OF for amounts OF NEW YORK and other expenses incurred in procuring compliance and may be subject to contempt. TO This form must be filled out with information known to the party acknowledging receipt and returned to the Clerk of Superior Court immediately. I understand that if I do not return this form immediately, I may be ordered to pay the costs of personal service, unless I can show good cause as to why it was not returned. GREETINGS: EMPLOYER/PAYOR OF FUNDS: PLEASE CHECK THE APPROPRIATE BOX AND COMPLETE INFORMATION REQUIRED. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , Court This Honorable the company employs/pays the employee/obligor. at the This company no longer employs the employee/obligor. located at County of Termination Date: in room , on the day of , 20 , at o'clock#: the noon, and at any recessed SSN in or adjourned date, to testify and give evidence as a witness in this action on the part of the Last known address: Name and address of New Employer: There is no record of this obligor ever being employed with this company. Additional Comments: Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Company Name result of your failure to comply. Email Address Witness, Honorable Court in County, Signature (Company Representative) , one of the Justices of the day of Date , 20 CERTIFIED MAILING (If this box is checked, this is a certified mailing.) (Attorney must sign above and type name below) A. If the obligor referenced above is employed with your company or you are obligated to pay this person, please complete the correct statement in the middle of the page and return this entire form. B. If the obligor referenced above is not employed with your company for you are not obligated to pay this Attorney(s) or person, please complete the correct statement in the middle of the page and return this entire form. SUBSEQUENT EMPLOYER/PAYOR OF FUNDS OF AN EX PARTE ORDER OF ASSIGNMENT (If this box is checked this is a subsequent order. Please read the following paragraph for the appropriate instruction.) Office and P.O. Address This is a subsequent Ex Parte Order of Assignment. You must begin withholding payments no later than 14 days after receipt. If payment to the obligor is due sooner than the 14 days you may implement the withholding for that date. Subsequent employers do not receive an additional copy toTelephone No.: serve on the employee. Facsimile No.: RETURN THIS ENTIRE ACKNOWLEDGMENT TO THE CLERK OF THE E-Mail Address: SUPERIOR COURT BY FAX (602) 506-1937 OR YOU MAY USE THE ENVELOPE PROVIDED. DO NOT RETURN THE ATTACHED PACKET. RETAIN A COPY OF THIS Mobile NOTICE AND ACKNOWLEDGMENT OF RECEIPT FOR FUTURE REFERENCE. Tel. No.: Page 1 of 1 American LegalNet, Inc. Form #412 LRD 2/23/01 ALL RIGHTS RESERVED www.USCourtForms.com © Clerk of Superior Court of Arizona in Maricopa County COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. EMPLOYER/PAYOR OF FUNDS INFORMATION SHEET : Calendar No. A.R.S. §25-504 : 1. Plaintiff(s) An Order of Assignment and an Order Terminating the Order JUDICIAL SUBPOENA of Assignment shall be served on any employer or payor of funds by first class mail, electronic transmission, personal delivery or -against: pursuant to the Arizona Rules of Civil Procedure. 2. Copies of Orders of Assignment and Orders Terminating Orders of Assignment do not need to : be certified to be effective. 3. : For .the. .cost. . . . compliance,. .you . may .Defendant(s) . . . .and retain an additional $1 per payment . . . . . . . . of . . . . . . . . . . . . . . . . . . also .withhold . . . .... ..... sent, not to exceed $4 per month for each obligor. 4. Any employer or other payor who has received any order of assignment shall withhold the THE PEOPLE OF THE STATE OF of assignment, together with the handling fee as provided in amount specified in the order NEW YORK section §25-510, from the income of the person obligated to pay support or spousal TO maintenance. Income” means any form of payment owed to an individual, regardless of the source, including wages, salaries, commissions, bonuses, workers’ compensation, disability payments, payments pursuant to a retirement program and interest. 5. The monthly fee of $2.25, to cover the cost of handling support and maintenance payments (A.R.S. §25-510), shall YOU, that all business and excuses being laid aside, you and each of you attendThis WE COMMAND also be deducted from the obligor’s income and transmitted. before handling fee is in addition to the monthly support obligation. Court , the Honorable at the 6. Ifin room the obligor is ordered to pay child support ,for more than one familythe the amount available , on the day of 20 , at o'clock in and noon, and at any recessed for adjourned date, to testify and giveto meet thea total combined current childof the or withholding is not sufficient evidence as witness in this action on the part support obligations the employer or payor of funds shall allocate any monies withheld from the obligor’s income to each family. Attached is a Child Support Allocation Worksheet for your use in allocating the payments. (Note: disposable income is the amount paid by