SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY FOR CLERK’S USE ONLY (1) Case No. ATLAS No Petitioner (in original case) (if applicable) Respondent (in original case) EX PARTE ORDER OF ASSIGNMENT A.R.S. § 25-504 TO: Current and future employers or other payers of: (2) Name: SSN: You shall withhold court-ordered payments as follows:(3) (Use same amounts as listed in (6) of the “Request”) Current Child Support $ Current Spousal Maintenance $ Payments on Child Support Arrearages/Interest $ Payments on Spousal Maintenance Arrearages/Interest $ Subtotal $ per month Clearinghouse handling fee $ 5.00* per month Total amount per month $ but no more than 50% of the disposable earnings (A.R.S. § 33-1131) to be made payable to the Support Payment Clearinghouse. * Effective July 1, 2010. The monthly Clearinghouse handling fee is set by statute and is subject to change (A.R.S. § 25-510). THIS ORDER MODIFIES AND REPLACES ANY PREVIOUSLY DATED ORDERS OF ASSIGNMENT WITH THE SAME CASE NUMBER. This Order of Assignment is effective immediately upon receipt by an employer or other payor, including self-employed persons, and continues until further Order, or until a period of ninety continuous days from the last payment to the person ordered to make support payments (the Obligor). If you are again obligated to pay monies to the Obligor within ninety days, you are again bound by this Order of Assignment. Payment must be sent to the Clearinghouse within two business days after the obligor is paid. This is an “Ex Parte” Order. If you are the first employer or other payor served, you are ordered to serve by personal delivery or by registered mail a copy of: (1) the Request, (2) the Order of Assignment, and (3) the Notice to the person ordered to pay within five (5) days of the date you were served. DRWA82f © Superior Court of Arizona in Maricopa County July 20, 2010 Page 1 of 2 Use Most Current Version ALL RIGHTS RESERVED American LegalNet, Inc. www.FormsWorkFlow.com Case No. The first employer or other payor served shall not withhold or deduct amounts specified in the Ex Parte Order of Assignment for fourteen (14) calendar days to allow the obligor an opportunity to contest the Order of Assignment, if necessary, pursuant to A.R.S. § 25-504(G). Any future employers or future payors shall begin withholding no later than fourteen (14) days after receipt of the Order of Assignment. YOU SHALL NOT DISCHARGE OR OTHERWISE DISCIPLINE THE PERSON NAMED IN THIS ASSIGNMENT BECAUSE OF SERVICE OF THIS ORDER OF ASSIGNMENT. THE ATLAS NUMBER AND EMPLOYEE'S NAME MUST APPEAR ON THE TRANSMITTAL FORM OR CHECK. Send Payments to: SUPPORT PAYMENT CLEARINGHOUSE, P.O. BOX 52107, PHOENIX, ARIZONA 85072-2107 Dated: Judicial Officer or Clerk of the Superior Court DRWA82f © Superior Court of Arizona in Maricopa County July 20, 2010 Page 2 of 2 Use Most Current Version ALL RIGHTS RESERVED American LegalNet, Inc. www.FormsWorkFlow.com