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Income Deduction Order (Non-Title IV Case) Form. This is a Florida form and can be use in Hillsborough Local County.
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INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM
12.996(a), INCOME DEDUCTION ORDER (3/10)
When should this form be used?
This form should be used in non‐Title IV‐D cases when the court has ordered that support be paid by the
obligor’s payor through an income deduction order.
This form includes several blanks that must be filled in as applicable. The obligor is the person who is
obligated to pay the support ordered by the court and the obligee is the person entitled to receive the
support awarded by the court.
In Paragraph 1, one of the three lines must be checked off. The court order that establishes the support
award and/or the settlement or mediation agreement entered into between the parties should state the
effective date of the Income Deduction Order. The appropriate effective date should be checked off in
Paragraph 1.
The blank lines in Paragraph 2 should be completed tracking the same terms of support as are in the
court order that establishes the support award and/or the settlement or mediation agreement. The first
blank in each line should state the amount of the support payment and the second blank in each line
should state the time period that covers said support award. For example, if the child support is $100
per month the first blank would say $ “100” and the second blank in that line would say “month”.
Similarly, if the payments are to be payable weekly, then the second blank would say “week”. If there
are any arrearages owed at the time the Income Deduction Order is entered, they must be included in
the line for arrears, along with the amount and frequency of the payments due for the arrears, which
shall be no less than 20% of the current support obligation. If the payments are to be payable through
the State Disbursement Unit, the actual dollar amount of the service fee for the support awarded in
your case (4% of each payment not to exceed $5.25 per payment) should be included on the appropriate
line.
Paragraph 6 must be completed to show what percentage, if any, of a one‐time payment made to the
obligor should be applied to any arrearage in support that may be due to the obligee.
What should I do next?
For this order to be effective, it must be signed by the judge. This form should be typed or printed in
black ink. After completing this form, you must first send a copy to the other party or his or her
attorney, if he or she is represented by an attorney, for approval or objection to the form before you
send it to the judge assigned to your case. If the opposing party or his or her attorney, if represented,
approves the form order, you may send the original proposed order and two copies to the judge
assigned to your case with a letter telling the judge that you have first sent a copy of this proposed order
to the opposing counsel or party, if unrepresented, and that they have no objection to the judge signing
Instructions for Florida Family Law Rules of Procedure Form 12.996(a), Income Deduction Order (3/10)
American LegalNet, Inc.
www.FormsWorkFlow.com
this order. If the other party or his or her attorney, if represented, has an objection to the proposed
order as completed by you, you must tell the judge that you have sent a copy of this proposed order to
the opposing party or his or her counsel, if represented, and that they specifically object to the entry of
the proposed form Income Deduction Order. You must also send stamped self‐addressed envelopes to
the judge addressed to you and the opposing party or his or her attorney, if represented. You should
keep a copy for your own records. If the judge signs the Income Deduction Order, the judge will mail
you and the opposing party (or their attorney) copies of the signed order in the envelopes you provide
to the court.
Where can I look for more information?
Before proceeding, you should read “General Information for Self‐Represented Litigants” found at the
beginning of these forms. The words that are in “bold underline” in these instructions are defined
there. For further information see section 61.1301, Florida Statutes.
Special Instructions...
When the Income Deduction Order becomes effective (either immediately or delayed until arrearage),
you must then also send a copy of the Income Deduction Order to the obligor’s employer along with a
Notice to Payor, Florida Family Law Rules of Procedure Form 12.996(b), for the Income Deduction
Order to take effect.
It is your responsibility to determine what extra steps and/or forms, if any, must be taken, supplied,
and/or filed to insure the Income Deduction Order is implemented.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules
of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms
also must put his or her name, address, and telephone number on the bottom of the last page of every
form he or she helps you complete.
Instructions for Florida Family Law Rules of Procedure Form 12.996(a), Income Deduction Order (3/10)
American LegalNet, Inc.
www.FormsWorkFlow.com
IN THE CIRCUIT COURT OF THE THIRTEENTH JUDICIAL CIRCUIT,
IN AND FOR HILLSBOROUGH COUNTY, FLORIDA
Case No: ________________________
Division: ________________________
_______________________________,
Petitioner,
And
_______________________________,
Respondent.
