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{\title Florida Family Law Rules of Procedure Form 12.996(b), Notice to Payor (1/09)}{\subject Florida Family Law Rules of Procedure Form 12.996(b)}{\author The Florida Bar}{\keywords Florida Family Law Forms, Notice to Payor}
{\doccomm Florida Family Law Rules of Procedure Form 12.996(b), Notice to Payor (1/09) with Instructions}{\operator Rebekah Crosby}{\creatim\yr2016\mo8\dy9\hr12\min57}{\revtim\yr2016\mo8\dy9\hr12\min57}{\printim\yr2012\mo10\dy22\hr15\min27}{\version2}
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\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid9458 \chftnsep 
\par }}{\*\ftnsepc \ltrpar \pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid9458 \chftnsepc 
\par }}{\*\aftnsep \ltrpar \pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid9458 \chftnsep 
\par }}{\*\aftnsepc \ltrpar \pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid9458 \chftnsepc 
\par }}\ltrpar \sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sftnbj {\footerl \ltrpar \pard\plain \ltrpar\s18\ql \li0\ri0\widctlpar\tqc\tx4320\tqr\tx8640\pvpara\phmrg\posxr\posy0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 
\rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \cs20\insrsid11027141 PAGE  }}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectdefaultcl\sftnbj {
\rtlch\fcs1 \af0 \ltrch\fcs0 \cs20\insrsid11027141 
\par }\pard \ltrpar\s18\ql \li0\ri360\widctlpar\tqc\tx4320\tqr\tx8640\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin360\lin0\itap0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid11027141 
\par }}{\footerr \ltrpar \pard\plain \ltrpar\s18\ql \li0\ri0\widctlpar\tqc\tx4320\tqr\tx9000\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid5771856 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid11027141\charrsid9334066 Instructions for Florida Family La}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid11027141 
w Rules of Procedure Form 12.996}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid11027141\charrsid9334066 (b), Notice to Payor }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid11027141 (09/12)}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 
\f37\fs20\insrsid11027141\charrsid9334066 
\par }}{\*\pnseclvl1\pnucrm\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl2\pnucltr\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl3\pndec\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl4\pnlcltr\pnstart1\pnindent720\pnhang {\pntxta )}}
{\*\pnseclvl5\pndec\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl6\pnlcltr\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl7\pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl8
\pnlcltr\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl9\pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}\pard\plain \ltrpar
\s1\qc \li0\ri0\keep\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel0\adjustright\rin0\lin0\itap0\pararsid16078652 \rtlch\fcs1 \ab\af0\afs28\alang1025 \ltrch\fcs0 \b\f39\fs28\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 
\af0 \ltrch\fcs0 \insrsid1209363\charrsid9334066 INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2240176 FORM 12.996}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid1209363\charrsid9334066 (b)}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid7108755\charrsid9334066 , }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid1209363\charrsid9334066 
NOTICE TO PAYOR}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2250591  (}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid11027141 09/12}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid85045 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid1209363\charrsid9334066 
\par }\pard\plain \ltrpar\qc \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1209363 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \f37\fs22\insrsid1209363\charrsid9334066 
\par }\pard\plain \ltrpar\s2\qc \li0\ri0\sb120\sa120\keep\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0\pararsid16078652 \rtlch\fcs1 \ab\af0\afs26\alang1025 \ltrch\fcs0 
\b\f39\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid1209363\charrsid9334066 When should this form be used?
\par }\pard\plain \ltrpar\qc \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1209363 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \ab\af0\afs22 
\ltrch\fcs0 \b\f37\fs22\insrsid1209363\charrsid9334066 
\par }\pard \ltrpar\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1209363 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid12341154 This form should be used}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid1209363\charrsid9334066  when an }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid1209363\charrsid9334066 Income Deduction Order}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid1209363\charrsid9334066 
 has been entered by the Court which is to take effect immediately.  
\par 
\par This form should be typed or printed in black ink. After completing this form, the original of this form should be }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\ul\insrsid1209363\charrsid9334066 filed}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid1209363\charrsid9334066  with the }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\ul\insrsid1209363\charrsid9334066 clerk of the circuit court}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid1209363\charrsid9334066 
 in the county in which the action is pending. You should keep a copy for your own records.  
