File No. STATE OF NORTH CAROLINA In The General Court Of Justice District Superior Court Division County Civil: Plaintiff Criminal: MOTION FOR MODIFICATION TERMINATION OF ORDER FOR WAGE WITHHOLDING STATE VERSUS Name Of Defendant G.S. 110-136.5(c) Name And Address Of Present Employer Name And Address Of Obligor (Employee) MOTION The undersigned requests the court that the Order To Withhold Wages To Enforce Child Support entered on ,2 be terminated modified in the following respect: In support of this Motion, the undersigned shows the court that: The Obligor's employment and/or the amount of the obligor's disposable wages has changed. The Obligor now receives disposable wages from the employer named above and in the amount set out below. Amount Of Support Obligation Weekly Monthly Bi-weekly $ Other (specify) . . The child support Order or Judgment on which withholding is based has expired or become invalid, in that: All arrearages are paid in full and the amount of the withholding shall be reduced to an amount sufficient to pay the obligor's continuing child support obligation. Other adequate means are available to enforce the support obligation, in that: The whereabouts of the child(ren) and recipient of the support payments are unknown; all valid arrearages owed to the State have been paid in full. Other: VERIFICATION I, the undersigned being first duly sworn, say that I have read this Motion and the contents are true to my own knowledge, except as to matters stated on information and belief, and as to those, I believe them to be true. Date SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME Signature Of Person Authorized to Administer Oaths Date Deputy CSC Assistant CSC Clerk Of Superior Court Signature Of Person Making Motion Name And Address Of Person Making Motion Date Commission Expires Notary County Where Notarized SEAL AOC-CV-621, Rev. 3/09 © 2009 Administrative Office of the Courts (Over) American LegalNet, Inc. www.FormsWorkFlow.com NOTICE OF MOTION TO THE DEFENDANT PLAINTIFF OTHER: You are notified to appear at the place, date and time shown below for a hearing on this Motion For Modification Or Termination Of The order For Wage Withholding entered in this action. Place Date Of Hearing Time Of Hearing AM Date Of Notice Signature Deputy CSC Assistant CSC Clerk Of Superior Court CERTIFICATE OF SERVICE I certify that I served a copy of this Motion by: delivering a copy personally to: Name Of Person With Whom Copy Left Name Of Person With Whom Copy Left depositing a copy in the United States mail in an envelope bearing proper postage and addressed as follows: Name And Address Name And Address leaving a copy at the office of the attorney named below, with a partner or employee Name Of Attorney Name Of Attorney Party Represented Party Represented Person With Whom Copies Left Person With Whom Copies Left Date Of Service AOC-CV-621, Side Two, Rev. 3/09 © 2009 Administrative Office of the Courts Signature Of Person Who Served Motion And Notice American LegalNet, Inc. www.FormsWorkFlow.com PM