STATE OF SOUTH CAROLINA } IN THE FAMILY COURT FOR } COUNTY OF CHARLESTON } THE NINTH JUDICIAL CIRCUIT } ____________________________________} vs. REQUES} T FOR VOLUNTARY WAGE WITHHOLDING } ____________________________________} NAME AND ADDRESS OF CLERK OF COURT : FILE NO.: ________________________________ JULIE J. ARMSTRONG 100 BROAD STREET, SUITE 143 D.O.B. ___________________________ CHARLESTON, SC 29401-2265 NAME OF OBLIGOR: ______________________________________________________________________ OBLIGORS ADDRESS: _______ _____________________________________________________________ OBLIGORS TELEPHONE NUMBER : ________________________________________________________ OBLIGORS SOCIAL SECURITY NUMBER: _____ ______________________________________________ EMPLOYER (Payor) NAME AND ADDRESS: __________________________________________________ ________________________________________________________________________ ___________ I , ____________________________________, request that my wages be withheld to satisfy my obligation for support to ______________________________________________________________. I understand that this wage withholding will remain in effect for no less than one (1) year, at which time I may petition the Court to terminate this wage withholding. I understand that I must notify the Clerk of Court, at the address shown above, of any change of employment within seven (7) days of any change. I also understand that my address listed above will be presumed to be my correct address for notice purposes unless I notify the Clerk of Court of any change of address. _____________________________________________ Signature of Obligor Dated: _____________________________ DISTRIBUTION: [ ] File (original) [ ] Obligor (Copy) [ ] Obligee [ ] DSS American LegalNet, Inc. www.USCourtForms.com