\par 
\par }\pard\plain \ltrpar\s2\qc \li0\ri0\sb120\sa120\keep\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0\pararsid16078652 \rtlch\fcs1 \ab\af0\afs26\alang1025 \ltrch\fcs0 
\b\f39\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid1209363\charrsid9334066 What should I do next?
\par }\pard\plain \ltrpar\qc \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1209363 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \ab\af0\afs22 
\ltrch\fcs0 \b\f37\fs22\insrsid1209363\charrsid9334066 
\par }\pard \ltrpar\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1209363 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid1209363\charrsid9334066 A copy of this form, and }{\rtlch\fcs1 \ai\af0\afs22 
\ltrch\fcs0 \f37\fs22\insrsid1209363\charrsid9334066 a copy of the Income Deduction Order}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid1209363\charrsid9334066 , must be sent to the }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\b\f37\fs22\ul\insrsid1209363\charrsid9334066 obligor\rquote s}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid1209363\charrsid9334066  payor by certified mail, return receipt requ
ested. The return receipt should be sent to the person that prepared this form so that it can filed with the clerk along with Florida Family Law Rules of Procedure Form 12.996(c)}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid15935647 ,}{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid1209363\charrsid9334066  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid1209363\charrsid9334066 Notice of Filing Return Receipt}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid1209363\charrsid9334066 .  
\par 
\par A copy of this form must also be  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid15935647 served on }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid1209363\charrsid9334066 the other party or his or her attorney.}{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \f37\fs22\insrsid15935647  Service must be in accordance with Florida Rule of Judicial Administration 2.516.}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid1209363\charrsid9334066 
\par 
\par }\pard\plain \ltrpar\s2\qc \li0\ri0\sb120\sa120\keep\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0\pararsid16078652 \rtlch\fcs1 \ab\af0\afs26\alang1025 \ltrch\fcs0 
\b\f39\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid1209363\charrsid9334066 Where can I look for more information?
\par }\pard\plain \ltrpar\qc \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1209363 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \ab\af0\afs22 
\ltrch\fcs0 \b\f37\fs22\insrsid1209363\charrsid9334066 
\par }\pard \ltrpar\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1209363 {\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f37\fs22\cf1\insrsid1209363\charrsid9334066 Before proceeding, you should read \'93
General Information for Self-Represented Litigants\'94 found at the beginning of these forms.}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\cf1\insrsid1209363\charrsid9334066   The words that are in }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 
\b\f37\fs22\cf1\insrsid1209363\charrsid9334066 \'93}{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f37\fs22\ul\cf1\insrsid1209363\charrsid9334066 bold underline}{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f37\fs22\cf1\insrsid1209363\charrsid9334066 \'94}{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\cf1\insrsid1209363\charrsid9334066  in these instructions are defined there.}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\cf1\insrsid15935647  For further information, see}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid15935647  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid1209363\charrsid9334066  section 61.1301}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid15935647 , Florida Statutes}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid1209363\charrsid9334066 .
\par 
\par }\pard\plain \ltrpar\s2\qc \li0\ri0\sb120\sa120\keep\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0\pararsid16078652 \rtlch\fcs1 \ab\af0\afs26\alang1025 \ltrch\fcs0 
\b\f39\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid1209363\charrsid9334066 Special Instructions...}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid1209363 
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid2250591 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid2250591\charrsid2250591 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid2250591 The Obligor\rquote s social security number must be written on the cop}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid15935647 ies}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid2250591  of the Notice to Payor that }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid15935647 are}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid2250591  mailed to the Obligor\rquote s Payor}{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \f37\fs22\insrsid15935647  and served on the other party or his or her attorney}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid2250591 .  The social security number should }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid15935647 
not}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid2250591  be written on the copy of the Notice to Payor filed with the court. }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid2250591\charrsid2250591 
\par }\pard \ltrpar\qc \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1209363 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid1209363\charrsid9334066 
\par }\pard \ltrpar\qj \li0\ri0\sl-264\slmult0\widctlpar\tx-720\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1209363 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\cf1\insrsid1209363\charrsid9334066 
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f37\fs22\cf1\insrsid1209363\charrsid9334066 
Disclosure from Nonlawyer}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\cf1\insrsid1209363\charrsid9334066 , Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also }{\rtlch\fcs1 
\ab\af0\afs22 \ltrch\fcs0 \b\f37\fs22\cf1\insrsid1209363\charrsid9334066 must}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\cf1\insrsid1209363\charrsid9334066 
 put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.
