Notice To Withhold Income - Douglas County
Download a blank fillable Notice To Withhold Income - Douglas County in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Notice To Withhold Income - Douglas County with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2NOTICE TO WITHHOLD INCOME
_________________________________________________________________________________
IN THE DISTRICT COURT ________DOUGLAS___________________ COUNTY, NEBRASKA
COURT CASE NUMBER:
Petitioner
***TERMINATION***
Vs.
NOTICE TO WITHHOLD INCOME
(OBLIGOR REQUESTED)
Respondent
Re: Employee (Obligor): _________________________________________________________
Employee's SSN: ____ ____ ____ - _____ _____ - _____ _____ _____ _____
To: (Employer
Payor) _____________________________________________________
or Other
Employer telephone number
Employer address
PURSUANT TO NEB. REV. STAT. § 43-1713.02, YOU ARE HEREBY NOTIFIED OF THE FOLLOWING:
(1)
I, ___________________________________, the above named employee/obligor, have been ordered to have an amount withheld
from my income to satisfy a child/spousal/medical support obligation. You are hereby directed to withhold $ ______________
per__________________(or the equivalent based on your pay period) from my net disposable income or _________% of my net
disposable income subject to CCPA limits (see (11) ), whichever is less. For the purpose of income withholding, net disposable
income is defined as that part of the employee's earnings remaining after the deductions for payment of federal and state
income taxes, employment taxes, Social Security (FICA) deductions, mandatory retirement and federal or state income tax liens.
(2)
The above amount is based on my support obligation(s) of:
Child Support
$
per _________________ and arrears of $
per _________________ and arrears of $
Spousal/Maintenance Support
$ (if included in the child support
order)
Medical Support
$ _____________per ______________ and arrears of $ (that is
reduced to a certain dollar amount)
(3)
Income withholding must be implemented no later than the first pay period that- occurs after fourteen (14) days following the date
of this notice.
(4)
If I as employee take an advance draw on my income, each draw is to be considered a pay period for the purpose of
income .withholding.
(5)
You must forward the withheld amount to the Nebraska Child Support Payment Center at the address listed below within seven
I
(7) days of the date
am paid.
Nebraska Child Support Payment Center
P. 0. Box 82890 ,
Lincoln, NE 68502-2890
(6)
I (
have) (
have not) been ordered to provide health insurance coverage for my dependent child(ren).
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial