FOR CLERKS USE ONLY IN THE DISTRICT COURT OF WYANDOTTE COUNTY, KANSAS CIVIL COURT DEPARTMENT ________________________________________ PLAINTIFF/PETITIONER Case No. ______________________ ________________________________________________ DEFENDANT/RESPONDENT EMPLOYER ANSWER IF THIS PERSON IS NOT YOUR EMPLOYEE: Check the box on the right and fill in Part 1. Please return this form immediately to the Court Trustees Office, 710 N. 7th St, Kansas City, KS 66101. Date employment ended: _________________________________. IF THIS PERSON IS YOUR EMPLOYEE: Please write the date you received the Income Withholding Order: ______________, and read the Employer Notice carefully. It tells you about due dates, combining payments that go to one office, and the rights and responsibilities of you and your employee. When you fill out this Answer, please print or type. Part 1. Employer Information: Mailing address (bookkeeping or payroll department): __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Phone number (including area code): ____________________________________________ Date Answer was prepared: ___________ By:_____________________________________ Part 2. Pay Period: [ ] Check here if employee’s income changes. Hourly pay: $___________. What is the employee’s normal pay period? (Check one) [ ] Weekly [ ] Semi-monthly [ ] Every 2 weeks [ ] Monthly (or Other:__________________________ Normal payroll dates each month: __________________________________________________ Part 3. Normal Amount to Withhold: (1) Total support per month (see Order Information “For a total of” on Order to Withhold) …..$_______ (1) (2) To calculate how much support to withhold from each pay check and send to the courts, divide the amount on line (1) by the appropriate number below: PAY PERIOD DIVIDE BY PAY PERIOD DIVIDE BY Weekly 4.333 Semi-Monthly 2 Every 2 Weeks 2.166 Monthly or “other” 1 Normal support amount to send in EACH pay period…………………………………………………….$________(2) (3) You are allowed (but not required) to charge a fee in any amount up to $5.00 per Withholding, not to exceed $10 per month. Employer Fee………………………………$________ (3) (4) Total normal withholding for each pay period: Line (2) plus Line (3)…………………...$________ (4) American LegalNet, Inc. www.USCourtForms.com Part 4. Limit on Withholding: Federal law protects your employee by limiting the total amount that can be deducted from net earnings. “Net earnings” (for income withholding purposes) means gross earnings minus only taxes, social security, Medicare, and certain deductions under Federal Law (bankruptcy, IRS levy). The following calculation tells you the withholding limit for one pay check. (5) Gross earnings for pay period …………………………………………………………….$________ (5) (6) Deductions: a. Federal income tax …………………………………………………$_________ b. State and local ………………………………………………………$_________ c. Social security or self-employment tax or RR tax ………………….$_________ d. Medicare ……………………………………………………………$_________ e. Other (federal) deduction …………………………………………...$_________ TOTAL: Add lines (6) (a) through (6) (e)……………………………………………..$________ (6) (7) Disposable earnings: Subtract the total on line (6) from line (5)………………………….$________ (7) (8) Percentage given in Federal Consumer Credit Protection Limit of the Order to Withhold (if none listed, use 50%). If you have more than one Order to Withhold for this employee, use the highest percentage marked on any of them……………………………………………………………………………..._______% (8) (9) Federal Consumer Credit Protection Limit (the most that can legally be withheld): Multiply line (8) times line (7) …………………………………………………………….$________ (9) If this is the only Order to Withhold for this employee, you withhold the amount on line (4) unless line (9) is smaller. If you cannot withhold the amount on line (4) because line (9) is smaller, withhold the amount on line (9) – keep your fee (if any) and send the rest to the Kansas Payment Center . (You are not required to try to make up the shortage out of future pay checks.) If this employee has more than one Order to Withhold, the total normal withholding amount (including fees) for all the orders cannot go over the amount on line (9). • If the total is less than or equal to the amount on line (9), withhold and send money to the Kansas Payment Center for each Order to Withhold, just as you normally would. (See #5 on additional Information page about combining payments for different orders from the same county) • If the total is more than the amount on line (9), you need special instructions – please call the (atty or person who filled this out) Right away. SEND THIS COMPLETED FORM TO: (name of person, atty, or agency) Reminder: You only fill out and send in an Answer when you begin withholding under this order or when the court specifically orders you to file a new Answer. If you have any questions or need help with this form, please call the (person or atty) listed on the Additional Information page at the bottom. THANK YOU FOR YOUR COOPERATION!!!!! American LegalNet, Inc. www.USCourtForms.com