REQUEST FOR ISSUANCE OF WRIT OF CHILD SUPPORT WITHHOLDING FC 158.104 NOTICE: REQUEST MUST BE COMPLETED AND DELIVERED TO THE DISTRICT CLERK TO ACTIVATE THE WITHHOLDING ORDER ALONG WITH A $15.00 FILING FEE. CAUSE NO. ___________, STYLE OF CASE: ______________________________________ VS. _______________________________________ OBLIGOR :________________________________ SOC.SEC #__________________________ ADDRESS:____________________________________________________________________ OBLIGEE:_________________________________ SOC.SEC #__________________________ ADDRESS:____________________________________________________________________ EMPLOYER'S NAME ____________________________________________________________ ADDRESS ____________________________________________________________________ ATTENTION : __________________________________________________ PAYROLL CLERK PHONE: _______________________________ MAIL PAYMENTS TO: TEXAS CHILD SUPPORT DISBURSEMENT UNIT P.O. BOX 659791 SAN ANTONIO, TEXAS 78265-9941 EMPLOYERS: Please put the cause # and/or SDU case # on your remittance. INFORMATION FURNISHED BY: ADDRESS: PHONE__________________ SIGNATURE: _________________________________ Attorney DATE: ______________________________________ Applicant 20______ ORIG: case file American LegalNet, Inc. www.FormsWorkflow.com