the employer/payor of funds after Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to deducting from such income those amounts required by law to be withheld) : GREETINGS: County of 7. located at the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. An employer or payor of funds may combine payments withheld for more than one obligor in a single payment. When combining payments in one check be sure to include a transmittal that Witness, Honorable , one of the Justices of the provides each of the payor's names, Social Security Numbers, ATLAS numbers, amounts Court in County, day of , 20 withheld for each payor, dates the funds were withheld, the date transmitted, and any handling fees withheld. Attached is a Transmittal of Payment Form for your use. Failure to provide the information on the Transmittal of Payment Form will result in a delay in processing the (Attorney must sign for and Support Payment payment. For all Arizona withholdings refer to the address above thetype name below) Clearinghouse. For other states refer to the court order for the appropriate address to remit payments. Attorney(s) for 8. Statute requires monies withheld be transmitted within 2 business days after obligor is paid or after the payment to the obligor is due. 9. When the obligor is no longer employed or the right to receive income or othe r monies is Office and P.O. Address terminated, within 10 days you must notify the Clerk or Support Payment Clearinghouse in writing of: the obligor’s Social Security Number, last known address, and the name and address of the obligor’s new employer, if known. You Telephone the attached Notice of change may use No.: of obligor’s employment or right to receive entitlements for this purpose. Facsimile No.: E-Mail Address: Mobile Tel. No.: Page 2 of 2 Form #412 LRD 2/23/01 ALL RIGHTS RESERVED © Clerk of Superior Court of Arizona in Maricopa County American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : 10. Index No. If the employee terminates but is reinstated within 90 days of the last payment the employer is : Calendar No. again obligated to withhold monies pursuant to the Order of Assignment. (This is applicable to payor of funds cases as well). Plaintiff(s) : JUDICIAL SUBPOENA 11. The first employer or payor of funds served with an Ex Parte Order of Assignment shall not -against: withhold or deduct amounts specified in the Ex Parte Order of Assignment for 14 days. (You are the first employer if you receive two copies of an Ex: Parte Order of Assignment, one copy for you and one copy for the obligor.) 12. Within 5 days after receipt, the first employer or payor of funds served with an Ex Parte Order Defendant(s) : of. .Assignment .must. .serve .on . the . employee. . . . .payor . of funds, by personal delivery or by . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . or . . . . . registered mail, one copy of the Order of Assignment, the Request, and the Notice. 13. If the subsequent employer/payor of funds box is marked on the Notice and THE PEOPLE OF THE STATE OF begin withholding no later than 14 days after receipt of the Acknowledgment of ReceiptNEW YORK Order but, if payment to the obligor is due sooner than the 14 days you may implement the TO withholding for that date. 14. An Order of Assignment has priority over all other executions, attachments, or garnishments. 15. An employer or payor of funds shall not refuse to hire a person and shall not discharge or otherwise discipline an obligor because of service of an Order aside, you and each An employer or WE COMMAND YOU, that all business and excuses being laid of Assignment. of you attend before payor of funds who refuses to hire a person or who discharges or otherwise disciplines an , the Honorable at the Court employee or obligor becauselocated at of service of an Order of Assignment is subject to contempt and County of sanctions as may be ordered by the court., 20 person who o'clock in the refused employment, A is wrongfully noon, and at any recessed in room , on the day of , at wrongfully discharged or otherwise disciplined is entitled to recoverpart of the sustained by the or adjourned date, to testify and give evidence as a witness in this action on the damages prohibited conduct, reinstatement, if appropriate, and attorney fees and costs incurred. 16. If the Social Security Number does not match the obligor and you are able to determine that Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalfyour subpoena was issued for a maximum penalty of $50 and all damages sustained as a the obligor named is this employee/obligor, honor the Order of Assignment. If you are not able to your failure to comply. result of make this determination, indicate this on the Notice and Acknowledgment of Receipt. Then, return the Notice and Acknowledgment of Receipt to the Clerk of the Superior Witness, Honorable Court. , one of the Justices of the 17. If the obligor tells you the amount on the Order of Assignment is wrong or that you should not honor the order, it is your employee's/obligor's responsibility to contest or challenge the Order of Assignment, if he or she believes it is in error. Proceed with the withholding until you (Attorney must of above and type name receive a court order modifying or terminating the existing Order signAssignment. below) : 18. 