Preview
5/3/2017 12:02:06 PM
Annle Rebecca Eillott
| District Clerk
Fort Bend County, Texas
Kathleen Geuea
INCOME WITHHOLDING FOR SUPPORT
f] ORIGINAL INCOME WITHHOLDING ORDERINOTICE FOR SUPPORT (IWO)
AMEN WO
IME ORDER/NOTICE FOR LUMP: SUM PAYMENT
MINATION OF WO Date! rit 11,2017
C)child ‘S(ippoit Enforcement gency [|Court [X] Attomey [_]Private IndividuaVEntity (Check One)
NOTE: is must be regula On its face.. Under certain circumstances you must reject this IWO and retum it tothe
sender (si ins ions www.a hh go programs/css/reso ome-wi ithhold for-s pport-instructions). If
you receive document cmpoms.omer than a state or tribal CSE agency ora : court,
om somes py of the ‘underlying order
must be-attached
State/Tribe/Territory Tew Remittance ID (include w/payment) 16-DCVv-232.757_
City/County/Dist./Tr| ‘ORT BEND, yy Order ID 16-DCV-232.757
Private Individual/En' CSE Agency Case ID
PWC. . RE: JAIN..VIBHA_-
Employer/income Withholder’s Name
a.
Employee/Obligor’s Name (Last, First, Middle)
1 5800,
mployer/income Withhoider's Addregs )bligor's Social Security Number
SE AT K
) stod Party/Obligee’s Name (Cast, First, Middle)
Employer/Income Withholder’s FEIN
Child(ren)'s Name(s) (Last, First, Middle) Child, Date(s)
|ME
|
ORDER INFORMATION: This document is based on the support or withholdingortler fro!
GiaterTrbe), You are required. by law to deduct these amounts from the emp! loyee/
$ 702,00 Per month current child support
past-due child support - Arrears gr fer 12 wee!
cae
igorsincome until her notice.
s [_]No
$ Per
$ 35,70 Per month. current cash medical.support
$ Per past-due cash medical support
$ Per current spousal support
$ Per past-due spousal support
Per other (must specify)
for a Total Amount to Withhold of $737.70 per
AMOUNTS TO WITHHOLD: You do.not-have to vary your pay cycle to be in.compliance.
nth,
your pay cycle does not match the ordered payment cycle, withhold one of the following amounts:
wen Se mn.If
$ 170,24per weekly pay period $ 368.85 per semimonthly pay: petiod, jice.a month)
$ 340,48 per biweekly pay period (every two weeks) $. 737.10 per monthly pay period
Lump Sum Payment: Do-not stop anyexisting IWO unless you receive a termination order.
Document Tracking ID. OMB 0970-0154
3
Employer's Name: PWC Employer FEIN: |
Employee/Obligor's Name: JAIN, VIBHA
CSE Agency:Case Identifier: Order Identifiet:, 1¢-DCEV-232,757
REMITTANC! IATIOI Ifthe employee/obligor's principal place of employment is:‘Texas
(State/Tri you ust begin withholding no later than the first pay period that-occurs immediately-after the date
Send payment.within 3. working days of the: pay. date. If you cannot withhold the full amount of support
orders for this employ obligor, withhold up to _50_ % of disposable income. If the obligoris a non-
nso
for ai
emp! obtain withholding {i Supplemental Information on page's. If the employee/obligor's principal place of
emplp nt is Not Texas (State/Tribe), obtain withholding limitations, time requirements,
and ah lowable employer fee: at WwW. .Ovit /cssirest state-i ntacts-and-
program, focmatios 6F the émployee/obligor's:principal place of employment.
For electronic pay ent requi ent nd centralized payment collection art disbursement facility information (State
Disbursement Unit (SDU)) ee wwweacf hhs. progran emplo ectronic-payme
include the Remittap eID th the payfnent and if necessary this FIPS code:
Remit payment to Texa ema Unit (SDU) (SDU/Tribal Order Payee)
at P.O, Box 659791, San Antonio, g878265-979 | (SDU/Tribal Payee Address)
CiReturn to Sender [Comflet ome Withholder]. Payment must be directed to an SDU in
accordance with 42.USC §668(b)(5) arid ) or Tribal Rayee (see Payments to SDU below): If payment is-not directed
to an SDU/Tribal Payee-or this IWO. not regularon ®, you must check this box and rétum the [WO to the:sender.
