Court File No. STATE OF NORTH CAROLINA IV-D Case No. County In The General Court Of Justice District Superior Court Division Civil: Criminal Plaintiff ORDER TO WITHHOLD FROM INCOME OTHER THAN WAGES TO ENFORCE CHILD SUPPORT STATE VERSUS Name Of Defendant G.S. 110-136.8 Name And Address Of Payor (Source Of Income) Name And Address Of Obligor (Supporting Party) Federal Tax ID No. Social Security No. The Court makes the following findings of fact and conclusions of law based on the record and the evidence presented. FINDINGS 1. This matter is before the court pursuant to recipient's motion for an order for income withholding. obligor's request for income withholding. Other (specify) . a show cause order issued in this action. the parties' request for entry of a Consent Order. the State's motion for income withholding. 2. The obligor was served on , . submitted to the Court's jurisdiction. 3. Present at the hearing were obligor, represented by recipient, represented by . . 4. The obligor is obligated to pay child support in the amount shown below. As of the date of the hearing, the obligor is in arrears as shown below. Amount Of Support Obligation Weekly Bi-weekly Date Of Support Order Or Judgment Monthly $ Other (specify) Amount Of Support Obligation $ (Date) As Of (check if applicable) At the time of the filing of the motion, issuuance of the show cause order, hearing, the obligor was in arrears equal to or more than support payable for one month. was delinquent in making child support payments. had been erratic in making child support payments. 5. The obligor receives disposable income as defined in G.S. 110-129(6) from the payor named above as set out below. Amount Of Disposable Income Weekly Monthly $ Bi-weekly Type Of Income Other (specify) 6. Other findings: (NOTE: This form may be used in both civil and criminal cases.) (Over) AOC-CV-907M, Rev. 3/03 © 2003 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkflow.com CONCLUSIONS 1. This matter is properly before the court and the court has jurisdiction over the parties and the subject matter. 2. The Support Order or Judgment referred to above is valid and continues to be in force and effect. 3. The obligor's disposable income is subject to withholding to enforce the child support obligation. 4. $ OR 40 percent (state different percent if applicable %), WHICHEVER IS LESS, is an appropriate amount to order withheld from the obligor's disposable income each pay period, which is weekly. . bi-weekly. monthly. Other (specify) ORDER It is ORDERED that: 1. The obligor's disposable income be subjected to withholding to enforce the child support obligation referred to herein. 2. The obligor's payor be served with a Notice Of Obligation To Withhold From Income Other Than Wages For Chid Support, directing said payor to withhold and transmit to the North Carolina Centralized Collection Office, PO Box 900012, Raleigh, NC 27675 from the obligor's disposable income each pay period the percentage set out below minus the $2 processing fee, or the exact amount set out below, WHICHEVER IS LESS. Amount* Weekly Monthly $ Bi-weekly Other (specify) Maximum Allowable Percentage % *Note: This amount plus the $2 processing fee may not exceed the maximum allowable percentage. 3. The withheld amounts shall be allocated as follows: (a) to obligor's continuting child support obligation. $ (b) to the arrearages until paid in full. $ Total (Note: Total should equal amount.) $ 4. When all arrearages are paid in full, the amoutn to be withheld shall be automatically reduced to the amount sufficient to pay the obligor's continuing child support obligation as listed in 3(a) above. The North Carolina Child Support Centralized Collection Office shall notify the payor and obligor of the reduced amount to be withheld. 5. The payor is entitled to retain a processing fee of $2.00 in addition to the amount of withholding for each withholding made. 6. The obligor shall remain responsible for the payment of support as previously ordered by the Court, and is responsible for payments that are due before withholding becomes effective and for any amount of the support obligation or arrearages that is not covered by the withheld amounts. 7. The obligor shall notify the Court when this Order and/or the Notice Of Obligation To Withhold From Income Other Than Wages For Child Support needs to be modified for any reason. 8. If the obligor or the payor gives notice that an adjustment to withholdg is needed, or if it so appears to the Clerk, this matter shall be scheduled for hearing before the Court. 9. Other: 10. The costs of this action are taxed against plaintiff. defendant. Date Order Entered (if different from date signed) Date Signed Name Of Presiding Judge (Type Or Print) Signature Of Presiding Judge CONSENTED TO: (if applicable) Signature Of Plaintiff Signature Of Defendant AOC-CV-907M, Side Two, Rev. 3/03 © 2003 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkflow.com