\par \sect }\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid7108198\sftnbj {\footerr \ltrpar \pard\plain \ltrpar\s18\ql \li0\ri0\widctlpar
\tqc\tx4320\tqr\tx9000\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid5771856 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 
\f37\fs20\insrsid11027141\charrsid9334066 {\*\bkmkstart _Hlk219782101}Florida Family Law Rules of Procedure Form 12.99}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid11027141 6(b), Notice to Payor (09/12}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 
\f37\fs20\insrsid11027141\charrsid9334066 ){\*\bkmkend _Hlk219782101}
\par }}\pard\plain \ltrpar\qc \li0\ri0\sl-242\slmult0\widctlpar\tx-720\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4275743 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\cf1\insrsid4275743\charrsid9334066 IN THE CIRCUIT COURT OF THE }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\ul\cf1\insrsid4275743\charrsid9334066                                                      }{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\cf1\insrsid4275743\charrsid9334066  JUDICIAL CIRCUIT,
\par IN AND FOR }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\ul\cf1\insrsid4275743\charrsid9334066                                                      }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\cf1\insrsid4275743\charrsid9334066  COUNTY, FLORIDA
\par }\pard \ltrpar\qj \li0\ri0\sl-242\slmult0\widctlpar\tx-720\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4275743 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\cf1\insrsid4275743\charrsid9334066 
\par }\pard \ltrpar\qj \li5040\ri0\sl-242\slmult0\widctlpar\tqr\tx9360\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin5040\itap0\pararsid4275743 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\cf1\insrsid4275743\charrsid9334066 Case No.: }{\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \f37\fs22\ul\cf1\insrsid4275743\charrsid9334066 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\cf1\insrsid4275743\charrsid9334066 
\par Division: }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\ul\cf1\insrsid4275743\charrsid9334066 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\cf1\insrsid4275743\charrsid9334066 
\par }\pard \ltrpar\qj \li0\ri0\sl-242\slmult0\widctlpar\tx-720\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4275743 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\ul\cf1\insrsid4275743\charrsid9334066 
                                                                      }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\cf1\insrsid4275743\charrsid9334066 ,
\par }\pard \ltrpar\qj \li2520\ri0\sl-242\slmult0\widctlpar\tx-720\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin2520\itap0\pararsid16078652 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\cf1\insrsid4275743\charrsid9334066 Petitioner,
\par }\pard \ltrpar\qj \li0\ri0\sl-242\slmult0\widctlpar\tx-720\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4275743 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\cf1\insrsid4275743\charrsid9334066 
\par }\pard \ltrpar\qj \li1440\ri0\sl-242\slmult0\widctlpar\tx-720\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin1440\itap0\pararsid4275743 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\cf1\insrsid4275743\charrsid9334066 and
\par }\pard \ltrpar\qj \li0\ri0\sl-242\slmult0\widctlpar\tx-720\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4275743 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\cf1\insrsid4275743\charrsid9334066 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\ul\cf1\insrsid4275743\charrsid9334066                                                                        }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\cf1\insrsid4275743\charrsid9334066 ,
\par }\pard \ltrpar\qj \li2340\ri0\sl-242\slmult0\widctlpar\tx-720\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin2340\itap0\pararsid16078652 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\cf1\insrsid4275743\charrsid9334066 Respondent.
