Family Law Assignment

IN THE CIRCUIT COURT OF THE FIFTH JUDICIAL CIRCUIT

IN AND FOR MARION COUNTY, FLORIDA

CASE NUMBER: 42-2018-DR-00

IN RE: The Marriage of

JOHN DOE,

Husband,

and

JANE DOE,

Wife.

____________________________/

INCOME WITHHOLDING FOR SUPPORT AND FLORIDA ADDENDUM

INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) AMENDED IWO

ONE-TIME ORDER/NOTICE FOR LUMP SUM PAYMENT

TERMINATION OF IWO Date: ________________

Child Support Enforcement (CSE) Agency Court

Attorney

Private Individual/Entity (Check One)

NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions www.acf.hhs.gov/css/resource/income-withholding-for-support-instructions ). If you receive this document from someone other than a state or tribal CSE agency or a court, a copy of the underlying support order must be attached.

State/Tribe/Territory FLORIDA Remittance ID (include w/payment) _______________________

City/County/Dist./Tribe Order ID __________________________________________

Private Individual/Entity Case ID ____________________________________________

RE:

Employer/Income Withholder’s Name Employee/Obligor’s Name (Last, First, Middle)

Employer/Income Withholder’s Address Employee/Obligor’s Social Security Number

Employee/Obligor’s Date of Birth

_ .

Custodial Party/Obligee’s Name (Last,First, Middle)

Employer/Income Withholder’s FEIN

Child(ren)’s Name(s) (Last, First, Middle) Child(ren)’s Birth Date(s)

ORDER INFORMATION : This document is based on the support order from____FLORIDA_____________(State/Tribe).

You are required by law to deduct these amounts from the employee/obligor's income until further notice.

$ Per month current child support

$ Per month past-due child support - Arrears greater than 12 weeks? Yes No

$ Per current cash medical support

$ Per past-due cash medical support

$ Per current spousal support

$ Per past-due spousal support

$ Per other (must specify) . for a Total Amount to Withhold of $ per month .

AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information. If your pay cycle does not match the ordered payment cycle, withhold one of the following amounts:

$ per weekly pay period $ per semimonthly pay period (twice a month)

$ per biweekly pay period (every two weeks)$ per monthly pay period

$ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order.

Document Tracking ID

REMITTANCE INFORMATION : If the employee/obligor's principal place of employment is FLORIDA (State/Tribe), you must begin withholding no later than the first pay period that occurs 14 days after the date of service of this IWO. Send payment within 2 business days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to the amount of disposable income specified in the paragraph below labeled “Withholding Limits”. If the obligor is a non-employee, obtain withholding limits from Supplemental Information. If the employee/obligor's principal place of employment is not Florida (State/Tribe), obtain withholding limitations, time requirements, and any allowable employer fees from the jurisdiction of the employee/obligor's principal place of employment. State- specific withholding limit information is available at www.acf.hhs.gov/css/resource/state-income-withholding-contacts

-and-program-requirements . For tribe-specific contacts, payment addresses, and withholding limitations, please contact the tribe at www.acf.hhs.gov/sites/default/files/programs/css/tribal_agency_contacts_printable_pdf.pdf or https://www.bia.gov/tribalmap/DataDotGovSamples/tld_map.html .

For electronic payment requirements and centralized payment collection and disbursement facility information [State Disbursement Unit (SDU)], see www.acf.hhs.gov/css/employers/employer-responsibilities/payments .

Include the Remittance ID with the payment and if necessary this locator code: .

Remit payment to STATE OF FLORIDA (SDU/Tribal Order Payee)

at P.O. BOX 8500, TALLAHASSEE, FLORIDA 32314-8500 (SDU/Tribal Payee Address)

Return to Sender (Completed by Employer/Income Withholder). Payment must be directed to an SDU in accordance with sections 466(b)(5) and (6) of the Social Security Act or Tribal Payee (see Payments to SDU below). If payment is not directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender.

