IN THE CIRCUIT OF THE TWELFTH JUDICIAL CIRCUIT IN AND FOR MANATEE COUNTY, FLORIDA CIVIL ACTION ______________________________, O BLIGEE and CASE NO: _________________ ______________________________, O BLIGOR. ______________________________________/ NOTICE TO PAYOR TO: ___________________________________________ ___________________________________________ ___________________________________________ RE: Obligor: ____________________________________ YOU ARE HEREBY NOTIFIED: 1. Deduction from Obligors Income. You are required to begin an income deduction in compliance with the Income Deduction Order entered by the court on __________________. A copy of that order and any Notice of Delinquency is enclosed for your payroll records. 2. Amount of Deduction. You must deduct from the income due the Obligor, the amount set forth in the Income Deduction Order, or in the case of a delinquency, the amount set forth in the Notice of Delinquency. 3. Place of Payment. All payments shall be paid to: STATE OF FLORIDA DISBURSEMENT UNIT POST OFFICE BOX 8500 TALLAHASSEE, FL 32314-8500 Each payment must be properly identified by showing the Obligors name, case number, security number and the words "Manatee County". 4. Effective Date. You must implement the income deduction no later than the first payment date which occurs more than 14 days after the date you receive this notice. 5. Forward Payments. You must forward to the FLSDU, within two (2) days after each payment date, the amount deducted from the Obligors income together with a statement as to whether the amount remitted totally or partially satisfies the periodic payment amount specified in the Income Deduction Order or Notice of Delinquency and the specific date each deduction is made. 6. Your Liability. If you fail to deduct the proper amount from the Obligors income, you are liable for the amount you should have deducted, plus costs, interest and reasonable attorneys fees. >>>> 2 7. Your Costs. You may deduct and retain from the Obligors income an additional $5.00 for the first deduction and $2.00 for each subsequent deduction to reimburse you for your administrative costs. 8. Consumer Credit Protection Act. The maximum amount to be deducted shall not exceed the amounts allowed under s. 303(b) of the Consumer Credit Protection Act, 15 U.S.C. 1673(b) as amended. The maximum amount to be deducted shall not exceed 50% of the disposable income where there is a second family, 60% where there is not a second family, and an additional 5% of either limit if the arrearage equals or exceeds 12 weeks of support payments. 9. Duration. The Income Deduction Order, this Notice to Payor, and in the case of a delinquency, the Notice of Delinquency, are binding upon you until released by the Court, until you no longer provide income to the Obligor, or in writing by the IV-D Agency or the office of the Clerk of the Circuit Court. 10. Duty to Report, Penalty If You Dont. You must notify the Court Depository when you are no longer providing income to the obligor. You must also provide the Obligors last known address, and the name and address of the Obligors new employer, if known. You are subject to a civil penalty not to exceed $250.00 for the first violation or $500.00 for any subsequent violation for failure to provide this notification. 11. Duty to Cooperate, Penalty If You Dont. You may not discharge, refuse to employ, or take disciplinary action against an Obligor because of an income deduction order. You face a civil penalty not to exceed $250.00 for the first violation or $500.00 for any subsequent violation. 12. Priority Under Law. The Income Deduction Order has priority over all other legal processes under state law pertaining to the same income. Payment in compliance with the Income Deduction Order is a complete defense by you against any claims of th e obligor or his creditors as to the sums paid. 13. Your Convenience. When you receive Income Deduction Orders requiring that the income of two or more obligors be deducted and sent to the same depo sitory, you may combine the amounts that are to be paid to the depository in a single payment as long as you identify that portion of the payment that is attributable to each obligor. 14. Conflict. If you receive more than one Income Deduction Order against the same Obligor, and the total amount to be deducted, including administrative fees, would exceed the maximum allowable percentage under the Consumer Credit Protection Act, you must contact the Clerk of the Circuit Court, Child Support Depository for further instructions. The phone number is (904)741-4038. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true copy of the Notice to Payor, the Income Deduction Order, and, in the case of a delinquency, the Notice of Delinquency, were served upon the above addressee by certified mail, return receipt requested, on the ______ day of _________________, 20______. __________________________________ PLEASE NOTE: THIS NOTICE APPLIES ONLY TO THE DEDUCTIONS BEING MADE UNDER THE ABOVE REFERENCED CASE NUMBER. ANY OTHER INCO ME DEDUCTION ORDER UNDER ANY OTHER CASE NUMBER SHALL REMAIN IN EFFECT. >>>> 3 INFORMATION TO AID IN COMPLYING WITH INCOME DEDUCTION ORDER OBLIGOR: ________________________________________________ SSN: _____________________ ___________________________ CASE NO: ________________________________________________ PAYMENT ADDRESS: State of Florida Disbursement Unit P. O. Box 8500 Tallahassee, Florida 32314-8500 INCLUDE THE FOLLOWING INFORMATION ON YOUR CHECK TO INSURE THAT YOUR PAYMENT IS PROPERLY CREDITED: Manatee County C ase Number O bligor Name Obligor Social Security Number D ate of Withholding >>>> 4 Instructions for filing the Notice to Payor This form should be typed or printed in black ink. After completing this form, you should file the original Notice to Payor with the Clerk of the Circuit Court, keep a copy for your records and make a copy for the employer. Complete the Information to Aid in Complying with Income Deduction Order form (do not file this form with the Clerk). Mail by certified mail or hand deliver to the employer the following: 1) Copy of the Income Deduction Order 2) Copy of the Notice to Payor 3) Aid in Complying with Income Deduction Order