Preview
MC: NM 0902E
FS# 325976715
Central File Maintenance
P. O. Box 12048
AUSTIN, TX 78711-2048
OFFICE OF THE ATTORNEY GENERAL
STATE OF TEXAS
CHILD SUPPORT DIVISION
GREG ABBOTT
Attorney General
THOMAS A. WILDER Date: December 2, 2010
200 E WEATHERFORD ST Custodial Parent: ESTELA GARZA
TARRANT COUNTY LAW CTR Non-Custodial Parent: JAVIER PUGA
FORT WORTH, TX 76196 Attorney General Case# 0012240552
Cause # 231-331746-02
Dear THOMAS A. WILDER:
Enclosed please find an Order/Notice to Withhold Income for Child Support (Administrative Writ of Withholding).
Please file this document in the above referenced cause number.
Feel free to contact me if you have any questions regarding this matter.
Sincerely,
BETTY A ACOSTA
CHILD SUPPORT UNIT 0902E
6100 WESTERN PLACE #405
FORT WORTH, TX 76107
(817) 731-9811
Enclosures
September 2005 Form 3L050
INCOME WITHHOLDING FOR SUPPORT
ADMINISTRATIVE WRIT OF WITHHOLDING
ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) AMENDED IWO
ONE-TIME ORDER/NOTICE-LUMP SUM PAYMENT
TERMINATION of IWO Date:12/2/2010
Child Support Enforcement (CSE IV-D) Agency Court Attorney Private Individual/Entity (Check One)
NOTE: If you receive this document from someone other than a State or Tribal Child Support Enforcement agency or a court, a copy of the underlying order that contains a provision
authorizing income withholding must be attached. Or if under State law an attorney in that State, or if under Tribal law a Tribal legal representative, may issue an income withholding order,
the attorney or Tribal legal representative must include a copy of the State or Tribal law authorizing the attorney or Tribal legal representative to issue an income withholding order.
Texas______________________________________
State/Tribe/Territory
0012240552___________________
Case Identifier
City/County/Dist./Tribe
231ST DISTRICT COURT TARRANT COUNTY________________
231-331746-02________________
Order Identifier
___________________________________________
Private Individual/Entity
CURTIS MECHANICAL CONTRACTORS RE: PUGA, JAVIER
Employer/Income Withholder's Name Employee/Obligor's Name (Last, First, MI)
1610 OSPREY DR 634-80-2224
DESOTO, TX 75115-2428-24 Employee/Obligor's Social Security Number (if known)
Employer/Income Withholder's Address GARZA, ESTELA
752234636 Custodial Party/Obligee's Name (Last, First, MI)
Employer /Income Withholder's Federal EIN
Child's Name (Last, First, MI)
PUGA, CASANDRA M_______________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
TEXAS_____________________________.
ORDER INFORMATION: This document is based on the support or withholding order from
You are required by law to deduct these amounts from the employee/obligor's income until further notice.
$ 284.00___________ Per monthly__________ current child support
$ 0.00_____________ Per monthly__________ past-due child support - Arrears greater than 12 weeks? Yes No
$ 75.00____________ Per monthly__________ current cash medical support
$ 0.00_____________ Per monthly__________ past-due cash medical support
$ _________________ Per _________________ current spousal support
$ _________________ Per _________________ past-due spousal support
$ _________________ Per _________________ other (must specify)
_____________________________
for a total of $ 359.00___ Per monthly__________ to be forwarded to the payee below.
AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information. If your pay cycle does not match the ordered payment cycle,
withhold one of the following amounts:
$ 82.85______ per weekly pay period. $ 179.50_____ per semimonthly pay period (twice a month).
$ 165.69_____ per biweekly pay period (every two weeks). $ 359.00_____ per monthly pay period.
$ ___________ONE-TIME LUMP SUM PAYMENT Do not stop any existing IWO unless you receive a termination order.
REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is in Texas, you must begin withholding no later than the first pay period following the date on
which this Order/Notice was delivered to the employer. Send payment on the same day of the pay date/date of withholding. If you cannot withhold the full amount of support for any or all
orders for this employee/obligor, withhold up to 50 % of disposable income for all orders.
If the employee/obligor's principal place of employment is not in Texas, see the ADDITIONAL INFORMATION FOR EMPLOYERS AND OTHER INCOME WITHHOLDERS section for
limitations on withholding, applicable time requirements, and any allowable employer's fees.
