INCOME WITHHOLDING FOR SUPPORT CC: C/S

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                                                         INCOME WITHHOLDING             FOR SUPPORT

                     □      INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO)
                     ~      AMENDEDIWO
                     □      ONE-TIME ORDER/NOTICE FOR LUMP SUM PAYMENT
                     □      TERMINATION OF IWO

                D  Child Support Enforcement (CSE) Agency          ~ Court    D Attorney    □ Private Individual/Entity     (Check One)
           NOTE:    This IWO must be regular on tts face.    Under certain circumstances you must reject this IWO and return tt to the
           sender (see IWO instructions www.acf.hhs.gov/css/resourcefrncome-withholdinq-for-support-instructions}.           If you receive
           this document from someone other than a state or tribal CSE agency or a court, a copy of the underlying support order must
           be attached.

            State/Tribe/Territory _,T-=E"-X"-A-"S'----~-----            R…