Fillable Notice To Payor - Florida Circuit Court (Page 2 of 4) in pdf

Notice To Payor - Florida Circuit Court Page 2

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IN THE CIRCUIT COURT OF THE

JUDICIAL CIRCUIT,

IN AND FOR

COUNTY, FLORIDA

Case No.:

Division:

Petitioner,

and

Respondent.

NOTICE TO PAYOR

TO:

Name of Obligor’s Payor:

Payor’s Address:

RE:

Obligor

Obligee

Name:

Address:

Obligor’s social security number:_________________________________;

NOTE: The Obligor’s social security number should be placed on the copy of the Notice to Payor that

is mailed to the Obligor’s Payor; This line should be left blank on the original Notice to Payor filed

with the court.

YOU, THE PAYOR, ARE HEREBY NOTIFIED that, under section 61.1301, Florida Statutes, you have the

responsibilities and rights set forth below with regard to the accompanying Income Deduction Order

and/or any attachment(s):

1. You are required to deduct from the obligor’s income the amount specified in the income deduction

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.

2. 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 deduction order or, in Title IV-D cases, income deduction notice 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.

3. 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

Florida Family Law Rules of Procedure Form 12.996(b), Notice to Payor (09/12)

Notice To Payor - Florida Circuit Court Page 2

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