\par }\pard \ltrpar\qc \li0\ri0\widctlpar\tx720\tqc\tx4680\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid9504112 
\par }{\rtlch\fcs1 \ab\af0\afs28 \ltrch\fcs0 \b\f37\fs28\insrsid9504112\charrsid2313787  }{\rtlch\fcs1 \ab\af0\afs28 \ltrch\fcs0 \b\f39\fs28\insrsid9504112\charrsid2313787 NOTICE TO PAYOR}{\rtlch\fcs1 \ab\af0\afs28 \ltrch\fcs0 
\b\f39\fs28\insrsid6427606\charrsid2313787 
\par }{\rtlch\fcs1 \ab\af0\afs28 \ltrch\fcs0 \b\f37\fs28\insrsid16078652\charrsid2313787 
\par }\pard \ltrpar\ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid16078652 {\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 TO:\tab 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\tx720\tx2340\tx5940\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid16078652 {\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 Name of Obligor\rquote s Payor:}{
\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid6427606\charrsid9334066 \tab }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid4275743\charrsid9334066 \tab 
\par }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid4275743\charrsid9334066 P}{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 ayor\rquote s Address:\tab }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 
\f37\fs22\ul\insrsid6427606\charrsid9334066 \tab }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par \tab \tab }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid6427606\charrsid9334066 \tab 
\par }\pard \ltrpar\ql \fi-720\li720\ri0\widctlpar\tx2160\tx4680\tx5580\tx6840\tx9360\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid16078652 {\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par RE:\tab \tab }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid6427606\charrsid9334066 Obligor}{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 \tab \tab \tab }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 
\b\f37\fs22\insrsid6427606\charrsid9334066 Obligee}{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\tx1440\tx4860\tx5580\tx9360\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid16078652 {\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 Name:\tab }{\rtlch\fcs1 
\ab\af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid6427606\charrsid9334066 \tab }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 \tab }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid6427606\charrsid9334066 \tab 

\par }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 Address:\tab }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid6427606\charrsid9334066 \tab }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid6427606\charrsid9334066 \tab }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid6427606\charrsid9334066 \tab 
\par }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 \tab }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid6427606\charrsid9334066 \tab }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid6427606\charrsid9334066 \tab }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid6427606\charrsid9334066 \tab }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid6427606 
\par }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid2250591 
\par }{\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid2250591 Obligor\rquote s social security number:_________________________________.
\par NOTE:  The Obligor\rquote s social security number should be placed on the copy of the Notice to Payor that is mailed to the Obligor\rquote s Payor.  This line should be left blank on the original Notice to Payor filed with the court.}{\rtlch\fcs1 
\ab\af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid2250591\charrsid2250591 
\par }\pard \ltrpar\ql \li2160\ri0\widctlpar\tx1800\tx4320\tx5580\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin2160\itap0\pararsid16078652 {\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid6427606\charrsid9334066 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\tqdec\tx540\tx900\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid16078652 {\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid6427606\charrsid9334066 \tab 
YOU, THE PAYOR, ARE HEREBY NOTIFIED }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 that, }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid4275743\charrsid9334066 under }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid6427606\charrsid9334066 section 61.1301, Florida Statutes, you have the responsibilities and rights set forth below with regard to the accompanying Income Deduction Order and/or any attachment(s):
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\tqdec\tx540\tx900\tx1080\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid16078652 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid16078652 \hich\af37\dbch\af0\loch\f37 1.\tab}}\pard\plain \ltrpar
\s24\ql \fi-360\li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid16078652 You are require}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6954177\charrsid16078652 d to deduct from the ob}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid6427606\charrsid16078652 ligor\rquote s income the amount specified in the income deduction order, and in the case of a delinquency the amount specified in the notice of delinquency,}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid2250591  and to pay that amount to the State of Florida Disbursement Unit}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid16078652 
.  The amount actually deducted plus all administrative charges shall not be excess of the amount allowed under s. 303(b) of the Consumer Cred}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid4275743\charrsid16078652 it Protection Act, 15 U.S.C. \'a7}
{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid16078652 1673(b) as amended.
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\tqdec\tx540\tx900\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid16078652 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 \hich\af37\dbch\af0\loch\f37 2.\tab}}\pard\plain \ltrpar
\s24\ql \fi-360\li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 You must implement income deduction no later than the first payment date which occurs more than 14 days after the date the income deduction }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid4275743\charrsid9334066 order}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066  wa
s served on you, and you shall conform the amount specified in the income deduction order or, in Title IV-D cases, income deduction noti}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6954177\charrsid9334066 ce to the o}{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \f37\fs22\insrsid4275743\charrsid9334066 bligor\rquote s pay cycle. }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 The court should request at the time of the order that the payment }{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \f37\fs22\insrsid6954177\charrsid9334066 cycle will reflect that of the o}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 bligor.