If Required by State or Tribal Law:

Signature of Judge/Issuing Official: Print Name of Judge/Issuing Official: Title of Judge/Issuing Official: Date of Signature:

If the employee/obligor works in a state or for a tribe that is different from the state or tribe that issued this order, a copy of this IWO must be provided to the employee/obligor.

If checked, the employer/income withholder must provide a copy of this form to the employee/obligor.

ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS

State-specific contact and withholding information can be found on the Federal Employer Services website located at www.acf.hhs.gov/css/resource/state-income-withholding-contacts-and-program-requirements .

Employers/income withholders may use OCSE's Child Support Portal ( https://ocsp.acf.hhs.gov/csp/ ) to provide information about employees who are eligible to receive a lump sum payment, have terminated employment, and to provide contacts, addresses, and other information about their company.

Priority: Withholding for support has priority over any other legal process under State law against the same income (section 466(b)(7) of the Social Security Act). If a federal tax levy is in effect, please notify the sender.

Combining Payments: When remitting payments to an SDU or tribal CSE agency, you may combine withheld amounts from more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/obligor's portion of the payment.

Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent by a court, attorney, or private individual/entity and the initial order was entered before January 1, 1994 or the order was issued by a tribal CSE agency, you must follow the “Remit payment to” instructions on this form.

Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the amount was withheld from the employee/obligor's wages. You must comply with the law of the state (or tribal law if applicable) of the employee/obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments.

Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to federal, state, or tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past-due support. Follow the state or tribal law/procedure of the employee/obligor's principal place of employment to determine the appropriate allocation method.

Lump Sum Payments: You may be required to notify a state or tribal CSE agency of upcoming lump sum payments to this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and/or withhold lump sum payments.

Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by state or tribal law/procedure.

Anti-discrimination: You are subject to a fine determined under state or tribal law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO.

Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) [15 USC §1673 (b)]; or 2) the amounts allowed by the law of the state of the employee/ obligor's principal place of employment, if the place of employment is in a state; or the tribal law of the employee/obligor's principal place of employment if the place of employment is under tribal jurisdiction. Disposable income is the net income after mandatory deductions such as: state, federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, those limits increase 5% --to 55% and 65% --if the arrears are greater than 12 weeks. If permitted by the state or tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in this section.

Depending upon applicable state or tribal law, you may need to consider amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits.

Arrears Greater Than 12 Weeks? If the Order Information section does not indicate that the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage.

Supplemental Information:

OMB 0970-0154 and Florida Addenum Page 1 of 7

OMB Expiration Date 08/31/2020. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version currently in use.

NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you are no longer withholding income for this employee/obligor, you must promptly notify the CSE agency and/or the sender by returning this form to the address listed in the contact information below:

This person has never worked for this employer nor received periodic income. This person no longer works for this employer nor receives periodic income.

Please provide the following information for the employee/obligor:

Termination date: Last known telephone number: Last known address:

Final payment date to SDU/Tribal Payee:

Final payment amount:

New employer's name:

New employer's address:

CONTACT INFORMATION:

To Employer/Income Withholder: If you have questions, contact State of Florida Disbursement Unit by telephone at 1-877-769-0251; or Marion County Clerk of Court, Domestic Relations Department by phone at (352) 671-5565.

Send termination/income status notice and other correspondence to: Marion County Clerk of Court, Domestic Relations Department, Post Office Box 1030, Ocala, Florida 34478-1030.

To Employee/Obligor: If the employee/obligor has questions, contact Marion County Clerk of Court, Domestic Relations Department by phone at (352) 671-5565.

IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor.

Encryption Requirements:

When communicating this form through electronic transmission, precautions must be taken to ensure the security of the data. Child support agencies are encouraged to use the electronic applications provided by the federal Office of Child Support Enforcement. Other electronic means, such as encrypted attachments to emails, may be used if the encryption method is compliant with Federal Information Processing Standard (FIPS) Publication 140-2 (FIPS PUB 140-2).

