JDF 84 3 /1 8 NOTI CE TO TERMINATE INCOME ASSIGNMENT District Court County Court Denver Juvenile Court County, Colorado Court Address: In re: Petitioner: v. Respondent/Co - Petitioner: COURT USE ONLY Attorney or Party Without Attorney (Name and A ddress) : Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom NOTICE TO TERMINATE INCOME ASSIGNMENT To (Employer/Trustee/Other Payor of Funds at (address) You are notified that the Income Assignment on (name of Obligee) activated on (date) will terminate effective (date). This notice is issued by: (check one) Obligee O Child Support Enforcement Unit Court By chec king this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. By checking this box, I am acknowledging that I have made a change to the original content of this form. VERIFICATION I declare under penalty of perjury under the law of Colorado that the foregoing is true and correct. Executed on the day of , , at (date) (month) (year) (city or other location, and state OR country ( P rinted n ame of Person filing ) Signature of Person filing CERTIFICATE OF MAILING I certify that on (date) the original and one copy of this docu ment were filed with the Court; and, a true and accurate copy of the NOTICE TO TERMINATE INCOME ASSIGNMENT was served on the other parties by placing it in the United States mail, postage pre - paid, and addressed to the following: TO: (Your signature) American LegalNet, Inc. www.FormsWorkFlow.com