Signature of Judge/Issuing Official (if Required by St: ea Caw we Laced
Print. Name of Judge/Issuing Official:
Title of Judge/Issuing Official: LL
Date of Signature: Pity AO/2
7
Ifthe employee/obligor works in a state. or for a’ es =
at om tl ite ‘or tribe that issued:this. ordér,'a copy of
this IWO. must be provided to the employee/obli
lf checked, thew employertncome withholder Ts st provid m ta(hd}employeerobigor
ADDITIONAL INFORMATION FORENPLOY S/INGOME, WITHHOLDERS
State-speotic contact and withholding information can be-fot rd on je Fed mp loyer Services website located at
ac, hhs.gov/programs source/state heorn withho \-information.
Priority: Withholding for support has priority over any other legal procé: under State gainst the same income, (42
USC §666(b)(7)). If'a federal tax levy is in effect, please notify the.send '
Combining Payments: When remitting payments to.an SDU or tribal agency, you’ co hheld amounts
from more than:one employee/obligor's income in-a single payment. Yo owever, ly identify: each
employee/obligor's portion of the payment.
Payments To SDU:-You must-send child support payments payable by income dig to the appropriate SDU or toa
tribal CSE.agency. If this |WO instructs youto send a payment to:an entity other ‘an SDU ( ble to thé.
custodial party, court, or attorney), you must check the box above and return this Notice to thes plion: If this
[WO was sent by a-court, attorney, or private individual/entity and the initial order was: tes janubry 11,1994.or
the-order was issued by a tribal. CSE. agency, you must follow the “Remit payment to” insti
Reporting the Pay Date: You must report the pay date when sending the payment. The the, ite-on wh he
amount was withheld from the employee/obligor's wages, You must.comply with the law tate (of tribal I
applicable) of the employee/obligor's principal place of employment regarding time periods wit Rin ich. yor
implement the withholding and forward the support payments
Multiple WOs: If there.is. more than-one |WO against this employee/obligor and you-are-unable to h6nor all IWOs
due ‘to federal, state, or tribal withholding limits, you must honor all:IWOs to the greatest extent possibfe, giving priority to
Ourrent support before payment of any past-due support. Follow the state or tribal law/procedure of the employee/obligor's
principal place of employment to determine-the appropriate allocation method.
OMB Expiration Date .- 7/31/2017. The OMB Expiration Date has no bearing on the termination date.of the IWO; it identifies the
version of the form currently in use.
x
Employer's Name: PWC Employer FEIN:
Employee/Obligor's Name: JAIN, VIBHA
GSE Agency Case Idey jer: Order Identifier: j6-DCV-232,757
zz
Lump: ayt its: You may be. required to notify a state or tribal CSE agency of upcoming lump sum paymerits to
this employe ligor such as.bonuses, commissions, of severance :pay.. Contact the senderto determine if you are
requirs ‘toréport and/or withhold I ip-suin payments,
Liability; If you have: any dou} ab ‘the validity of this 1WO, contact the sender. If you fail to withhold income from the
emp! fobligor's incom: is thi directs, you are liable for both the accumulated amount you should have: withheld
andany penalties set ‘state’r tribal law/procedure.
7
F
auvteiserimination Yu a re ine determined under state or tribal law for discharging an-employee/obligor
from émployment, refusing to e1 ooking disciplinary action against an employee/obligor because of this IWO.
i
1
L
| |
Withholding Limits: You may not withhol th the lesser of, he jounts allowed by the Federal Consumer
Credit Protection Act (CCPA) (15 USC § Or 2), mot lowed by the state of the employee/obligor's
principal. place of employment or tribal law if.a tribal (si nse Tito nation). Disposable income is the net.
income after mandatory. deductions such as: state, ‘local t , Sor ect taxes;'statutory pension |
contributions; and Medicare taxes. The federal | it is,50% of the disposable incd ift he obligor is supporting another
family :and 60% of the disposable income if the obligor is not's) Spo! notherfé » However, those limits increase
5% —to.55% and 65% --if the-arrears are greater than 12 ‘eks, perrhittest by-the’state or tribe, you may dedilct a fee
for administrative costs. The combined support amountend may note ed the limit indicated in this:section.
For tribal orders, you may not.withhold more than. the amounts allo éd nder the law of the issuing tribe. For tribal
émployérs/income withhalders:who receive a state-1WO, you ithhold oreth n the limit set by tribal law.