The Paperwork Reduction Act of 1995

This information collection and associated responses are conducted in accordance with 45 CFR 303.100 of the Child Support Enforcement Program. This form is designed to provide uniformity and standardization. Public reporting for this collection of information is estimated to average two to five minutes per response. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

FLORIDA ADDENDUM

THE PAYOR, {name} , IS HEREBY NOTIFIED that, under sections 61.13 and 61.1301, Florida Statutes, you have the responsibilities and rights set forth below with regard to the Income Withholding Order/Notice for Support:

1. The Income Withholding Order/Notice for Support is enforceable against employers specifically listed upon the form as well as all subsequent employers/payors of Obligor, {name}

2. You are required to deduct from the obligor’s income the amount specified in the income withholding order, and in the case of a delinquency the amount specified in the notice of delinquency, and to pay that amount to the State of Florida Disbursement Unit. The amount actually deducted plus all administrative charges shall not be excess of the amount allowed under s. 303(b) of the Consumer Credit Protection Act, 15 U.S.C. §1673(b), as amended.

3. You must implement income deduction no later than the first payment date which occurs more than 14 days after the date the income deduction order was served on you, and you shall conform the amount specified in the income withholding order to the obligor’s pay cycle. The court should request at the time of the order that the payment cycle will reflect that of the obligor.

4. You must forward, within 2 days after each date the obligor is entitled to payment from you, to the State of Florida Disbursement Unit, the amount deducted from the obligor’s income, a statement as to whether the amount totally or partially satisfies the periodic amount specified in the income withholding order, and the specific date each deduction is made. If the IV-D agency is enforcing the order, you shall make these notifications to the agency.

5. If you fail to deduct the proper amount from the obligor’s income, you are liable for the amount you should have deducted, plus costs, interest, and reasonable attorneys’ fees.

6. You may collect up to $5 against the obligor’s income to reimburse you for administrative costs for the first income deduction and up to $2 for each deduction thereafter.

7. The Income Withholding Order/Notice for Support is binding on you until further notice by court order or until you no longer provide income to the obligor.

8. When you no longer provide income to the obligor, you shall notify the obligee, {name} , and provide the obligor’s last known address and the name and address of the obligor’s new payor, if known utilizing the form contained within the Income Withholding Order/Notice for Support. If you violate this provision, you are subject to a civil penalty not to exceed $250 for the first violation or $500 for any subsequent violation. If the IV-D agency is enforcing the order, you shall make these notifications to the agency instead of the obligee. Penalties shall be paid to the obligee or the IV-D agency, whichever is enforcing the income deduction order.

9. You shall not discharge, refuse to employ, or take disciplinary action against an obligor because of the requirement for income deduction. A violation of this provision subjects you to a civil penalty not to exceed $250 for the first violation or $500 for any subsequent violation. Penalties shall be paid to the obligee or the IV-D agency, whichever is enforcing the income deduction, if any alimony or child support obligation is owing. If no alimony or child support obligation is owing, the penalty shall be paid to the obligor.

10. The obligor may bring a civil action in the courts of this state against a payor who refuses to employ, discharges, or otherwise disciplines an obligor because of income deduction. The obligor is entitled to reinstatement of all wages and benefits lost, plus reasonable attorneys’ fees and costs incurred.

11. In a Title IV-D case, if an obligation to pay current support is reduced or terminated due to the emancipation of a child and the obligor owes an arrearage, retroactive support, delinquency, or costs, income deduction continues at the rate in effect immediately prior to emancipation until all arrearages, retroactive support, delinquencies, and costs are paid in full or until the amount of withholding is modified.

12. All notices to the obligee shall be sent to the address provided in this notice to payor, or anyplace thereafter the obligee requests in writing.