325976715_____
Document Tracking Identifier
For EFT/EDI instructions, contact the EFT/EDI office at
1-877-474-4463
before first submission.
IMPORTANT: The person completing this form is advised that the information on this form may be shared with the obligor. OMB 0970-0154
August 2009 Form 3N051
If paying by check, make check payable to: Send TX CHILD SUPPORT SDU
check to: P O BOX 659791
Office of the Attorney General SAN ANTONIO, TX 78265-9791
Include these Remittance Identifiers with payment:
AG Case # 0012240552
Cause #231-331746-02 4800000
FIPS code (if necessary):
12/2/2010
Signature and Date
Print Name:Alicia G. Key
Deputy
Title of Issuing Official: Attorney General for Child Support
If checked, you are required to provide a copy of this form to your employee/obligor. If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that
issued this order, a copy must be provided to your employee/obligor even if the box is not checked.
ADDITIONAL INFORMATION FOR EMPLOYERS AND OTHER INCOME WITHHOLDERS
State specific information may be viewed on the OCSE Employer Services website located at:
http://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contacts.htm
Priority: Withholding for support has priority over any other legal process under State law (or Tribal law, if applicable) against the same income. If a Federal
tax levy is in effect, please notify the contact person listed below.
Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency/party
requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor.
Reporting the Pay Date/Date of Withholding: You must report the pay date when sending the payment. The pay date is the date on which the amount was
withheld from the employee/obligor's wages. You must comply with the law of the State (or Tribal law, if applicable) of the employee/obligor's principal
place of employment with respect to the time periods within which you must implement the withholding and forward the support payments.
Employee/Obligor with Multiple Support Withholdings: If there is more than one Order/Notice against this employee/obligor and you are unable to fully
honor all support Orders/Notices due to Federal, State, or Tribal withholding limits, you must follow the State or Tribal law/procedure of the
employee/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible, giving priority to current support before
payment of any past-due support.
Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. Contact the
agency or person listed below to determine if you are required to withhold or if you have any questions about lump sum payments.
Liability: If you have any doubts about the validity of the Order/Notice, contact the agency or person listed below. If you fail to withhold income as the
Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and any other penalties
set by State or Tribal law/procedure.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from employment, refusing to
employ, or taking disciplinary action against any employee/obligor because of a child support withholding.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act(CCPA)(15
U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee/obligor's principal place of employment. Disposable income is the net
income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes.
The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not
supporting another family. However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If
permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section.
IMPORTANT: The person completing this form is advised that the information on this form may be shared with the obligor. OMB 0970-0154
August 2009 Form 3N051
Employee/Obligor's NameJAVIER PUGA___________________________________ 0012240552______________________
Case Identifier
231-331746-02__________________________________
Order Identifier Employer's NameCURTIS MECHANICAL CONTRACTORS__
Arrears greater than 12 weeks: If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate
the CCPA limit using the lower percentage.
For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order,
you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted
under section 303(d) of the CCPA (15 U.S.C. 1673 (b)).
Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income
and applying appropriate withholding limits.
Additional information:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
NOTIFICATION OF TERMINATION OF EMPLOYMENT: You must promptly notify the Child Support Enforcement Agency and/or the person listed
below by returning this form to the correspondence address if:
This person has never worked for this employer.
This person no longer works for this employer.
