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Order For Income Withholding Form. This is a Hawaii form and can be use in Family Court Statewide.
Tags: Order For Income Withholding, Hawaii Statewide, Family Court
STATE OF HAWAI‘I
FAMILY COURT
_________ CIRCUIT
CASE NUMBER
ORDER FOR
INCOME WITHHOLDING
FC-D NO.
Preparer’s Name, Address and Telephone Number
PLAINTIFF,
VS.
DEFENDANT.
Hearing Date:
Judge:
Date Support Order Filed:
TO THE EMPLOYER OR SUCCESSOR EMPLOYER OF:
Employee/Obligor:
Address:
Social Security Number:
IT IS HEREBY ORDERED that:
I.
Pursuant to Hawai‘i Revised Statutes (HRS) §§ 571-52.2 and 52.3, the employer or successor employer shall:
A. Withhold from any salary, wages or any entitlement of money payable to the above employee/obligor, the amount
of $_____________ per month. The amount to be withheld may be apportioned from each pay period in the
month. The withholding, including a $2.00 administrative fee charged to the employee/obligor, shall not exceed
the maximum permitted by section 303(b) Consumer Credit Protection Act (15 USC 1673(b));
B. Begin withholding the above amount no later than the first pay period within seven (7) days after a certified copy
of this order is mailed to the employer.
C. Deliver the withheld amount payable to the Child Support Enforcement Agency (CSEA), P.O. Box 1860,
Honolulu, Hawai‘i 96805-1860 no later than five (5) business days after the employee/obligor has been paid. If
employer is ordered to withhold amounts for more than one employee/obligor, the total withholdings may be paid
in one check with a list of amounts applicable to each employee/obligor by case number, name and social security
number.
II. The employer is notified that:
A. It may charge the employee/obligor a $2.00 administrative fee for each payment made to CSEA. Said fee shall not
be deducted from the amount paid the CSEA (HRS §571-52.2(f));
B. This withholding order has priority over any other garnishment, attachment, execution or assignment and is not
subject to exemptions or restriction s under HRS Chapter 651, 652 and 653 (HRS §571-52.2(f));
C. It is unlawful for an employer to ignore this order. Failure to comply with this order
will result in the employer being responsible for the full amount ordered to be
withheld (HRS §571-52.2(g));
D. It is a crime for an employer to refuse to hire, discharge or discipline a (prospective)
employee/obligor due in any part to this order. (HRS §§571-52(c), 710-1077(1)(g),
706-640, and 706-663. Penalties include imprisonment and fines.
REVISED 2/99
ORDER FOR INCOME WITHHOLDING
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