13. An employer who employed 10 or more employees in any quarter during the preceding state fiscal year or who was subject to and paid tax to the Department of Revenue in an amount of $20,000 or more shall remit support payments deducted pursuant to an income deduction order or income deduction notice and provide associated case data to the State Disbursement Unit by electronic means approved by the department. Payors who are required to remit support payments electronically can find more information on how to do so by accessing the State Disbursement Unit’s website at www.floridasdu.com and clicking on “Payments.” Payment options include Expert Pay, Automated Clearing House (ACH) credit through your financial institution, www.myfloridasdu.com, or Western Union. Payors may contact the SDU Customer Service Employer telephone line at 1-888-883-0743.

14. The amount of arrears owed, if any, is $ You must withhold an additional twenty percent (20%) or more of the ongoing periodic obligation towards same at the rate of $ per month until full payment is made of any arrearage, attorney's fees and costs – provided that no deduction shall be applied to attorney's fees and costs until the full amount of any arrearage is paid. If a delinquency accrues after the order establishing, modifying, or enforcing support has been entered and there is no existing order for repayment of the delinquency or a pre-existing arrearage, a payor shall deduct $ per month (which represents an additional twenty percent (20%) of the current support obligation, or other amount agreed to by the parties) until the delinquency and any attorneys’ fees and costs are paid in full. No deduction may be applied to attorneys’ fees and costs until the delinquency is paid in full.

15. Pursuant to sections 61.13 and 61.1301, Florida Statutes, the amounts listed for payment on the Income Withholding Order must be varied by the employer/payor for bonus income, or similar one-time payment.

You shall deduct [Choose only one] ( X ) the full amount, (___) _____%, or ( ) none of the income which is payable to the obligor in the form of a bonus or other similar one-time payment, up to the amount of arrearage reported in the Income Deduction Order or the remaining balance thereof, and forward the payment to the State of Florida Disbursement Unit. For purposes of this subparagraph, “bonus” means a payment in addition to an obligor's usual compensation and which is in addition to any amounts contracted for or otherwise legally due and shall not include any commission payments due an obligor.

16. Child Support Reduction/Termination Schedule. Child support amount listed on this IWO shall be automatically reduced or terminated as set forth in the following schedule:

Please list children by initials from eldest to youngest		Insert in this column the day, month, and year the child support obligation terminates for each designated child (see instructions)		Insert in this column the amount of child support for all minor children remaining (including designated child)
Child 1 (Eldest) Initials & year of birth:	From the effective date of this Income Deduction Order until the following date:		child support for Child 1 and all other younger child(ren) should be paid in the following monthly amount:
Child 2 Initials & year of birth:	After the date set forth in the row above until the following date:		child support for Child 2 and all other younger child(ren) should be paid in the following monthly amount:
Child 3 Initials & year of birth:	After the date set forth in the row above until the following date:		child support for Child 3 and all other younger child(ren) should be paid in the following monthly amount:
Child 4 Initials & year of birth:	After the date set forth in the row above until the following date:		child support for Child 4 and all other younger child(ren) should be paid in the following monthly amount:

(Continue on additional pages for additional children)

NOTE: This change only relates to the amount of the ongoing child support obligation portion of the payments listed in the first page of this Income Withholding Order. If there is a child support arrearage in a Title IV-D case, the amount will not be reduced due to the child no longer being eligible for ongoing support pursuant to par. 11 above.

17. Additional information regarding the implementation of income deduction may be found at www.florida.sdu.com.

DONE AND ORDERED in Chambers at Inverness, Citrus County, Florida, this ____ day of ______________, 2018.

_____________________________________

@@, CIRCUIT JUDGE

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a correct copy of the foregoing has been furnished by U.S. Mail on this ____ day

of _________________, 2018 to the following:

Attorney for Former Husband

Department of Revenue, C.S.E.

95 North Lecanto Highway

Lecanto, Florida 34461-9187

By: ______________________________________

Administrative Secretary