IN THE CIRCUIT COURT OF THE TENTH JUDICIAL CIRCUIT
IN AND FOR POLK COUNTY, FLORIDA
_____________________________,
Plaintiff/Petitioner,
CASE NO:____________________
vs.
DRD NO:_____________________
_____________________________,
Defendant/Respondent
INCOME DEDUCTION ORDER
TO: Company
Company Address
Company Town, current, former or future employer or payor of ____________________ (Defendant), Social Security #_____________________, Obligor, and all subsequent employers and payors of Obligor.
YOU ARE HEREBY DIRECTED, pursuant to Chapter 61, Florida Statutes, to make regular deductions from all income including but not limited to, present or past employment, commissions and bonuses, retirement benefits, pensions, workers
= compensation, dividends, royalties, or trust accounts of ____________________ (Defendant), in accordance with the terms of this Notice and the Notice to Payor. YOU ARE FURTHER DIRECTED:1. To deduct from all income due and payable to _________________ (Defendant), the sum of $_______ per ________ for ongoing support, plus the Clerk
=s fee of $_____, for a total of $_______ per _______ for the support of the following named dependents:Child
=s Name Child=s Date of BirthChild
=s Name Child=s Date of BirthThe first deduction shall include an additional one-time fee of $20.00 for the processing of the Income Deduction Order by the Clerk
=s Office.2. To send payments to Richard M. Weiss, Clerk of Courts, Domestic Relations Department, Drawer CC-5, P.O. Box 9000, Bartow, FL 33831-9000, within two days of disbursement of said income.
3. Pursuant to the consumer Credit Protection Act, 15. U.S. C., s. 1673(b), as amended, if the Obligor is supporting a spouse or dependent child other than those named in paragraph 1 above, you shall not deduct more than 55% of the Obligor
=s disposable earnings. If the Obligor is not supporting a spouse or dependent other than those named in Paragraph One above, you shall not deduct more than 65% of the obligor=s disposable earnings.4. To deduct from any bonus, settlement, award or other single one-time payment, which is not defined as disposable earnings, the full amount of arrears due or the remaining balance thereof and forward said amount to the Clerk of Court as defined in Paragraph Two above. The amount of arrearage may be determined by calling the Domestic Relations Department at 534-4514, or by writing to the above address.
ORDERED at Bartow, Polk County, Florida, this _________ day of _________________, 1998.
____________________________________
Copies furnished to: CIRCUIT JUDGE
Employer or Payor of Defendant
Domestic Relations Depository and Enforcement
Plaintiff/Petitioner and Defendant/Respondent
IN THE CIRCUIT COURT OF THE TENTH JUDICIAL CIRCUIT
IN AND FOR POLK COUNTY, FLORIDA
_____________________________,
Plaintiff/Petitioner,
CASE NO:____________________
vs.
DRD NO:_____________________
_____________________________,
Defendant/Respondent
NOTICE TO PAYOR
TO: Company Name
Address
City, State, Zip
AS REQUIRED BY CHAPTER 61, FLORIDA STATUTES, YOU ARE HEREBY NOTIFIED OF THE FOLLOWING:
1. You have been served with an Income Deduction Order for _________________, Obligor. This Order must be implemented no later than the first payment date which occurs more than 14 days after you were served with the Order.
2. Payments must be sent to the Domestic Relations Department, Clerk of Courts, Drawer CC-5, P.O. Box 9000, Bartow, FL 33831-9000.
3. You are required to forward the amounts deducted to the depository in Paragraph 2 within two working days after each payment date, and at the same time forward to the depository a statement as to whether the amount deducted totally or partially satisfies the amount specified in the Income Deduction Order. For example: A child support order requires the father to pay monthly. The father=s employer distributes paychecks each week. The employer must therefore remit to the Clerk on a weekly pro-rata basis.
4. You must specify the dates for which the deductions have been made. For example, if the check covers a period of two weeks, please note the specific dates, such as November 1, 1997 through November 14, 1997.
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 attorney=s fees.
6. You may withhold and retain up to $5.00 against the Obligor=s income to reimburse you for administrative costs for the first deduction, and up to $2.00 for each deduction thereafter.
7. You are required to deduct from any bonus, settlement, award or other single one-time payment the full amount of the arrears due or the remaining balance thereof and forward the payment to the governmental depository.
8. The Income Deduction Order and this Notice are binding on you until further notice, or until you no longer provide income to the Obligor.
9. At no time may you stop the deduction solely upon the request of the Obligor.
10. When you no longer provide income to the Obligor, you shall notify the Domestic Relations Enforcement Office at the address in Paragraph 16 below, and shall also provide the Obligor=s last known address and the name and address of the Obligor=s new payor, if known. 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. Penalties shall be paid to the depository.
11. You shall not discharge, refuse to employ, or take disciplinary action against any person because of an Income Deduction Order. 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 depository.
12. The Obligor may bring a civil action in the courts of this state against you if you refuse to employ, discharge, or otherwise discipline him or her because of an Income Deduction Order. The Obligor is entitled to reinstatement, all wages and benefits lost, plus reasonable attorney fees and costs incurred.
13. The Income Deduction Order has priority over all other legal processes under state law pertaining to the same income. Payment, as required by the Income Deduction Order, is a complete defense by you against any claims of the Obligor or his/her creditors as to the sum paid.
14. If you receive Income Deduction Order requiring that the income of two or more Obligors be deducted and sent to the same depository, you may combine the amounts that are to be paid to the depository in a single payment as long as you identify that portion of the payment attributable to each obligor.
15. If you receive more than one Income Deduction Order against the same Obligor, you shall contact the court for further instructions. Upon being so contacted, the court shall allocate amounts available for income deduction, giving priority to current child support obligations up to the limits imposed under s. 303(b) of the consumer Credit Protection Act, 15 U.S.C., s. 1673(b).
16. The address to which notices are to be sent is: Richard M. Weiss, Clerk of Courts, Domestic Relations Enforcement, Drawer CC-15, P.O. Box 9000, Bartow, FL 33831-9000.
BY ORDER OF THE COURT
Richard M. Weiss, Clerk of Courts
By:_____________________________
Deputy Clerk
I certify that a true copy of this Notice to Payor has been served on the person, firm, agency, office or political subdivision to whom this statement is directed by certified mail, return receipt, this _____ day of __________________, 1998.
Richard M. Weiss, Clerk of Courts
By:_____________________________
Deputy Clerk