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\tqdec\tx540\tx900\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid16078652 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 \hich\af37\dbch\af0\loch\f37 3.\tab}}\pard\plain \ltrpar
\s24\ql \fi-360\li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 You must forward, within 2 days after each date the obligor is entitl}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid2250591 
ed to payment from you, to the State of Florida Disbursement Unit}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 , the amount deducted from }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6954177\charrsid9334066 the o}{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 bligor\rquote s income, a statement as to whether the amount totally or par
tially satisfies the periodic amount specified in the income deduction order, or in Title IV-D cases, income deduction notice, and the specific date each deduction is made.  If the IV-D agency is enforcing the order, you shall make these notification}{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid2250591 s to the agency.}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\tqdec\tx540\tx900\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid16078652 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 \hich\af37\dbch\af0\loch\f37 4.\tab}}\pard\plain \ltrpar
\s24\ql \fi-360\li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 If you fail to ded}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6954177\charrsid9334066 uct the proper amount from the o}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid6427606\charrsid9334066 bligor\rquote s income, you are liable for the amount you should have deducted, plus costs, in}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid4275743\charrsid9334066 terest, and reasonable attorney}{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 s}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid4275743\charrsid9334066 \rquote }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066  fees;
\par }\pard \ltrpar\s24\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 \hich\af37\dbch\af0\loch\f37 5.\tab}}\pard \ltrpar
\s24\ql \fi-360\li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 You ma}{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \f37\fs22\insrsid6954177\charrsid9334066 y collect up to $5 against the o}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 bligor\rquote 
s income to reimburse you for administrative costs for the first income deduction and up to $2 for each deduction thereafter.
\par }\pard \ltrpar\s24\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 \hich\af37\dbch\af0\loch\f37 6.\tab}}\pard \ltrpar
\s24\ql \fi-360\li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
The notice to payor, or, in Title IV-D cases, income deduction notice, and in the case of a delinquency, the notice of delinquency, are binding on y}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6954177\charrsid9334066 
ou until further notice by the o}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 bligee, IV-D agency, or the court or until you no}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid2250591  longer provide}{\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6954177\charrsid9334066  income to the o}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 bligor.
\par }\pard \ltrpar\s24\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 \hich\af37\dbch\af0\loch\f37 7.\tab}}\pard \ltrpar
\s24\ql \fi-360\li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 When you no longer provi}{\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6954177\charrsid9334066 de income to the obligor, you shall notify the o}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 bli}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid6954177\charrsid9334066 gee and provide the o}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 bligor\rquote s last known address and the name and address of th}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid6954177\charrsid9334066 e o}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid4275743\charrsid9334066 bligor\rquote s new payor, if known.}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066  }{\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid4275743\charrsid9334066 I}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
f you violate this provision, you are subject to a civil penalty not to exceed $250 for the first violation or $500 for any subsequent violation. If the IV-D agency is enforcing the order, you shall make these notification}{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \f37\fs22\insrsid6954177\charrsid9334066 s to the agency instead of the o}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 bligee. Penalties shall be paid to the }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid6954177\charrsid9334066 o}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 bligee or the IV-D agency, whichever is enforcing the income deduction order.
\par }\pard \ltrpar\s24\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 \hich\af37\dbch\af0\loch\f37 8.\tab}}\pard \ltrpar
\s24\ql \fi-360\li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
You shall not discharge, refuse to employ, or take disciplinary action against an }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6954177\charrsid9334066 o}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
bligor because of the requirement for income deduction. A violation of this provision subjects you to a civil penalty not to exceed $250 for the first violation or $500 for any subsequent violation.  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid2313787 Penalties shall be paid to the o}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
bligee or the IV-D agency, whichever is enforcing the income deduction, if any alimony or child support obligation is owing.  If no alimony or child support obligation is owing, th}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid6954177\charrsid9334066 e penalty shall be paid to the o}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 bligor.