Depending upon applicable state or tribal law, you may need to’Consid¢ etints paid ealth care premiums in
determining disposable income.and applying appropriate withholding
Arrears gréater than 12 weeks? If the Order Information does not ind te that the are; S-aregreal han 12 weeks,
‘then the employer should calculate-the CCPA limit using the lower pero ge. !
Supplemental Information:
\e TE
IMPORTANT: The person completing this form is advised that the information may.be shared with the employee/obligor.
3
Employer's Name; PWC Employer FEIN:
Employee/Obligor's Name: JAIN, VIBHA.
CSE Agency cnc Ordertdentifier: 16-DCV-232,757
_—_
NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this.employee/obligor never worked for
you oryi are, longer withholding income. for this: employee/obligor, you must promptly notify the CSE agenty and/or
@
the sender: retuming this form to. zaddress listed in the contact information below:
Cthis.p n-has never worked his employer nor received periodic income.
Dithis n-ne lon Wo} for this employer nor receives periodic income.
Please provide the foll remem
ing. infor employee/obligor: satin pan naeer
Termination date:
Last known address: \\
Fn pyr SUN: Final payment amount:
New employer's name:
New employer's address [f ) |
CONTACT INFORMATION:
‘o. Employer/income Withholder: If you have questions, contact Seay ien (issuer name)
by phone:713.243-7100 by fax:713-780-2986 by of web Hoyer om OV
Send termination/income status notice and other corres p dénce to:
Lexa Attorney Genera ild pport ‘Division entra ile’ nicnance O4 Austin rx 3711-2048 {issuer address).
To
Employee/Obligor: If the employee/obligor has: question: Ct Offic of th General (issuer name)
by phone: 713-243-7100 by fax:713-780-2986 by e-mail or bs >: http texa tiorneygenera BON
YO
The Paperwork Reduction Act-of 1995
This information collection and associated responses are conducted in accordance-with 45 CFR.303.100°0 Child Uppo nt Enforcement
Program. This form is designed to provide uniformity and standardization. Public reporting burd rth tion of information is:
estimated'to average’5 minutes per response for Non-IV-D CPs; 2 minutes per response for emp Ise e-) © emplo
including-the time for reviewing instructions, gathering and maintaining the data needed, and revi 19 Col ion of hformatio
An-agency.may not conduct or sponsor, and a person is not required to respond to, a collection. of Infori tion fess:it disp ‘urrently
Valid OMB contro} number.
Preview
5/3/2017 12:02:06 PM Annle Rebecca Eillott | District Clerk Fort Bend County, Texas Kathleen Geuea INCOME WITHHOLDING FOR SUPPORT f] ORIGINAL INCOME WITHHOLDING ORDERINOTICE FOR SUPPORT (IWO) AMEN WO IME ORDER/NOTICE FOR LUMP: SUM PAYMENT MINATION OF WO Date! rit 11,2017 C)child ‘S(ippoit Enforcement gency [|Court [X] Attomey [_]Private IndividuaVEntity (Check One) NOTE: is must be regula On its face.. Under certain circumstances you must reject this IWO and retum it tothe sender (si ins ions www.a hh go programs/css/reso ome-wi ithhold for-s pport-instructions). If you receive document cmpoms.omer than a state or tribal CSE agency ora : court, om somes py of the ‘underlying order must be-attached State/Tribe/Territory Tew Remittance ID (include w/payment) 16-DCVv-232.757_ City/County/Dist./Tr| ‘ORT BEND, yy Order ID 16-DCV-232.757 Private Individual/En' CSE Agency Case ID PWC. . RE: JAIN..VIBHA_- Employer/income Withholder’s Name a. Employee/Obligor’s Name (Last, First, Middle) 1 5800, mployer/income Withhoider's Addregs )bligor's Social Security Number SE AT K ) stod Party/Obligee’s Name (Cast, First, Middle) Employer/Income Withholder’s FEIN Child(ren)'s Name(s) (Last, First, Middle) Child, Date(s) |ME | ORDER INFORMATION: This document is based on the support or withholdingortler fro! GiaterTrbe), You are required. by law to deduct these amounts from the emp! loyee/ $ 702,00 Per month current child support past-due child support - Arrears gr fer 12 wee! cae igorsincome until her notice. s [_]No $ Per $ 35,70 Per month. current cash medical.support $ Per past-due cash medical support $ Per current spousal support $ Per past-due spousal support Per other (must specify) for a Total Amount to Withhold of $737.70 per AMOUNTS TO WITHHOLD: You do.not-have to vary your pay cycle to be in.compliance. nth, your pay cycle does not match the ordered payment cycle, withhold one of the following amounts: wen Se mn.If $ 170,24per weekly pay period $ 368.85 per semimonthly pay: petiod, jice.a month) $ 340,48 per biweekly pay period (every two weeks) $. 