In The Family Court Of St. Louis County Missouri printable pdf download

Person Completing this Form must Also Submit Form CCFC133 To Ensure Proper

Disbursement by the Family Support Payment Center

IN THE FAMILY COURT OF ST. LOUIS COUNTY, MISSOURI

For File Stamp Only

Petitioner

Date

vs.

Case Number

Respondent

Division

APPLICATION AND NOTICE OF TEMPORARY INCOME WITHHOLDING–(CHAPTER 455)

TO:

__________________________________________

_______________________________________________

(Employer) (Payor)

(Employee) (Payee) Name

SSN

__________________________________________

_______________________________________________

(Address)

__________________________________________

_______________________________________________

The law requires a wage withholding order for child support or maintenance, whether or not the employee/payee is delinquent, anytime the

court enters such an order and that all wage withholding orders shall be paid through the Family Support Payment Center.

Pursuant to 452.350 RSMo., the income withholding shall begin on the above named employee/payee not later than two weeks after mailing

and shall continue until further order of the Court.

You (employer/payor) are directed to withhold subject to the Federal Consumer Protection Act (See Reverse) the following amounts:

$_________________________ per _____________________ for CURRENT CHILD SUPPORT

$_________________________ per _____________________ for CURRENT MAINTENANCE

$________________________ per____________________ until a TOTAL ARREARAGE OF $ ________________ has

been paid. When the total arrearage amount is paid in full, then withhold for current amounts only. The arrearage payment withheld shall not

exceed fifty percent (50%) of the current child support and maintenance amount.

The court’s order for child support and/or maintenance is entered under Chapter 455 RSMo. The court’s order in this case is temporary

and has a termination date of ____________________ . No additional child support may be collected past the termination date unless further

ordered by the court or an additional wage issued. However, all delinquency must be paid in full before this wage assignment may be

terminated.

For each payment you may charge a fee not to exceed six dollars ($6.00) per month, which is to be deducted from the money, to be paid by the

employee in addition to the amount deducted to meet child support or maintenance obligation.

FAILURE TO HONOR THIS NOTICE OF WITHHOLDING MAY SUBJECT YOU TO CONTEMPT OF COURT PROCEEDINGS AND

LIABILITY FOR THE AMOUNT NOT WITHHELD.

Payments shall be made to:

FAMILY SUPPORT PAYMENT CENTER

P.O. BOX 109001

JEFFERSON CITY, MO 65110-9001

Check must include court case number to ensure proper credit. See reverse side for further instructions.

Prepared By:

I certify that a copy of this notice was mailed to the employer/payor by certified mail

return receipt requested on ____________________ and by regular mail to

_______________________________________________________

employee/payee on _____________________.

Signature of person or legal representative requesting withholding

JOAN M. GILMER, Circuit Clerk

_______________________________________________________

Print or type name

_______________________________________________________

Address

By ________________________________

Deputy Clerk

_______________________________________________________

Telephone

An obligated party’s request for a hearing on the issue of whether the withholding shall take effect must be made within two weeks after mailing

of this notice (See Reverse). Such request shall be made by proper written motion. Please contact your attorney for legal advice.

CCFC104-WA Rev. 12/08 (PREVIOUS VERSION OBSOLETE)

In The Family Court Of St. Louis County Missouri

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