IN THE UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF ILLINOIS EASTERN DIVISION In re: ) Case No. ) ) Chapter 13 ) SSN: XXX-XX- Debtors ) To: ORDER TO EMPLOYER TO PAY THE TRUSTEE Attn: Payroll Department WHEREAS, the above named debtor has a plan to pay his/her debts out of his/her future earnings, and by his/her plan submits all of his/her future earnings to the supervision and control of this Court for the purpose of carrying out the Plan: NOW IT IS THEREFORE ORDERED, that until further order of this Court,, employer of , deduct from the earnings of the debtor the sum of $ each month beginning on the next pay day following the receipt of this order and to pay the sum so deducted to , IT IS FURTHER ORDERED, that the employer shall stop or change the deduction upon written notice from the Trustee; IT IS FURTHER ORDERED, that the employer shall notify the Trustee if the employment of the debtor is terminated and the reason for such termination; IT IS FURTHER ORDERED, that all earnings of the debtor, except amounts required to be withheld by the provisions of Federal or State law or for insurance, pension or union dues, be paid to the debtor and that no deduction other than authorized or directed by this order be made by the employer. Date Entered: Jeffrey Allsteadt, Clerk, United States Bankruptcy Court Attorney Signature Date: Check this box if the debtor has agreed to the entry of this order without further notice or hearing through Section I of the Chapter 13 Plan. American LegalNet, Inc. www.FormsWorkFlow.com