737.10 per monthly pay period Lump Sum Payment: Do-not stop anyexisting IWO unless you receive a termination order. Document Tracking ID. OMB 0970-0154 3 Employer's Name: PWC Employer FEIN: | Employee/Obligor's Name: JAIN, VIBHA CSE Agency:Case Identifier: Order Identifiet:, 1¢-DCEV-232,757 REMITTANC! IATIOI Ifthe employee/obligor's principal place of employment is:‘Texas (State/Tri you ust begin withholding no later than the first pay period that-occurs immediately-after the date Send payment.within 3. working days of the: pay. date. If you cannot withhold the full amount of support orders for this employ obligor, withhold up to _50_ % of disposable income. If the obligoris a non- nso for ai emp! obtain withholding {i Supplemental Information on page's. If the employee/obligor's principal place of emplp nt is Not Texas (State/Tribe), obtain withholding limitations, time requirements, and ah lowable employer fee: at WwW. .Ovit /cssirest state-i ntacts-and- program, focmatios 6F the émployee/obligor's:principal place of employment. For electronic pay ent requi ent nd centralized payment collection art disbursement facility information (State Disbursement Unit (SDU)) ee wwweacf hhs. progran emplo ectronic-payme include the Remittap eID th the payfnent and if necessary this FIPS code: Remit payment to Texa ema Unit (SDU) (SDU/Tribal Order Payee) at P.O, Box 659791, San Antonio, g878265-979 | (SDU/Tribal Payee Address) CiReturn to Sender [Comflet ome Withholder]. Payment must be directed to an SDU in accordance with 42.USC §668(b)(5) arid ) or Tribal Rayee (see Payments to SDU below): If payment is-not directed to an SDU/Tribal Payee-or this IWO. not regularon ®, you must check this box and rétum the [WO to the:sender. Signature of Judge/Issuing Official (if Required by St: ea Caw we Laced Print. Name of Judge/Issuing Official: Title of Judge/Issuing Official: LL Date of Signature: Pity AO/2 7 Ifthe employee/obligor works in a state. or for a’ es = at om tl ite ‘or tribe that issued:this. ordér,'a copy of this IWO. must be provided to the employee/obli lf checked, thew employertncome withholder Ts st provid m ta(hd}employeerobigor ADDITIONAL INFORMATION FORENPLOY S/INGOME, WITHHOLDERS State-speotic contact and withholding information can be-fot rd on je Fed mp loyer Services website located at ac, hhs.gov/programs source/state heorn withho \-information. Priority: Withholding for support has priority over any other legal procé: under State gainst the same income, (42 USC §666(b)(7)). If'a federal tax levy is in effect, please notify the.send ' Combining Payments: When remitting payments to.an SDU or tribal agency, you’ co hheld amounts from more than:one employee/obligor's income in-a single payment. Yo owever, ly identify: each employee/obligor's portion of the payment. Payments To SDU:-You must-send child support payments payable by income dig to the appropriate SDU or toa tribal CSE.agency. If this |WO instructs youto send a payment to:an entity other ‘an SDU ( ble to thé. custodial party, court, or attorney), you must check the box above and return this Notice to thes plion: If this [WO was sent by a-court, attorney, or private individual/entity and the initial order was: tes janubry 11,1994.or the-order was issued by a tribal. CSE. agency, you must follow the “Remit payment to” insti Reporting the Pay Date: You must report the pay date when sending the payment. The the, ite-on wh he amount was withheld from the employee/obligor's wages, You must.comply with the law tate (of tribal I applicable) of the employee/obligor's principal place of employment regarding time periods wit Rin ich. yor implement the withholding and forward the support payments Multiple WOs: If there.is. more than-one |WO against this employee/obligor and you-are-unable to h6nor all IWOs due ‘to federal, state, or tribal withholding limits, you must honor all:IWOs to the greatest extent possibfe, giving priority to Ourrent support before payment of any past-due support. Follow the state or tribal law/procedure of the employee/obligor's principal place of employment to determine-the appropriate allocation method. OMB Expiration Date .