\par }\pard \ltrpar\s24\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6954177\charrsid9334066 \hich\af37\dbch\af0\loch\f37 9.\tab}}\pard \ltrpar
\s24\ql \fi-360\li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6954177\charrsid9334066 The o}{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 bligor may bring a civil action in the courts of this state against a payor who refuses to employ, discharge}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6954177\charrsid9334066 
s, or otherwise disciplines an o}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 bligor bec}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6954177\charrsid9334066 ause of income deduction.  The o}{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 bligor is entitled to reinstatement of all wages and benefits}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid4275743\charrsid9334066  lost, plus reasonable attorney}{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 s}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid4275743\charrsid9334066 \rquote }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066  fees and costs incurred.
\par }\pard \ltrpar\s24\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 \hich\af37\dbch\af0\loch\f37 10.\tab}}\pard \ltrpar
\s24\ql \fi-360\li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
The requirement for income deduction has priority over all other legal processes under state law pertaining to the same income and that payment, as required by the notice to payor or the income deduction notice, is a complete defen
se by the payor against any claims of the obligor or his or her creditors as to the sum paid.
\par }\pard \ltrpar\s24\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 \hich\af37\dbch\af0\loch\f37 11.\tab}}\pard \ltrpar
\s24\ql \fi-360\li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
When you receive notices to payor or income deduction notices requiring that the income of two or more obligors be deducted and sent to the same depository, 
the payor may combine the amounts that are to be paid to the depository in a single payment as long as the payments attributable to each obligor are clearly identified.
\par }\pard \ltrpar\s24\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 \hich\af37\dbch\af0\loch\f37 12.\tab}}\pard \ltrpar
\s24\ql \fi-360\li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
If you receive more than one notice to payor or income deduction notice against the same obligor, the payor shall contact the court or, in Title IV-D cases, the Title IV-D agency for further instructions.
\par }\pard \ltrpar\s24\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 \hich\af37\dbch\af0\loch\f37 13.\tab}}\pard \ltrpar
\s24\ql \fi-360\li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
In a Title IV-D case, if an obligation to pay current support is reduced or terminated due to the emancipation of a child and th
e obligor owes an arrearage, retroactive support, delinquency, or costs, income deduction continues at the rate in effect immediately prior to emancipation until all arrearages, retroactive support, delinquencies, and costs are paid in full or until the a
mount of withholding is modified.
\par }\pard \ltrpar\s24\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6954177\charrsid9334066 \hich\af37\dbch\af0\loch\f37 14.\tab}}\pard \ltrpar
\s24\ql \fi-360\li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6954177\charrsid9334066 All notices to the o}{\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 bligee shall be sent to the address provided in this notice to payor, or any}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid9504112  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid6427606\charrsid9334066 place thereafter t}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6954177\charrsid9334066 he o}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 bligee requests in writing.
\par }\pard \ltrpar\s24\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 \hich\af37\dbch\af0\loch\f37 15.\tab}}\pard \ltrpar
\s24\ql \fi-360\li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
An employer who employed 10 or more employees in any quarter during the preceding state fiscal year or who was subject to and paid tax to the Departme}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid13785233 nt of Revenue in an amount of $2}{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 0,000 or more shall remit support payments deducted pursuant to an income 
deduction order or income deduction notice and provide associated case data to the State Disbursement Unit by electronic means approved by the department.  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid13785233 
Payors who are required to remit support payments electronically can find more information on how to do so by accessing the State Disbursement Unit\rquote s website at }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid6766531 
HYPERLINK "http://www.floridasdu.com"}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid15952563 {\*\datafield 
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}}{\fldrslt {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \cs23\f37\fs22\ul\cf2\insrsid13785233\charrsid3556824 www.floridasdu.com}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid7108198\sftnbj {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid13785233  and clicking on \'93Payments.\'94  Payment options include Expert Pay,}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid12531074  Automated Clearing House (ACH)}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid13785233 
 credit through your financial institution, }{\field{\*\fldinst {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid11027141  HYPERLINK "http://}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid11027141\charrsid11027141 www.myfloridacounty.com}{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid11027141 " }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid12455918 {\*\datafield 
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0000a5ab000000}}}{\fldrslt {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \cs23\f37\fs22\ul\cf2\insrsid11027141\charrsid7942453 www.myfloridacounty.com}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid7108198\sftnbj {\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \f37\fs22\insrsid13785233 , or Western Union.  Payors may contact the SDU Customer Service Empl}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid11027141 oyer telephone line at}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid13785233 
