COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : APPENDIX “E” : Plaintiff(s) Index No. Calendar No. JUDICIAL SUBPOENA ALTERNATIVE PAYMENT ARRANGEMENT -against: 1. The parties have agreed to this alternative payment:arrangement in substitution for mandatory income withholding. The definitions of the Income Withholding for Child Support Act shall apply. . : 2. Both parties have provided bank routing and account numbers for their respective bank accounts set forth below. Until the obligation for support terminates or until further order, each party shall Defendant(s) : .maintain .such. account .as. open .and. . . .good . standing. with. his . or. her financial institution and take all steps . . . . . . . . . . . . . . . . . . . . . . in . . . . . . . . . . . . . . . . reasonably necessary to obtain execution of all financial institution participation required by this arrangement. Only financial institutions insured by the Federal Deposit Insurance Corporation and having electronic payment and receipt capability through the Federal Reserve or ACH shall be eligible for participation. THE PEOPLE OF THE STATE OF NEWthe date of each scheduled transfer, the obligor (paying party) shall 3. At least 72 hours prior to YORK assure that collected funds greater than the scheduled transfer and any other outstanding checks drawn upon or TO charges against the account are on deposit in such account. 4. The obligor’s financial institution shall electronically transmit such collected funds in the amount of the required monthly support installment at such time as to be received by the obligee’s (receiving party’s) financial institution in funds immediately available for deposit to obligee’s designated account, less any GREETINGS: by the receiving financial institution for such transaction, as of the first day of the calendar amount charged month. If the first day of the calendar month falls on a banking nonbusiness day, the next banking business WE COMMAND YOU, obligor shall be responsible for any transaction charges imposed attend day shall substitute therefor. Thethat all business and excuses being laid aside, you and each of youby the the Honorable at the transmitting financial institution (which may be charged to the obligor’sCourt account) and such charges shall not reduce the County of amount transmitted. located at before in room 5. , on the day of , shall , at o'clock in the noon, and at any recessed Any participating financial institution 20 have the right to withdraw from the arrangement at orany time. Upon withdrawal and give institution,as a witness in this action onthe State of the adjourned date, to testify by either evidence income withholding through the part Disbursement Unit shall be implemented until a substitute financial institution has been arranged and written notice provided to the court clerk. No liability shall arise against any participating financial institution as a result of this arrangement or participation in this arrangement. Liability of any participating financial institution shall be limited to the Your failure such institution this own customer (obligor and transmitting bank; obligee and receiving contractual liability of to comply with to its subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a bank). result of your failure to comply. 6. The arrange ment shall not become effective until written acceptance of such arrangement by both financial institutions is received and filed by the court clerk in this case. Witness, Honorable , one of the Justices of the Participation in this arrangement by a party shall constitute that party’s authorization to his Court in 7. County, day of , 20 or her financial institution to provide account information regarding such payments or deposits to the court clerk, the other party or such party’s counsel, and to the county attorney or other authorized attorney responsible for enforcement of the support obligation. (Attorney must sign above and type name below) 8. At least once each calendar year, by December 20 of such calendar year, the obligee shall file a written report with the court clerk, stating the amounts and dates of each payment received during that calendar year. The obligee shall provide an additional report regarding dates of payments received, supported by oath or affirmation if requested, upon request by any of the persons listed in for Attorney(s) paragraph 7 above or upon order of the court. 9. The financial institution information is: Financial Institution Name Routing Number Account Number Office and P.O. Address Obligor Obligee Appendix “E” Telephone No.: Facsimile No.: E-Mail Address: Alternative Mobile Tel. No.: Payment Arrangement American LegalNet, Inc. www.USCourtForms.com ,