Employment Information - Pinal County, Arizona
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1CLERK
O F
T HE
C OURT
SUPERIOR
C OURT
O F
A RIZONA
TEL:
( 520)
8 66-‐5321
AMANDA STANFORD
P INAL
C OUNTY
P .O.
B ox
6 28
F AX:
( 520)
8 66-‐5377
CLERK
F lorence,
A rizona
8 5132
EMPLOYMENT INFORMATION
TO BE COMPLETED BY THE NON CUSTODIAL PARENT/OBLIGOR/PAYOR ONLY
THIS FORM MUST BE COMPLETED FOR:
[ ]
NOTIFICATION OF EMPLOYER
[ ]
NOTIFICATION OF A CHANGE OF EMPLOYER
CASE NUMBER: _________________________________
ATLAS NUMBER: ______________________________
OBLIGOR/PAYOR: ________________________________________________________________________________
(PERSON TO MAKE PAYMENTS)
LIST ONLY THE EMPLOYER’S NAME AND PAYROLL ADDRESS WHERE THE INCOME WITHHOLDING ORDER
OR ORDER TO STOP SHOULD BE MAILED:
CURRENT EMPLOYER NAME:
___________________________________________________________________
PAYROLL ADDRESS:
___________________________________________________________________
CITY: ________________________________ STATE: ______________
ZIP CODE: _____________________
EMPLOYER TELEPHONE: _________________________________________________________________________
EMPLOYER FAX:
_________________________________________________________________________
______________________________________________
______________________________________
Non
C ustodial
P arent
S ignature
Date
Pursuant
t o
A .R.S.
§
2 5-‐504(K)
U nless
a
c ourt
h as
o rdered
o therwise,
t he
p erson
o rdered
t o
p ay
s upport
o r
s pousal
m aintenance
s hall
n otify
t he
clerk
o f
s uperior
c ourt
o r
t he
s upport
c learinghouse
i n
w riting
o f
t he
o bligor’s
r esidential
a ddress
a nd
t he
n ame
a nd
a ddress
o f
a ny
e mployer,
and
w ithin
1 0
d ays
o f
a ny
c hange.
F ailure
t o
d o
s o
m ay
s ubject
t he
p erson
t o
s anctions
f or
c ontempt
o f
c ourt,
i ncluding
r easonable
a ttorney
f ees
and
c osts.
Form
U pdated
0 3/07/2014
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