Name Address Phone Representing Self SUPERIOR COURT OF ARIZONA YAVAPAI COUNTY (2) Case No _________________ (1)________________________________ Petitioner/Plaintiff ATLAS No. _________________ _________________________________ Respondent/Defendant ORDER OF ASSIGNMENT A.R.S. § 25-504 TO: Current and future employers or other payors of: Name (3):____________________________________ SSN:_________________________ You shall withhold court-ordered monthly payments as follows: Current Child Support Current Spousal Maintenance Child Support Arrearages/Interest Spousal Maintenance Arrearages/Interest Clearinghouse Handling Fee Total Amount Per Month $ $ $ $ $ $ 5.00 * ** * The $5.00 Handling Fee is subject to statutory change pursuant to A.R.S. § 25-510(D). **No more than 50% of the employee’s disposable earnings may be taken to satisfy an order issued for support or spousal maintenance. A.R.S. § 33-1131 This Order of Assignment modifies any previously dated Orders of Assignment with the same case number as listed above in (2). 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 (person ordered to make support payments). If you are again obligated to pay monies to the obligor within 90 days, you are bound by this Order of Assignment. Payment must be sent to the Clearinghouse within 2 business days after the obligor is paid. This Order 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. All payments shall be sent to: Support Payment Clearinghouse P.O. Box 52107 Phoenix, AZ 85072-2107 The ATLAS number above in (2) and the employee’s name and social security number in (3) must appear on the transmittal payment form or check. You shall not discharge or otherwise discipline the person named in this assignment because of service of this Order of Assignment. Date Judicial Officer or Clerk of the Superior Court Superior Court of Arizona in Yavapai County July 2010 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com DRS82f CURRENT EMPLOYER INFORMATION CASE NUMBER: DO ______________________ ATLAS #________________________ NAME OF PERSON WHO IS PAYING SUPPORT ________________________________ CURRENT EMPLOYER NAME __________________________________________ ADDRESS _______________________________________ CITY ___________________________________ STATE/ ZIP ___________ PHONE ________________________________ FAX ______________ PREVIOUS EMPLOYER (if known) NAME __________________________________________ ADDRESS ______________________________________ CITY ___________________________________ STATE/ ZIP ____________ PHONE _______________________________ FAX ______________ DATE SUBMITTED BY Superior Court of Arizona in Yavapai County July 2010 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com DRS82f