JASON MURRAY DISTRICT CLERK GALVESTON COUNTY, TEXAS Galveston Office League City Office 600 59th St., Ste. 4001 Galveston, TX 77551-2388 Phone(409)766-2424 Fax (409)766-2292 174 Calder Rd. League City, TX 77573 Phone (281)316-8729 Fax (281) 316-8740 REQUEST FOR NOTICE TO EMPLOYER TO WITHHOLD INCOME FROM EARNINGS FOR SPOUSAL SUPPORT Date of Request: ____________________________ Case Number: _________________________ Court Number: ________________ Name of Payor/Employee: _____________________________________________ Social Security No. of Employee:_______________________________________ Employer’s name: __________________________________________________ Attention: _________________________________________________________ Employer’s mailing address ___________________________________________ City ____________________________, State ___________ Zip Code _________ Name and address of Payee, (person receiving the support payment):___________ __________________________________________________________________ Signature of requesting party: __________________________________________ Address of requestor:________________________________________________ City: ____________________________ State: ___________ Zip Code:_________ Phone Numbers: (1) Work; ___________________ (2) Home;_________________ SERVICE WILL BE ISSUED UPON PAYMENT OF THE $15.00 FEE Date $15.00 fee was paid: _______________________ (to be completed by Clerk) Issued by: __________________________________________________________ Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com