REQUEST FOR VOLUNTARY WRIT OF WITHHOLDING FC 158.011 *** REQUEST MUST BE NOTARIZED AND DELIVERED TO THE DISTRICT CLERK WITH A FEE OF $15.00 TO ISSUE THE WRIT OF WITHHOLDING CAUSE NO. ___________ STYLE OF CASE: _____________________________________________________ OBLIGOR: ________________________________ SOC.SEC #__________________ ADDRESS: ____________________________________________________________ CITY, STATE, ZIP: ______________________________________________________ OBLIGEE: _________________________________ SOC.SEC #__________________ ADDRESS: ____________________________________________________________ CITY, STATE, ZIP: ______________________________________________________ EMPLOYER'S NAME: ___________________________________________________ ADDRESS: ____________________________________________________________ CITY, STATE, ZIP: ______________________________________________________ ATTENTION: _____________________PAYROLL CLERK PHONE: _____________ THE OBLIGOR AND OBLIGEE BY SIGNATURE BELOW AGREE THAT THE EMPLOYER SHALL IMMEDIATELY BEGIN WITHHOLDING CHILD SUPPORT. OBIGOR SIGNATURE: _______________________________________________________ SUBSCRIBED TO AND SWORN TO BEFORE ME THIS MY COMMISSION EXPIRES DAY OF , 20____. Notary Public In And For The STATE OF TEXAS ____________________________________ ____________________________________ PRINTED NAME OF NOTARY OBLIGEE SIGNATURE: _______________________________________________________ SUBSCRIBED TO AND SWORN TO BEFORE ME THIS MY COMMISSION EXPIRES ____________ DAY OF , 20_____. Notary Public In And For The STATE OF TEXAS _______________________________________________ _______________________________________________ PRINTED NAME OF NOTARY American LegalNet, Inc. www.FormsWorkFlow.com