Please provide the following information for the terminated employee:
Termination date: _______________________________________ Last known phone number: _____________________________
Last known home address: ____________________________________________________________________________________
____________________________________________________________________________________
Date final payment made to the State Disbursement Unit or Tribal CSE agency:
________________________________________________
Final payment amount: ____________________________________ New employer's name: ______________________________
New employer's address: _____________________________________________________________________________________
_____________________________________________________________________________________
CONTACT INFORMATION
To employer: If the employer/income withholder has any questions, contact
BETTY A ACOSTA_____________________ at:
CHILD SUPPORT UNIT 0902E
6100 WESTERN PLACE #405
FORT WORTH, TX 76107
by phone at (817) 731-9811, by fax at
(817) 731-9239, or by Internet for employers at http://employer.oag.state.tx.us
Send termination notice and other correspondence to: Or You may submit the termination online via the Internet at
http://employer.oag.state.tx.us
Office of the Attorney General
Child Support Division
Central File Maintenance
P O Box 12048
Austin, TX 78711-2048
To employee/obligor:
If the employee/obligor has any questions, contact
BETTY A ACOSTA_____________________ at:
CHILD SUPPORT UNIT 0902E
6100 WESTERN PLACE #405
FORT WORTH, TX 76107
by phone at (817) 731-9811, by fax at
(817) 731-9239, or by Internet for employees at http://childsupport.oag.state.tx.us
IMPORTANT: The person completing this form is advised that the information on this form may be shared with the obligor. OMB 0970-0154
August 2009 Form 3N051
Preview
MC: NM 0902E FS# 325976715 Central File Maintenance P. O. Box 12048 AUSTIN, TX 78711-2048 OFFICE OF THE ATTORNEY GENERAL STATE OF TEXAS CHILD SUPPORT DIVISION GREG ABBOTT Attorney General THOMAS A. WILDER Date: December 2, 2010 200 E WEATHERFORD ST Custodial Parent: ESTELA GARZA TARRANT COUNTY LAW CTR Non-Custodial Parent: JAVIER PUGA FORT WORTH, TX 76196 Attorney General Case# 0012240552 Cause # 231-331746-02 Dear THOMAS A. WILDER: Enclosed please find an Order/Notice to Withhold Income for Child Support (Administrative Writ of Withholding). Please file this document in the above referenced cause number. Feel free to contact me if you have any questions regarding this matter. Sincerely, BETTY A ACOSTA CHILD SUPPORT UNIT 0902E 6100 WESTERN PLACE #405 FORT WORTH, TX 76107 (817) 731-9811 Enclosures September 2005 Form 3L050 INCOME WITHHOLDING FOR SUPPORT ADMINISTRATIVE WRIT OF WITHHOLDING ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) AMENDED IWO ONE-TIME ORDER/NOTICE-LUMP SUM PAYMENT TERMINATION of IWO Date:12/2/2010 Child Support Enforcement (CSE IV-D) Agency Court Attorney Private Individual/Entity (Check One) NOTE: If you receive this document from someone other than a State or Tribal Child Support Enforcement agency or a court, a copy of the underlying order that contains a provision authorizing income withholding must be attached. Or if under State law an attorney in that State, or if under Tribal law a Tribal legal representative, may issue an income withholding order, the attorney or Tribal legal representative must include a copy of the State or Tribal law authorizing the attorney or Tribal legal representative to issue an income withholding order. Texas______________________________________ State/Tribe/Territory 0012240552___________________ Case Identifier City/County/Dist./Tribe 231ST DISTRICT COURT TARRANT COUNTY________________ 231-331746-02________________ Order Identifier ___________________________________________ Private Individual/Entity CURTIS MECHANICAL CONTRACTORS RE: PUGA, JAVIER Employer/Income Withholder's Name Employee/Obligor's Name (Last, First, MI) 1610 OSPREY DR 634-80-2224 DESOTO, TX 75115-2428-24 Employee/Obligor's Social Security Number (if known) Employer/Income Withholder's Address GARZA, ESTELA 752234636 Custodial Party/Obligee's Name (Last, First, MI) Employer /Income Withholder's Federal EIN Child's Name (Last, First, MI) PUGA, CASANDRA M_______________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ TEXAS_____________________________. ORDER INFORMATION: This document is based on the support or withholding order from You are required by law to deduct these amounts from the employee/obligor's income until further notice. $ 284.00___________ Per monthly__________ current child support $ 0.00_____________ Per monthly__________ past-due child support - Arrears greater than 12 weeks? Yes No $ 75.00____________ Per monthly__________ current cash medical support $ 0.00_____________ Per monthly__________ past-due cash medical support $ _________________ Per _________________ current spousal support $ _________________ Per _________________ past-due spousal support $ _________________ Per _________________ other (must specify) _____________________________ for a total of $ 359.00___ Per monthly__________ to be forwarded to the payee below. AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information. If your pay cycle does not match the ordered payment cycle, withhold one of the following amounts: $ 82.85______ per weekly pay period. $ 179.50_____ per semimonthly pay period (twice a month). $ 165.69_____ per biweekly pay period (every two weeks). $ 359.00_____ per monthly pay period. $ ___________ONE-TIME LUMP SUM PAYMENT Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is in Texas, you must begin withholding no later than the first pay period following the date on which this Order/Notice was delivered to the employer. Send payment on the same day of the pay date/date of withholding. