COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index Authorization AgreeDirect DepositNo. Child Support ment for Automatic Deposits (ACH Direct Deposit Application : Calendar No. CREDITS) DIRECT DEPOSIT INFORMATION : JUDICIAL SUBPOENA Plaintiff(s) NAME _________________________________________________ Child support payments can be sent to you by direct deposit. (please print) first m.i. last If you want all payments you receive from the Florida State Disbursement -against: Unit (SDU) to be directly deposited to your financial institution, complete CASE NO. ______________________________________________ the Direct Deposit Application using the following instructions. With the exception of your signature, type or print the requested information. : LOCAL DEPOSITORY __________________________________ (Count(ies) in which your case(s) is filed) If you need help or further clarification please contact your local deposi: tory (Clerk’s Office in which your child support case is filed). DAY TIME PHONE _(______)_____________________________ Return the form to your local depository (Clerk’s Office in which your Defendant(s) : child support . . . . .filed).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HOME . . . . . . . case is . . . . . . . . PHONE _(______)_______________________ Keep these instructions and a copy of the completed form for your records. Original must be submitted with voided check or deposit slip. If you do not provide all the information requested, the Clerk may not be THE PEOPLE OF THE STATE OF NEW YORK able to process your application in a timely fashion. TO FREQUENTLY ASKED QUESTIONS 1. Who is eligible for this service? If you currently receive payments from the Florida SDU and your case is not handled by the Department of Revenue. I hereby authorize the local depository (Clerk of the Circuit Court) and/or Florida SDU to initiate credit entries and to initiate if necessary, debit entries and adjustments for any credit entries in error to my: (check one) _____Checking Account _____ Savings Account Indicate below the bank name to credit and/or debit the same to such account. GREETINGS: Bank Name 2. How secure and reliable is direct deposit? Direct Deposit is very safe and reliable. It allows money allbe electroni- and excuses being laid aside, you and each of you attend before to business WE COMMAND YOU, that cally transferred from the Florida SDU bank account to your financial the Honorable at the Branch Court institution. located at County Deposit eliminates the possibility of lost /stolen checks. of • Direct City • in With direct deposit, there are no mail delays and no check cash- , 20 room , on the day of , at o'clock in the noon, and at any recessed oring fees to pay. Funds may be available sooner than a mailed witness in this action on the part of the Zip Code adjourned date, to testify and give evidence as a State payment. • Avoid the inconvenience of a long line at the bank. Account Number • Automatic deposit while you are on vacation, traveling on business or in the event that you are ill. Routing as a contempt of court and will make you liable to Your failure to comply with this subpoena is punishable Number for a maximum penalty of $50 and all damages sustained as a 3. What do I do if I change financial institutions or close my account the party on whose behalf this subpoena was issued or move? result of your failure to comply. If you change banks or close your account and want to discontinue direct deposit, you must complete a new form. Witness, Honorable 4. How do I sign up for direct deposit? To signCourtdirect deposit, complete the attached Direct Deposit Appliup for in County, day of cation. Instructions are at the top of this form to assist you in completing this application. Make sure that you include the financial institution routing number, account number, account type and a voided check with your application. 5. How log does it take to set up or change direct deposit? Please allow a maximum of 30 days for processing new information or updating existing information. 6. How will I know when my payments are being paid by direct deposit instead of by check? Any payments received between the receipt of your authorization form and the start of the direct deposit will be mailed to you. 7. Will I be notified when money is posted in my account? The local depository or Florida SDU will not send you a notice each time a payment is deposited to your account. You can verify that a payment was deposited to your account by: • logging on to MyFloridaCounty.com • calling Florida SDU VRU – 1-877-769-0251 • local (Tallahassee area) 201-0140 • calling your financial institution FACC 05.14.2003 Social Security Number Signature Date , one of the Justices of the The , 20 authority is to remain in effect until the local Depository (Clerk of the Circuit Court) receives written notification from me of its termination in such time and in such manner as to afford the local Depository (Clerk) and/or Florida SDU a reasonable opportunity to act on it. The local Depository (Clerk of Court) and or (Attorney must sign above and type name below) the Florida SDU shall not be held liable for any loss sustained as a result of any incorrect credit or debit except to the extent of the amount of error in said credit or debit. Attorney(s) for ● If you will be using a checking account, attach a voided check to this form. ● If you will be using a savings account, attach a deposit slip to this form. Office and P.O. Address Keep these instructions and a copy of the completed form for your records. Original must be submitted with voided check or deposit slip. Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Please mail form to: LOCAL DEPOSITORY (The Clerk’s Office where the case is filed) American LegalNet, Inc. www.USCourtForms.com ,