REQUEST FOR TERMINATION or MODIFICATION OF CHILD SUPPORT WITHHOLDING FC 158.402 & FC 158.403 NOTICE: REQUEST MUST BE NOTARIZED AND DELIVERED TO THE DISTRICT CLERK WITH A FEE OF $15.00 TO ACTIVATE THE TERMINATION OF WITHHOLDING. CAUSE NO. ______________ STYLE:____________________________________________ ____________________________________________ ____________________________________________ OBLIGOR: NAME:____________________________________________________________ ADDRESS:_________________________________________________________ PHONE:________________________ SOC. SEC.#_________________________ OBLIGEE: NAME:____________________________________________________________ ADDRESS:_________________________________________________________ PHONE:________________________ SOC.SEC #_________________________ THE OBLIGEE AND OBLIGOR NAMED HEREIN HEREBY AGREE THAT THE EMPLOYER SHALL IMMEDIATELY TERMINATE THE WITHHOLDING OF CHILD SUPPORT. _________________________________ OBLIGEE __________________________________ OBLIGOR Sworn and subscribed to before this undersigned authority by ____________________________ Obligor this the _____ day of _______________ 20____. __________________________ ______________________County, Texas Print Name:_______________________________ My commission expires:_____________________ Sworn and subscribed to before this undersigned authority by ____________________________ Obligee this the _____ day of _______________ 20____. __________________________ ______________________County, Texas Print Name:_______________________________ My commission expires:_____________________ American LegalNet, Inc. www.FormsWorkflow.com