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 50 % of disposable income for all orders. If the employee/obligor's principal place of employment is not in Texas, see the ADDITIONAL INFORMATION FOR EMPLOYERS AND OTHER INCOME WITHHOLDERS section for limitations on withholding, applicable time requirements, and any allowable employer's fees. 325976715_____ Document Tracking Identifier For EFT/EDI instructions, contact the EFT/EDI office at 1-877-474-4463 before first submission. IMPORTANT: The person completing this form is advised that the information on this form may be shared with the obligor. OMB 0970-0154 August 2009 Form 3N051 If paying by check, make check payable to: Send TX CHILD SUPPORT SDU check to: P O BOX 659791 Office of the Attorney General SAN ANTONIO, TX 78265-9791 Include these Remittance Identifiers with payment: AG Case # 0012240552 Cause #231-331746-02 4800000 FIPS code (if necessary): 12/2/2010 Signature and Date Print Name:Alicia G. Key Deputy Title of Issuing Official: Attorney General for Child Support If checked, you are required to provide a copy of this form to your employee/obligor. If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy must be provided to your employee/obligor even if the box is not checked. ADDITIONAL INFORMATION FOR EMPLOYERS AND OTHER INCOME WITHHOLDERS State specific information may be viewed on the OCSE Employer Services website located at: http://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contacts.htm Priority: Withholding for support has priority over any other legal process under State law (or Tribal law, if applicable) against the same income. If a Federal tax levy is in effect, please notify the contact person listed below. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency/party requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. Reporting the Pay Date/Date of Withholding: You must report the pay date when sending the payment. The pay date is the date on which the amount was withheld from the employee/obligor's wages. You must comply with the law of the State (or Tribal law, if applicable) of the employee/obligor's principal place of employment with respect to the time periods within which you must implement the withholding and forward the support payments. Employee/Obligor with Multiple Support Withholdings: If there is more than one Order/Notice against this employee/obligor and you are unable to fully honor all support Orders/Notices due to Federal, State, or Tribal withholding limits, you must follow the State or Tribal law/procedure of the employee/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible, giving priority to current support before payment of any past-due support. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. Contact the agency or person listed below to determine if you are required to withhold or if you have any questions about lump sum payments. Liability: If you have any doubts about the validity of the Order/Notice, contact the agency or person listed below. If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and any other penalties set by State or Tribal law/procedure. ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a child support withholding. ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act(CCPA)(15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. IMPORTANT: The person completing this form is advised that the information on this form may be shared with the obligor. OMB 0970-0154 August 2009 Form 3N051 Employee/Obligor's NameJAVIER PUGA___________________________________ 0012240552______________________ Case Identifier 231-331746-02__________________________________ Order Identifier Employer's NameCURTIS MECHANICAL CONTRACTORS__ Arrears greater than 12 weeks: If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Additional information: ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ NOTIFICATION OF TERMINATION OF EMPLOYMENT: You must promptly notify the Child Support Enforcement Agency and/or the person listed below by returning this form to the correspondence address if: This person has never worked for this employer. This person no longer works for this employer. Please provide the following information for the terminated employee: Termination date: _______________________________________ Last known phone number: _____________________________ Last known home address: ____________________________________________________________________________________ ____________________________________________________________________________________ Date final payment made to the State Disbursement Unit or Tribal CSE agency: ________________________________________________ Final payment amount: ____________________________________ New employer's name: ______________________________ New employer's address: _____________________________________________________________________________________ _____________________________________________________________________________________ CONTACT INFORMATION To employer: If the employer/income withholder has any questions, contact BETTY A ACOSTA_____________________ at: CHILD SUPPORT UNIT 0902E 6100 WESTERN PLACE #405 FORT WORTH, TX 76107 by phone at (817) 731-9811, by fax at (817) 731-9239, or by Internet for employers at http://employer.oag.state.tx.us Send termination notice and other correspondence to: Or You may submit the termination online via the Internet at http://employer.oag.state.tx.us Office of the Attorney General Child Support Division Central File Maintenance P O Box 12048 Austin, TX 78711-2048 To employee/obligor: If the employee/obligor has any questions, contact BETTY A ACOSTA_____________________ at: CHILD SUPPORT UNIT 0902E 6100 WESTERN PLACE #405 FORT WORTH, TX 76107 by phone at (817) 731-9811, by fax at (817) 731-9239, or by Internet for employees at http://childsupport.oag.state.tx.us IMPORTANT: The person completing this form is advised that the information on this form may be shared with the obligor. OMB 0970-0154 August 2009 Form 3N051