IN THE CIRCUIT COURT OF THE TENTH JUDICIAL CIRCUIT

IN AND FOR POLK COUNTY, FLORIDA

Plaintiff/Petitioner,

CASE NO.:

vs.

DRD NO.:

Defendant/Respondent.

/

TO: Defendant

The Court has ordered you to pay child support, alimony, or both. Pursuant to Section 61.1301, Florida Statutes, the payments are to be deducted by your employer or payor and forwarded directly by your employer or payor to the Clerk of the Circuit Court for the distribution to the obligee (the person to whom you owe the obligation) of these funds.

The Clerk's fee for the income deduction order is $20.00.

The total amount of income that will be deducted from your payment is $ every . This sum is calculated as follows:

$__________ Child Support

$__________ Alimony

$__________ Arrearage of $

$__________ Clerk's collection fee

The income deduction order applies to current and future employers and payors, and periods of employment.

Your employer or payor will be instructed to deduct the amount of money you have been ordered to pay. The payor shall also be instructed to deduct twenty percent (20%) of that periodic payment to be applied to any arrearage that may have accrued in your case.

Your employer or payor may deduct a fee for administrative costs of up to Five Dollars ($5.00) for the first periodic payment and up to Two Dollars ($2.00) for each periodic payment made thereafter (Section 61.13015, Florida Statutes).

You may contest enforcement of the Income Deduction Order in writing pursuant to Chapter 61, Florida statutes, only on the following mistakes of fact: (1) the amount of the obligation; (2) the arrearage amount, or (3) the identity of obligor or identity of obligee. You have 15 days from (date of notice), to file your application to contest the order.

The total amount deducted by your employer or payor from your periodic income payments may not exceed the amounts allowed under Section 303(b) of the Consumer Credit Protection Act, 15 U.S.C. 167(b), as amended. If you support a spouse or dependent child other than those in this case, no more than 55% of your disposable earnings may be deducted per payment. If you do not support anyone other than those persons named in this case, no more than 65% of your disposable earnings may be deducted per payment.

You are required to notify the obligee and the Domestic Relations Enforcement Office within seven days of a change in your address, your employment or your employer's address.

I certify that a true copy of the foregoing was served on (defendant), by (type of service) this day of , 1998.

RICHARD M. WEISS, CLERK OF COURTS

BY:

DEPUTY CLERK

STMTRGTS.FRM