 1-888-833-0743. }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par }\pard \ltrpar\s24\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid16078652\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid13785233 \hich\af37\dbch\af0\loch\f37 16.\tab}}\pard \ltrpar
\s24\ql \fi-360\li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin360\itap0\pararsid13785233\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid13785233 
Additional information regarding the implementation of this Notice to Payor may be found at }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid6766531 HYPERLINK "http://www.florida.sdu.com"}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid15952563 
{\*\datafield 
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0000}}}{\fldrslt {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \cs23\f37\fs22\ul\cf2\insrsid13785233\charrsid3556824 www.florida.sdu.com}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid7108198\sftnbj {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid13785233 . }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid5583993 
\par }\pard \ltrpar\s24\ql \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid13785233\contextualspace {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid13785233\charrsid13785233 
\par }\pard\plain \ltrpar\ql \fi720\li0\ri0\sl-234\slmult0\keep\keepn\widctlpar\tqr\tx9360\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid16078652 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid5583993 
\par }\pard \ltrpar\ql \li0\ri0\sl-234\slmult0\keep\keepn\widctlpar\tqr\tx9360\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid15935647 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid6427606\charrsid6887761 I certify tha}{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid4719796\charrsid6887761 t a copy of this document was [}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid3802274\charrsid6887761 check all used}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\b\f37\fs22\insrsid6427606\charrsid6887761 ]}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid3802274\charrsid6887761 :  (   ) emailed }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid15935647\charrsid6887761 (\~\~\~\~) mailed
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid6427606\charrsid6887761 (\~\~\~\~) faxed  (\~\~\~\~) hand delivered to the person(s) listed below on }{\rtlch\fcs1 \ai\af0\afs22 \ltrch\fcs0 \b\i\f37\fs22\insrsid6427606\charrsid6887761 \{date\}}{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid6427606\charrsid6887761  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid15935647\charrsid6887761 _________________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\b\f37\fs22\insrsid6427606\charrsid6887761 .
\par }\pard \ltrpar\ql \li0\ri0\sl-234\slmult0\keep\keepn\widctlpar\tx-720\tx0\tx720\tx1440\tx2160\tx3240\tx4320\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid16078652 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid6427606\charrsid9334066 
\par }\pard \ltrpar\qj \li0\ri0\sl-234\slmult0\keep\keepn\widctlpar\tx-720\tx0\tx720\tx1440\tx2160\tx3240\tx4320\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4275743 {\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 
\b\f37\fs22\insrsid6427606\charrsid9334066 Other party or his/her attorney:}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par Name: }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid6427606\charrsid9334066 \tab \tab \tab \tab \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par Address: }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid6427606\charrsid9334066 \tab \tab \tab \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par }\pard \ltrpar\qj \li0\ri0\sl-234\slmult0\keep\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3081767 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 City, State, Zip: }{\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid6427606\charrsid9334066 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid3081767                                          }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid3081767\charrsid3081767 ______}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid3081767 __  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par }\pard \ltrpar\qj \li0\ri0\sl-234\slmult0\keep\widctlpar\tx-720\tx0\tx720\tx1440\tx2160\tx3240\tx4320\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3802274 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid6427606\charrsid9334066 Fax Number: }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid6427606\charrsid9334066 \tab \tab \tab \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid11027141 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid3802274 Email Address(es):______________________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid3802274\charrsid9334066 
\par }\pard \ltrpar\qj \li0\ri0\sl-234\slmult0\keep\keepn\widctlpar\tx-720\tx0\tx720\tx1440\tx2160\tx3240\tx4320\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4275743 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid6427606\charrsid9334066 \tab \tab 
\par }\pard \ltrpar\qj \li0\ri0\sl-234\slmult0\keep\keepn\widctlpar\tx4320\tqr\tx9360\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4275743 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 \tab }{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid6427606\charrsid9334066 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par }\pard \ltrpar\qj \fi4320\li0\ri0\sl-234\slmult0\keep\keepn\widctlpar\tx-720\tx0\tx720\tx1440\tx2160\tx3240\tx4320\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4275743 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid6427606\charrsid9334066 Signature of Party or his/her attorney