INCOME DEDUCTION ORDER (Non‐Title IV Case)
TO: ANY PRESENT OR SUBSEQUENT EMPLOYERS/PAYORS OF OBLIGOR
{name} ________________________________________________________
YOU ARE HEREBY ORDERED to make regular deductions from all income due and payable to the
above‐named obligor in accordance with the terms of this order as follows:
1. This Income Deduction Order shall be effective
[Choose only one]
___ immediately.
___ upon a delinquency in the amount of $___________ but not to exceed one month’s payment,
pursuant to the order establishing, enforcing, or modifying the obligation.
___ beginning {date} __________________.
2. You shall deduct:
$_______________ per _______________ for child support
$_______________ per _______________ for permanent alimony
$_______________ per _______________ for rehabilitative alimony
$_______________ per _______________ for ______________arrears totaling $____________
The deduction for arrears shall be no less than 20% of the current support obligation. After the full
amount of any arrears is paid, you shall deduct for attorneys’ fees and costs owed until the full amount
is paid.
$_______________ per _______________ for attorneys’ fees and costs totaling $___________
$_______________ per _______________ for State of Florida Disbursement Unit fee
(4% of each payment not to exceed $5.25 per payment)
$_______________ Total amount of income to be deducted each pay period
Instructions for Florida Family Law Rules of Procedure Form 12.996(a), Income Deduction Order (3/10)
American LegalNet, Inc.
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3. You shall pay the deducted amount to the “State of Florida Disbursement Unit”, and mail it to the
State of Florida Disbursement Unit P.O. Box 8500, Tallahassee, FL 32314‐8500, (tel.) (877) 769‐0251.
All payments must include the obligor’s name (last, middle, first), obligor’s social security number,
obligee’s name (last, middle, first), name of county where court order originated, and case number.
All payments must be made by check, money order, cashier’s check, certified check, or through the
Internet with access provided by the State of Florida www.floridasdu.com. No credit will be given for
any payments made directly to the obligee without a court order permitting direct payments.
4. If a delinquency accrues after the order establishing, modifying, or enforcing the obligation has been
entered and there is no order for repayment of the delinquency or a preexisting arrearage, a payor
shall deduct an additional 20 percent of the current support obligation or other amount agreed to
by the parties until the delinquency and any attorneys’ fees and costs are paid in full. No deduction
may be applied to attorneys’ fees and costs until the delinquency is paid in full.
5. You shall not deduct in excess of the amounts allowed under the Consumer Credit Protection Act, 15
U.S.C. §673(b), as amended.
6. You shall deduct ( Choose only one) ( ) the full amount, ( ) _____%, or ( ) none of the income
which is payable to the obligor in the form of a bonus or other similar one‐time payment, up to the
amount of arrearage reported in the Income Deduction Order or the remaining balance thereof, and
forward the payment to the State of Florida Disbursement Unit. For purposes of this subparagraph,
“bonus” means a payment in addition to an obligor's usual compensation and which is in addition to
any amounts contracted for or otherwise legally due and shall not include any commission
payments due an obligor.
7. This Income Deduction Order shall remain in effect so long as the underlying order of support is
effective or until further order of the court.
STATEMENT OF OBLIGOR’S RIGHTS, REMEDIES, AND DUTIES
8. The obligor is required to pay all amounts and fees specified within this Income Deduction Order.
9. The amounts deducted may not be in excess of that allowed under the Consumer Credit Protection
Act, 15 U.S.C. §1673(b) as amended.
10. This income deduction order applies to all of the obligor’s current and subsequent payors and
periods of employment.
11. A copy of the Income Deduction Order will be served upon the obligor’s payor or payors.
12. Enforcement of the Income Deduction Order may only be contested on the ground of mistake of
fact regarding the amount owed pursuant to the order establishing, enforcing, or modifying the
obligation, the arrearages, or the identity of the obligor, the payor, or the obligee.
13. The obligor is required to notify the obligee and, when the obligee is receiving IV‐D services, the IV‐D
agency, within 7 days of any changes in the obligor’s address, payors, and the addresses of the
obligor’s payors.