19. GREETINGS: Court in County, day of , 20 A.R.S. §25-646 states that an income withholding order issued in another state may be sent to the person or entity defined as the obligor’s employerAttorney(s) for and the obligor’s employer shall treat an income withholding order issued in another state that appears regular on its face as if it had been issued by a tribunal of this state. If an obligor voluntarily provides you a copy of an Order of and P.O. Address Office Assignment, begin withholding the support payments according to the terms of the Order of Assignment. Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. Page 3 of 3 Form #412 LRD 2/23/01 ALL RIGHTS RESERVED www.USCourtForms.com © Clerk of Superior Court of Arizona in Maricopa County COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. CHILD SUPPORT ALLOCATION WORKSHEET : Calendar No. Arizona Revised Statute §25-504 requires employers to allocate current child support payments when the amount available for withholding is not sufficient to meet the total combined current support obligation. : Plaintiff(s) JUDICIAL SUBPOENA USE THIS FORM ONLY IF-against- TOTAL AMOUNT OF : ALL CURRENT CHILD SUPPORT THE ORDERS EXCEEDS THE MAXIMUM ALLOWABLE WITHHOLDING OF 50% OF THE : EMPLOYEE'S DISPOSABLE INCOME. If you need assistance in completing the worksheet, please contact the Department of Economic Security : through the Employer Hotline at (602) 252-4045. Defendant(s) : STEP 1:. .LIST .THE .CURRENT. CHILD .SUPPORT .AMOUNTS .FOR EACH ORDER .... .... ......... ....... ......... .......... ... A) $ B) $ THE PEOPLE OF THE STATE OF NEW YORK C) $ TO STEP 2: TOTAL THE CURRENT CHILD SUPPORT AMOUNTS FOR EACH ORDER A) $ + B) $ + C) $ = D) $ STEP 3:GREETINGS: THE ALLOCATION RATIOS BY DIVIDING EACH CURRENT CHILD SUPPORT COMPUTE AMOUNT ORDER BY THE TOTAL CURRENT CHILD SUPPORT AMOUNT WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before = E) (ALLOCATION RATIO) , at the Court located at County of / D) $ B) $ = F) (ALLOCATION RATIO) in room , on the day of , 20 , at o'clock in the noon, and at any recessed C) $or adjourned/ date, to testify and give evidence as(ALLOCATION RATIO) part of the D) $ = G) a witness in this action on the A) $the HonorableD) $ / STEP 4: DETERMINE THE AMOUNT TO ALLOCATE TO EACH CURRENT CHILD SUPPORT WAGE WITHHOLDING ORDER BYcomply with this subpoenaMAXIMUM as a contempt of court and will make 50%liable to Your failure to MULTIPLYING THE is punishable WITHHOLDING AMOUNT OF you OF THE EMPLOYEE'Swhose behalf this INCOMEwas issued ALLOCATION RATIO FORand all damages sustained as a the party on DISPOSABLE subpoena BY THE for a maximum penalty of $50 EACH ORDER. result of NET INCOME: your failure to comply. H) $ X 50% = H) $ X E) % = I) Witness, Honorable H) $Court in X F) County, % = J) of day H) $ X G) %= K) (ALLOCATION AMOUNT FOR ORDER A) , one of the Justices of the (ALLOCATION AMOUNT FOR ORDER B) , 20 (ALLOCATION AMOUNT FOR ORDER C) (Attorney must sign STEP 5: PAY THE AMOUNT ALLOCATED TO EACH CURRENT CHILD above and type name below)TO THE SUPPORT ORDER ADDRESS AS DIRECTED ON EACH WAGE WITHHOLDING ORDER. Attorney(s) for PLEASE NOTE THAT ORDERS OF ASSIGNMENT MAY HAVE BEEN DIRECTED FROM STATES OTHER THAN ARIZONA AND PAYMENTS SHOULD BE SENT TO THE APPROPRIATE ADDRESSES AS STATED ON THE ORDER. THESE PAYMENTS SHOULD BE MADE ON SEPARATE CHECKS. PLEASE INDICATE ON EACH CHECK THAT AN ALLOCATION HAS Office and P.O. Address BEEN MADE. Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Page 4 of 4 American LegalNet, Inc. Form #412 LRD 2/23/01 ALL RIGHTS RESERVED www.USCourtForms.com © Clerk of Superior Court of Arizona in Maricopa County COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. EMPLOYER/PAYOR OF FUNDSNo. : Calendar TRANSMITTAL OF PAYMENT FORM Plaintiff(s) : JUDICIAL SUBPOENA This format should be used by employers/payor of funds who choose to send one check to the Support Payment -against: Clearinghouse (P.O. Box 52107, Phoenix, AZ 85072-2107) for support payments for numerous employees/payor of funds. : PAY PERIOD ENDING DATE: : Defendant(s) : . . . . . . EMPLOYER/PAYOR OF FUNDS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................. FROM: ADDRESS THE PEOPLE OF THE STATE OF NEW YORK TO CONTACT PERSON PHONE FAX TRANSMITTAL DATE: GREETINGS: ATLAS NUMBER EMPLOYEE'S EMPLOYEE'S TOTAL WE COMMAND YOU, that all business and excuses being laid aside, TRANSMITTED (*) you and each of you attend before NAME SSN , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Court in Witness, Honorable County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address GRAND TOTAL $_______________________ (*) If you have allocated support, please use an asterisk next to Telephone No.: amount in this column. the payment Facsimile No.: E-Mail Address: Mobile Tel. No.: Page 5 of 5 American LegalNet, Inc. Form #412 LRD 2/23/01 ALL RIGHTS RESERVED www.USCourtForms.com © Clerk of Superior Court of Arizona in Maricopa County