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Request By Supporting Party For Wage Withholding Form. This is a North Carolina form and can be use in Civil Statewide.
Tags: Request By Supporting Party For Wage Withholding, CV-617, North Carolina Statewide, Civil
Court File No.
STATE OF NORTH CAROLINA
In The General Court Of Justice
District
Superior Court Division
County
Civil:
Plaintiff
Criminal:
Defendant
REQUEST BY SUPPORTING PARTY
FOR WAGE WITHHOLDING
STATE
VERSUS
G.S. 110-136.3(b)
Name, Mailing And Location Address Of Employer
Name, Mailing And Location Address Of Supporting Party
REQUEST
I, the undersigned Supporting Party, request that wage withholding begin as a means of payment of the child support obligation I owe.
1. Pursuant to an order entered by this Court for support of the child(ren) named below, I am obligated to pay child support in the
amount shown below.
Name And Date Of Birth Of Each Child For Whose Benefit Support Is Owed
Amount Of Support Obligation
Weekly
Monthly
$
Bi-weekly
Other (specify)
Date Of Support Order
2. I receive disposable wages from the employer named above in the amount of:
Amount Of Disposable Wages
Weekly
Monthly
$
Bi-weekly
Other (specify)
3. I understand that if withholding is implemented:
a. The withholding will apply to my current employer and all subsequent employers and will continue until:
(1) the child support order expires or becomes invalid; or
(2) the initiating party, the district court judge, and I agree to terminate withholding because there is another adequate means to
collect child support or arrearages; or
(3) all valid arrearages owed to the state are paid in full, and the whereabouts of each child for whom support is owed and the
party entitled to receive the support payments are unknown.
b. The amount withheld will include an amount sufficient to pay current child support, an additional amount toward liquidation of any
arrearages, and a $2.00 processing fee to be retained by my employer for each withholding, but that the total amount withheld
may not exceed the following percentage of my disposable income;
40% (I am not already subject to an order for withholding child support.)
45% (I am already subject to an order for withholding for child support and I am supporting other dependent child(ren) or a
spouse.)
50% (I am already subject to an order for withholding for child support and I am not supporting other dependent child(ren)
or a spouse.)
4. As of this date,
As of this date,
I am delinquent in payments under the child support order.
I am not delinquent in payments under the child support order.
5. I understand the court may require a hearing in any case.
(check one of the following:)
I WAIVE my right to a hearing and consent to the entry of an order for withholding of an amount the court determines to be
appropriate within the percentage limit set out above.
I DO NOT WAIVE my right to a hearing.
Date Withholding Requested
Signature Of Supporting Party
NOTE: This form may be used in both civil and criminal cases.
(Over)
AOC-CV-617, Rev. 3/09
© 2009 Administrative Office of the Courts
American LegalNet, Inc.
www.FormsWorkFlow.com
VERIFICATION
I, the undersigned being first duly sworn, say that I have read this Request 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.
SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME
Date
Signature Of Person Authorized to Administer Oaths
Deputy CSC
Assistant CSC
Clerk Of Superior Court
Date
Signature Of Person Making Motion
Name And Address Of Person Making Motion
Date Commission Expires
Notary
SEAL
County Where Notarized
AOC-CV-617, Side Two, Rev. 3/09
© 2009 Administrative Office of the Courts
American LegalNet, Inc.
www.FormsWorkFlow.com