COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: Index No. CR-119 : Plaintiff(s) : : : : Calendar No. FOR COURT USE ONLY JUDICIAL SUBPOENA -against- PEOPLE OF THE STATE OF CALIFORNIA v. DEFENDANT: Defendant(s) : ...................................................... ORDER FOR INCOME DEDUCTION (Pen. Code, § 1202.42) CASE NUMBER: THE PEOPLE OF THE STATE OF NEW YORK To: Employer: TO Address: GREETINGS: Phone: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court The court has found that the defendant has the ability to pay restitution under Penal Code section 1202.42 and has ordered that located at County of he or she pay restitution of $ plus 10% interest. in room , on the day of , 20 , at o'clock in the noon, and at any recessed You adjourned date, to testify and give evidence of thewitness in in this actionon the part of the , or are ordered to withhold a portion of the earnings as a defendant this action (name): (last 4 digits of social security number (specify): 3. You are ordered to deduct: $ funds to the Your failure to comply ), each pay period. from the above named employee's pay each period and forward 1. 2. 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 Other (specify): Clerk of the above entitled court result of your failure to comply. , one of the Justices of the 4. This order will terminate upon payment in full or further order of this court. Witness, Honorable Court in County, day of , 20 Date: (Attorney must sign above and type name below) CLERK'S CERTIFICATE Attorney(s)The foregoing is a full, true, and correct for copy of the original on file in this office. SEAL Office and P.O. Address Date: By CLERK OF THE SUPERIOR COURT , Deputy Form Approved for Optional Use Judicial Council of California CR-119 [New January 1, 2005] Telephone No.: Facsimile No.: E-Mail Address: ORDER FOR INCOME DEDUCTION No.: Mobile Tel. (Pen. Code, § 1202.42) Page 1 of 2 Penal Code, § 1202.42 www.courtinfo.ca.gov American LegalNet, Inc. www.USCourtForms.com PEOPLE OF THE STATE OF CALIFORNIA v. DEFENDANT: CASE NUMBER: Notice to Employer re: Order for Income Deduction (Pen. Code, § 1202.42) 1. You are required to deduct the amount specified in the Order for Income Deduction from the employee's income and to pay that amount to the clerk of the above entitled court or its agent. The order is to be implemented no later than the first payment date that occurs more than 14 days after the date of service of the order. Within two days after each payment date, forward the amount deducted and a statement about whether the amount totally or partially satisfies the periodic amount specified in the income deduction order. If you fail to deduct the proper amount from the employee's income, you are liable for the amount you should have deducted, plus costs, interest, and reasonable attorney fees. You may collect up to five dollars ($5) against the employee's income to reimburse you for administrative costs for the first deduction and up to one dollar ($1) for each deduction thereafter. This order and notice are binding until further notice by the court or until you no longer provide income to the employee. When you no longer provide income to the employee, you must notify the clerk of the above entitled court and provide the employee's last known address and the name and address of the employee's new employer, if known. If you violate this provision, you are subject to a civil penalty not to exceed two hundred fifty dollars ($250) for the first violation or five hundred dollars ($500) for any subsequent violation. You must not discharge, refuse to employ, or take disciplinary action against the employee because of an income deduction order. If you violate this provision, you are subject to a civil penalty not to exceed two hundred fifty dollars ($250) for the first violation or five hundred dollars ($500) for any subsequent violation. If you receive income deduction orders for two or more employees sent by the same court, you may combine the amounts that are to be paid in a single payment, but you must identify the portion of the payment that is attributable to each employee. 2. 3. 4. 5. 6. 7. 8. 9. 10. If you receive two or more income deduction orders against the same employee, you must contact the above entitled court for further instructions. CR-119 [New January 1, 2005] ORDER FOR INCOME DEDUCTION (Pen. Code, § 1202.42) Page 2 of 2