Instructions for Florida Family Law Rules of Procedure Form 12.996(a), Income Deduction Order (3/10)
American LegalNet, Inc.
www.FormsWorkFlow.com
14. In a Title IV‐D case, if an obligation to pay current support is reduced or terminated due to
emancipation of a child and the obligor owes an arrearage, retroactive support, delinquency, or
costs, income deduction continues at the rate in effect immediately prior to emancipation until all
arrearages, retroactive support, delinquencies, and costs are paid in full or until the amount of
withholding is modified.
ORDERED on_____________________________.
______________________________
CIRCUIT JUDGE
COPIES TO:
Obligee
Obligor
Other: ____________________________________
Instructions for Florida Family Law Rules of Procedure Form 12.996(a), Income Deduction Order (3/10)
American LegalNet, Inc.
www.FormsWorkFlow.com
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE
FORM 12.996(b), NOTICE TO PAYOR (3/10)
When should this form be used?
This form should be used for when an Income Deduction Order has been entered by the Court which is
to take effect immediately.
This form should be typed or printed in black ink. After completing this form, the original of this form
should be filed with the clerk of the circuit court in the county in which the action is pending. You
should keep a copy for your own records.
What should I do next?
A copy of this form, and a copy of the Income Deduction Order, must be sent to the obligor’s payor by
certified mail, return receipt requested. The return receipt should be sent to the person that prepared
this form so that it can filed with the clerk along with Florida Family Law Rules of Procedure Form
12.996(c) Notice of Filing Return Receipt.
A copy of this form must also be mailed or hand delivered to the other party or his or her attorney.
Where can I look for more information?
Before proceeding, you should read “General Information for Self‐Represented Litigants” found at the
beginning of these forms. The words that are in “bold underline” in these instructions are defined
there. See Florida Statute section 61.1301.
Special Instructions...
The Obligor’s social security number must be written on the copy of the Notice to Payor that is mailed to
the Obligor’s Payor. The social security number should not be written on the copy of the Notice to Payor
filed with the court.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules
of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms
also must put his or her name, address, and telephone number on the bottom of the last page of every
form he or she helps you complete.
Instructions for Florida Family Law Rules of Procedure Form 12.996(b), Notice to Payor (3/10)
American LegalNet, Inc.
www.FormsWorkFlow.com
IN THE CIRCUIT COURT OF THE THIRTEENTH JUDICIAL CIRCUIT,
IN AND FOR HILLSBOROUGH COUNTY, FLORIDA
Case No: ________________________
Division: ________________________
_________________________________,
Petitioner,
And
_________________________________,
Respondent.
NOTICE TO PAYOR
TO:
Name of Obligor’s Payor: ____________________________________
Payor’s Address:
____________________________________
RE:
Obligor
Obligee
Name:
___________________________________
________________________________
Address:
___________________________________
________________________________
___________________________________
________________________________
Obligor’s social security number:_______________________________.
NOTE: The Obligor’s social security number should be placed on the copy of the Notice to Payor that is
mailed to the Obligor’s Payor. This line should be left blank on the original Notice to Payor filed with
the court.
YOU, THE PAYOR, ARE HEREBY NOTIFIED that, under section 61.1301, Florida Statutes, you have the
responsibilities and rights set forth below with regard to the accompanying Income Deduction Order
and/or any attachment(s):
1. You are required to deduct from the obligor’s income the amount specified in the income deduction
order, and in the case of a delinquency the amount specified in the notice of delinquency, and to
pay that amount to the State of Florida Disbursement Unit. The amount actually deducted plus all
administrative charges shall not be in excess of the amount allowed under s. 303(b) of the Consumer
Credit Protection Act, 15 U.S.C. §1673(b) as amended.
2. You must implement income deduction no later than the first payment date which occurs more than
14 days after the date the income deduction order was served on you, and you shall conform the
amount specified in the income deduction order or, in Title IV‐D cases, income deduction notice to
the obligor’s pay cycle. The court should request at the time of the order that the payment cycle will
reflect that of the obligor.
