IN THE SUPERIOR COURT OF FULTON COUNTY STATE OF GEORGIA FAMILY DIVISION Petitioner: Civil Action File No. and Respondent: INCOME DEDUCTION ORDER FOR PETITIONER TO PAY This matter having come on for hearing, and the Respondent having been lawfully served, it is hereby ordered and adjudged as follows: 1. Income Deduction. The Petitioner’s employer, future employer, or any other person, private entity, Federal or State government, or any unit of local government providing or administering any income due the Petitioner as wages, salary, bonus, commission, compensation as independent contractor, workers compensation, disability benefits, pensions, dividends, interest royalties, trust or any other payments shall deduct from all monies due and payable to the Petitioner the following amounts: TOTAL AMOUNT OF DEDUCTION: $ per This is the total amount to be deducted. This amount will decrease to $ per when all Support Arrearage has been paid in full. The deduction amount consists of the following: A. CURRENT CHILD SUPPORT: $ per B. CURRENT SPOUSAL SUPPORT: $ per C. SUPPORT ARREARAGE: $ per as of Payment for previously owed support is behind in the amount of $ shall be withheld each $ until the amount of unpaid support is paid in full. The arrearage stated in this order is the amount due as of this date. The Respondent shall have the right to any additional arrearage which may accrue. D. OTHER: $ per E. FAMILY SUPPORT REGISTRY FEE**: per $ ** Note: You will be notified by Child support Enforcement when the FSR fee is to be deducted. 2. Place of Payment. The employer shall make the amounts deducted payable to, and forward them within two (2) business days after each payment to the Respondent at the following address (check one): IDO Petitioners Income Deduction Order © 2006 Fulton County Superior Court Family Division Page 1 of 2 American LegalNet, Inc. www.USCourtForms.com □ Child Support Enforcement P.O. Box 1800 Carrollton, GA 30112-1600 3. □ _______________________________ OR ____________________________________ ____________________________________ ____________________________________ Payment Instructions. If you are deducting child support for more than one IDO, you must, upon future notification by Child Support Enforcement, deduct the FSR fee for each IDO. If the amount you are deducting for any one case is $40.00 or more, the FSR fee for that IDO is $2.00. If the deduction is less than $40.00, the FSR fee is 5%of the amount deducted. For example, the FSR fee would be $1.75 for a $35.00 deduction. The Total Amount of Deduction will decrease after all Support Arrearage is paid in full; it will be reduced to the Current Child Support plus Current Spousal Support plus the FSR fee. If Current Child or Spousal Support shall end before all Support Arrearage is paid in full, you should continue to deduct the Total Amount until all Support Arrearage is paid in full. 4. Consumer Credit Protection Act. The maximum amount to be deducted shall not exceed the amounts allowed under Sec. 303. b of the Consumer Credit Protection Act, 15 U.S.C. Sec. 1673 (b) , as amended. 5. Effective Date. This Income Deduction Order shall become effective: □ Immediately upon signing. □ Upon a delinquency equal to one month’s support. This court finds that good cause was shown to delay the effective date of this order. The Obligee or the IV-D agency may enforce this Income Deduction Order by serving a “Notice of Delinquency” upon the Obligor as provided in O.C.G.A. §19-6-32(f). 6. Duration. This Income Deduction Order supersedes any income deduction order which may have been previously entered in this case and shall remain in full force and effect until the original support order upon which this order is based no longer requires payment, is modified, suspended or terminated by the order of this Court. 7. Service. This order and all further papers required to be served pursuant to O.C.G.A. §19-6-30 et seq. shall be served upon the Petitioner by regular mail in accordance with the alternative service provisions of O.C.G.A. §19-11-4 (i) and O.C.G.A. §19-6-33 (b). A copy of this order shall also be mailed by Respondent to Child Support Enforcement, IDO Registry, 3201 Atlanta Industrial Parkway, Suite 104, Atlanta, GA 30331. 8. DUTY TO INSURE COMPLIANCE: The Petitioner is ordered to perform all acts necessary for the proper withholding of the sums stated in this IDO, including delivery of the same to his/her employer and future employers, and to personally monitor and confirm on an ongoing basis that the payments withheld are timely and properly deducted from his/her income and forwarded as ordered, and correctly identified with the above case. Failure of the employer to perform under this order does not relieve the Petitioner of his/her obligation to insure that payments are made. This day of , Judge Superior Court of Fulton County . IDO Petitioners Income Deduction Order © 2006 Fulton County Superior Court Family Division Page 2 of 2 American LegalNet, Inc. www.USCourtForms.com