For Clerk’s Use Only THE SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY ) ) ) ) ) ) (1) Petitioner/Plaintiff vs. (2) Respondent/Defendant TO: (3) Case Number: (4) ATLAS Number: ORDER OF ASSIGNMENT Current and future employers or other payors of: SSN: (5)Name: This order modifies and replaces any previous “Order of Assignment” with the same case number. You shall withhold court-ordered payments as follows: Current Child Support $ Current Spousal Maintenance/Support $ Payments on Arrears / Interest $ Clearinghouse Handling Fee $ 2.25 per month* TOTAL AMOUNT per month $ , but no more than 50% of disposable earnings (A.R.S. § 33-1131). *The Clearinghouse handling fee is set by statute and subject to change (A.R.S. § 25-510). 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 90 continuous days from the last payment to the Obligor. If you are again obligated to pay monies to the Obligor within 90 days, you are again bound by this “Order of Assignment.” Payment must be sent to the Support Payment Clearinghouse within two (2) business days of the date the monies were withheld. This Order of Assignment terminates on the last day of , unless it includes an arrearage payment, in which case the total amount listed above shall continue to be withheld until further order. You shall NOT discharge or otherwise discipline the person named in this assignment, because of service of this “Order of Assignment.” The above ATLAS number and employee's name must appear on the Transmittal Form or check. Make payments payable and send to: Support Payment Clearinghouse, P.O. Box 52107, Phoenix, AZ 85072-2107 Dated this day of , 20 . Judicial Officer or Clerk of Superior Court OOA Form #407 County Page 1 of 1 LRD 03/21/2005 ALL RIGHTS RESERVED © Clerk of Superior Court of Arizona in Maricopa American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS FOR COMPLETING AN ORDER OF ASSIGNMENT DEFINITIONS: "Obligor" is the person ordered to make support payments. "Obligee" is the person or agency entitled to receive support. COMPLETE THIS FORM FOR AN ORDER OF ASSIGNMENT IF: You have been directed by the court to prepare an Order of Assignment. You want to modify the Order of Assignment you may wish to seek legal advice from an attorney or you can obtain the forms from the Self-Service Center. These forms are not provided by Fax-onDemand. You may select fax document number 106 to obtain information on obtaining forms from the Self-Service Center. HOW TO COMPLETE THIS FORM: Step Number Instruction TYPE OR PRINT NEATLY USING BLACK INK. Follow the instructions given below. Match each numbered step in the instructions with the item on the attached form that has the same number. 1. Match the numbered instructions below with the matching numbers on the form. 2. Fill in the name of the person shown as the petitioner on the original “Order of Assignment.” 3. Fill in the name of the person shown as the respondent on the original “Order of Assignment.” 4. Fill in the case number and ATLAS Number (if any) that appears on the original “Order of Assignment.” 5. Fill in the name and Social Security Number (SSN) of the person obligated to make payments. STOP. Judicial Officers or staff will complete the rest of this page. Proceed to next form. OOA Form #407 County Page 2 of 1 LRD 03/21/2005 ALL RIGHTS RESERVED © Clerk of Superior Court of Arizona in Maricopa American LegalNet, Inc. www.FormsWorkflow.com