Instructions for Florida Family Law Rules of Procedure Form 12.996(b), Notice to Payor (3/10)
American LegalNet, Inc.
www.FormsWorkFlow.com
3. You must forward, within 2 days after each date the obligor is entitled to payment from you, to the
State of Florida Disbursement Unit, the amount deducted from the obligor’s income, a statement as
to whether the amount totally or partially satisfies the periodic amount specified in the income
deduction order, or in Title IV‐D cases, income deduction notice, and the specific date each
deduction is made. If the IV‐D agency is enforcing the order, you shall make these notifications to
the agency.
4. If you fail to deduct the proper amount from the obligor’s income, you are liable for the amount you
should have deducted, plus costs, interest, and reasonable attorneys’ fees.
5. You may collect up to $5 against the obligor’s income to reimburse you for administrative costs for
the first income deduction and up to $2 for each deduction thereafter.
6. The notice to payor, or, in Title IV‐D cases, income deduction notice, and in the case of a
delinquency, the notice of delinquency, are binding on you until further notice by the obligee, IV‐D
agency, or the court or until you no longer provides income to the obligor.
7. When you no longer provide income to the obligor, you shall notify the obligee and provide the
obligor’s last known address and the name and address of the obligor’s new payor, if known. If you
violate this provision, you are subject to a civil penalty not to exceed $250 for the first violation or
$500 for any subsequent violation. If the IV‐D agency is enforcing the order, you shall make these
notifications to the agency instead of the obligee. Penalties shall be paid to the obligee or the IV‐D
agency, whichever is enforcing the income deduction order.
8. You shall not discharge, refuse to employ, or take disciplinary action against an obligor because of
the requirement for income deduction. A violation of this provision subjects you to a civil penalty
not to exceed $250 for the first violation or $500 for any subsequent violation. Penalties shall be
paid to the Obligee or the IV‐D agency, whichever is enforcing the income deduction, if any alimony
or child support obligation is owing. If no alimony or child support obligation is owing, the penalty
shall be paid to the obligor.
9. The obligor may bring a civil action in the courts of this state against a payor who refuses to employ,
discharges, or otherwise disciplines an obligor because of income deduction. The obligor is entitled
to reinstatement of all wages and benefits lost, plus reasonable attorneys’ fees and costs incurred.
10. The requirement for income deduction has priority over all other legal processes under state law
pertaining to the same income and that payment, as required by the notice to payor or the income
deduction notice, is a complete defense by the payor against any claims of the obligor or his or her
creditors as to the sum paid.
11. When you receive notices to payor or income deduction notices requiring that the income of two or
more obligors be deducted and sent to the same depository, the payor may combine the amounts
that are to be paid to the depository in a single payment as long as the payments attributable to
each obligor are clearly identified.
12. If you receive more than one notice to payor or income deduction notice against the same obligor,
the payor shall contact the court or, in Title IV‐D cases, the Title IV‐D agency for further instructions.
Instructions for Florida Family Law Rules of Procedure Form 12.996(b), Notice to Payor (3/10)
American LegalNet, Inc.
www.FormsWorkFlow.com
13. In a Title IV‐D case, if an obligation to pay current support is reduced or terminated due to the
emancipation of a child and the obligor owes an arrearage, retroactive support, delinquency, or
costs, income deduction continues at the rate in effect immediately prior to emancipation until all
arrearages, retroactive support, delinquencies, and costs are paid in full or until the amount of
withholding is modified.
14. All notices to the obligee shall be sent to the address provided in this notice to payor, or any place
thereafter the obligee requests in writing.
15. An employer who employed 10 or more employees in any quarter during the preceding state fiscal
year or who was subject to and paid tax to the Department of Revenue in an amount of $20,000 or
more shall remit support payments deducted pursuant to an income deduction order or income
deduction notice and provide associated case data to the State Disbursement Unit by electronic
means approved by the department. Payors who are required to remit support payments
electronically can find more information on how to do so by accessing the State Disbursement Unit’s
website at www.floridasdu.com and clicking on “Payments.” Payment options include Expert Pay,
Automated Clearing House (ACH) credit through your financial institution,
www.myfloridacounty.com, or Western Union. Payors may contact the SDU Customer Service
Employer telephone line at 1‐888‐833‐0743.