- 7/31/2017. The OMB Expiration Date has no bearing on the termination date.of the IWO; it identifies the version of the form currently in use. x Employer's Name: PWC Employer FEIN: Employee/Obligor's Name: JAIN, VIBHA GSE Agency Case Idey jer: Order Identifier: j6-DCV-232,757 zz Lump: ayt its: You may be. required to notify a state or tribal CSE agency of upcoming lump sum paymerits to this employe ligor such as.bonuses, commissions, of severance :pay.. Contact the senderto determine if you are requirs ‘toréport and/or withhold I ip-suin payments, Liability; If you have: any dou} ab ‘the validity of this 1WO, contact the sender. If you fail to withhold income from the emp! fobligor's incom: is thi directs, you are liable for both the accumulated amount you should have: withheld andany penalties set ‘state’r tribal law/procedure. 7 F auvteiserimination Yu a re ine determined under state or tribal law for discharging an-employee/obligor from émployment, refusing to e1 ooking disciplinary action against an employee/obligor because of this IWO. i 1 L | | Withholding Limits: You may not withhol th the lesser of, he jounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 USC § Or 2), mot lowed by the state of the employee/obligor's principal. place of employment or tribal law if.a tribal (si nse Tito nation). Disposable income is the net. income after mandatory. deductions such as: state, ‘local t , Sor ect taxes;'statutory pension | contributions; and Medicare taxes. The federal | it is,50% of the disposable incd ift he obligor is supporting another family :and 60% of the disposable income if the obligor is not's) Spo! notherfé » However, those limits increase 5% —to.55% and 65% --if the-arrears are greater than 12 ‘eks, perrhittest by-the’state or tribe, you may dedilct a fee for administrative costs. The combined support amountend may note ed the limit indicated in this:section. For tribal orders, you may not.withhold more than. the amounts allo éd nder the law of the issuing tribe. For tribal émployérs/income withhalders:who receive a state-1WO, you ithhold oreth n the limit set by tribal law. Depending upon applicable state or tribal law, you may need to’Consid¢ etints paid ealth care premiums in determining disposable income.and applying appropriate withholding Arrears gréater than 12 weeks? If the Order Information does not ind te that the are; S-aregreal han 12 weeks, ‘then the employer should calculate-the CCPA limit using the lower pero ge. ! Supplemental Information: \e TE IMPORTANT: The person completing this form is advised that the information may.be shared with the employee/obligor. 3 Employer's Name; PWC Employer FEIN: Employee/Obligor's Name: JAIN, VIBHA. CSE Agency cnc Ordertdentifier: 16-DCV-232,757 _—_ NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this.employee/obligor never worked for you oryi are, longer withholding income. for this: employee/obligor, you must promptly notify the CSE agenty and/or @ the sender: retuming this form to. zaddress listed in the contact information below: Cthis.p n-has never worked his employer nor received periodic income. Dithis n-ne lon Wo} for this employer nor receives periodic income. Please provide the foll remem ing. infor employee/obligor: satin pan naeer Termination date: Last known address: \\ Fn pyr SUN: Final payment amount: New employer's name: New employer's address [f ) | CONTACT INFORMATION: ‘o. Employer/income Withholder: If you have questions, contact Seay ien (issuer name) by phone:713.243-7100 by fax:713-780-2986 by of web Hoyer om OV Send termination/income status notice and other corres p dénce to: Lexa Attorney Genera ild pport ‘Division entra ile’ nicnance O4 Austin rx 3711-2048 {issuer address). To Employee/Obligor: If the employee/obligor has: question: Ct Offic of th General (issuer name) by phone: 713-243-7100 by fax:713-780-2986 by e-mail or bs >: http texa tiorneygenera BON YO The Paperwork Reduction Act-of 1995 This information collection and associated responses are conducted in accordance-with 45 CFR.303.100°0 Child Uppo nt Enforcement Program. This form is designed to provide uniformity and standardization. Public reporting burd rth tion of information is: estimated'to average’5 minutes per response for Non-IV-D CPs; 2 minutes per response for emp Ise e-) © emplo including-the time for reviewing instructions, gathering and maintaining the data needed, and revi 19 Col ion of hformatio An-agency.may not conduct or sponsor, and a person is not required to respond to, a collection. of Infori tion fess:it disp ‘urrently Valid OMB contro} number.