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

Notice To Payor - Florida Circuit Court Page 4

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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.

14. All notices to the obligee shall be sent to the address provided in this notice to payor, or any place

thereafter the obligee requests in writing.

15. 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

and clicking on “Payments;” Payment options include Expert Pay,

Automated Clearing House (ACH) credit through your financial institution,

, or Western Union. Payors may contact the SDU Customer Service

Employer telephone line at 1-888-833-0743.

16. Additional information regarding the implementation of this Notice to Payor may be found at

I certify that a copy of this document was [check all used]: ( ) emailed ( ) mailed

( ) faxed ( ) hand delivered to the person(s) listed below on {date} _________________.

Other party or his/her attorney:

Name:

Address:

City, State, Zip:

________

Fax Number:

Email Address(es):______________________

Signature of Party or his/her attorney

Printed Name:

Address:

City, State, Zip:

Telephone Number:

Fax Number:

E-Mail Address(es):___________________________

Florida Bar Number:___________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:

[fill in all blanks] This form was prepared for the {choose only one} (

) Petitioner (

) Respondent

This form was completed with the assistance of:

{name of individual}

___________________________________,

{name of business} _______________________________________________________________,

{street}

____________________________________________________________,

{city}

______________________________,

{state}

, {telephone number}

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

Notice To Payor - Florida Circuit Court Page 4

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