16. Additional information regarding the implementation of this Notice to Payor may be found at
www.floridasdu.com.
I certify that a copy of this document was [Choose only one] ( ) mailed ( ) faxed and mailed
( ) hand delivered to the person(s) listed below on {date} _____________________________________
Other party or his/her attorney:
Name: ________________________________________
Address: ______________________________________
City, State, Zip: _________________________________
Fax Number: __________________________________
_____________________________________________
Signature of Party or his/her attorney
Printed Name: _________________________________
Address: ______________________________________
City, State, Zip: _________________________________
Telephone Number: _____________________________
Fax Number: ___________________________________
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks]
I, {full legal name and trade name of nonlawyer} _____________________________________________,
a nonlawyer, whose address is {street} _________________________, {city} ______________________,
{state} ______________,{phone} _________, helped {name} _______________________________, who
is the petitioner, fill out this form.
Instructions for Florida Family Law Rules of Procedure Form 12.996(b), Notice to Payor (3/10)
American LegalNet, Inc.
www.FormsWorkFlow.com
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE
FORM 12.996(c) NOTICE OF FILING RETURN RECEIPT (3/10)
When should this form be used?
This form should be used when an Income Deduction Order, Florida Family Law Rules of Procedure
Form 12.996(a), is entered by the court and a Notice to Payor, Florida Family Law Rules of Procedure
Form 12.996(b), has been sent by certified mail to the obligor’s payor. When the post office returns the
return receipt to you showing that the obligor’s payor has received the Notice to Payor, you should type
or print this form in black ink. After completing this form, you should sign it and attach the return
receipt you received from the post office. The original of this form (and the attached return receipt)
should be filed with the clerk of the circuit court in the county in which the action is pending. You
should keep a copy for your own records.
What should I do next?
A copy of this form must be mailed or hand delivered to the other party or his or her attorney.
Where can I look for more information?
Before proceeding, you should read “General Information for Self‐Represented Litigants” found at the
beginning of these forms. The words that are in “bold underline” in these instructions are defined
there. For further information, see section 61.1301, Florida Statutes.
Special notes...
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules
of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms
also must put his or her name, address, and telephone number on the bottom of the last page of every
form he or she helps you complete.
Instructions for Florida Family Law Rules of Procedure Form 12.996(c), Notice of Filing Return Receipt (3/10)
American LegalNet, Inc.
www.FormsWorkFlow.com
IN THE CIRCUIT COURT OF THE THIRTEENTH JUDICIAL CIRCUIT,
IN AND FOR HILLSBOROUGH COUNTY, FLORIDA
Case No: ________________________
Division: ________________________
_________________________________,
Petitioner,
And
_________________________________,
Respondent.
NOTICE OF FILING RETURN RECEIPT
{Name}_____________________, the [Choose only one] ( )Petitioner ( )Respondent, files
the attached Return Receipt in reference to the Notice to Payor sent by certified mail to {Payor’s name}
___________________________, the [Choose only one] ( )Petitioner’s ( ) Respondent’s employer.
I certify that a copy of this document was [Choose only one] ( ) mailed ( ) faxed and mailed
( ) hand delivered to the person(s) listed below on {date} _____________________________________
Other party or his/her attorney:
Name: ________________________________________
Address: ______________________________________
City, State, Zip: _________________________________
Fax Number: __________________________________
_____________________________________________
Signature of Party or his/her attorney
Printed Name: _________________________________
Address: ______________________________________
City, State, Zip: _________________________________
Telephone Number: _____________________________
Fax Number: ___________________________________
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks]
I, {full legal name and trade name of nonlawyer} _____________________________________________,
a nonlawyer, whose address is {street} _________________________, {city} ______________________,
{state} ______________,{phone} _________, helped {name} _______________________________, who
is the petitioner, fill out this form.
Instructions for Florida Family Law Rules of Procedure Form 12.996(c), Notice of Filing Return Receipt (3/10)
American LegalNet, Inc.
www.FormsWorkFlow.com