IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT, LAKE COUNTY, ILLINOIS ) Petitioner, ) ) ) ) ) Respondent. ) Gen. No. PETITION TO CONTEST NOTICE TO WITHHOLD INCOME Now comes to Withhold Income dated appropriate) 1. The amount of delinquent support stated in the Notice to Withhold Income is incorrect in that , obligor in the above entitled case and states that service of the Notice is being contested for the following reason(s): (Complete as 2. There is not a delinquency in this case in that 3. Payment for support is ensured in that 4. The Petitioner disputes that he/she is the Obligor in that Wherefore Obligor Prays: 1. That service of the Notice to Withhold Income dated 2. For such other and further relief as the Court deems just. be amended/vacated. CERTIFICATION Under penalties as provided by law pursuant to 735 ILCS 5/1-109 of the Code of Civil Procedure, the undersigned certifies that the statements set forth in this instrument are true and correct, except as to matters therein stated to be on information and belief and as to such matters the undersigned certifies as aforesaid that he/she verily believes the same to be true. Obligor or Legal Representative By: Signature Street Address City & State Home Phone No. Work Phone No. 171-80 4/98 2000 © American LegalNet, Inc.