\par }\pard \ltrpar\qj \li4320\ri0\sl-210\slmult0\keep\keepn\widctlpar\tqr\tx9360\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin4320\itap0\pararsid4275743 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 Printed Name: }{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid6427606\charrsid9334066 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par }\pard \ltrpar\qj \fi4320\li0\ri0\sl-210\slmult0\keep\keepn\widctlpar\tqr\tx9360\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4275743 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 Address: }{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid6427606\charrsid9334066 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par City, State, Zip: }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid6427606\charrsid9334066 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par Telephone Number: }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid6427606\charrsid9334066 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par }\pard \ltrpar\qj \fi4320\li0\ri0\sl-234\slmult0\keep\keepn\widctlpar\tqr\tx9360\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4275743 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 Fax Number: }{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid6427606\charrsid9334066 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid6427606 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid11027141 E-Mail Address(es):___________________________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid3802274\charrsid11027141 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid11027141 Florida Bar Number:___________________________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid3802274\charrsid11027141 
\par }\pard \ltrpar\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4275743 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid6427606\charrsid9334066 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7108755 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid7108755\charrsid9334066 IF A NONLAWYER HELPED YOU FILL OUT THIS FORM}{\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid7108755\charrsid9334066 , }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid7108755\charrsid9334066 HE/SHE MUST FILL IN THE BLANKS BELOW: }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid8733441 \line }
{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid5583993\charrsid3081767 [}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid5583993\charrsid9334066 fill}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid7108755\charrsid9334066  in }{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\f37\fs22\insrsid7108755\charrsid9334066 all }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid7108755\charrsid9334066 blanks]}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid11027141 
 This form was prepared for the }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \i\f37\fs22\insrsid11027141 \{choose only }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\i\f37\fs22\insrsid11027141 one}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \i\f37\fs22\insrsid11027141 \} }{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid11027141 (     ) Petitioner (     ) Respondent}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid7108755 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid11027141 This form was completed with the assistance of:}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid11027141\charrsid11027141 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \i\f37\fs22\insrsid11027141 \{name of individual}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \i\f37\fs22\insrsid7108755\charrsid9334066 \}}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid7108755\charrsid9334066   \tab 
\tab \tab \tab \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid11027141 __________________________________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid11027141 _,}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid11027141\charrsid11027141 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \i\f37\fs22\insrsid11027141 \{name of business\} }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid11027141 _______________________________________________________________,}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid5587758  
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \i\f37\fs22\insrsid7108755\charrsid9334066 \{street\}}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \i\f37\fs22\ul\insrsid7108755\charrsid9334066 \tab \tab \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \i\f37\fs22\ul\insrsid5587758 
_}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid11027141 ___________________________________________________________,}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid7108755\charrsid9334066  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid11027141 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \i\f37\fs22\insrsid7108755\charrsid9334066 \{city\}}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid7108755\charrsid9334066  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid7108755\charrsid9334066 \tab }{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid8733441 _____________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid11027141 ______________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid16729849 ___}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid8733441 ,}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid7108755\charrsid8733441 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \i\f37\fs22\insrsid7108755\charrsid9334066 \{state\}}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\insrsid7108755\charrsid9334066  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid7108755\charrsid9334066              }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid7108755\charrsid9334066 , }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\i\f37\fs22\insrsid7108755\charrsid9334066 \{}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \i\f37\fs22\insrsid11027141 tele}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \i\f37\fs22\insrsid7108755\charrsid9334066 phone}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\i\f37\fs22\insrsid11027141  number}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \i\f37\fs22\insrsid7108755\charrsid9334066 \}}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid7108755\charrsid9334066  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f37\fs22\ul\insrsid7108755\charrsid9334066                                 }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\ul\insrsid16729849 _}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f37\fs22\insrsid16729849 .}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
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