_____________________________________,
Petitioner
v. No. _____________
_____________________________________,
Respondent
This matter having come before the court for entry of a wage
withholding order. The parties have agreed as follows:
A. Information on the paying parent:
Name of parent: __________________________________
Parent's address: __________________________________
__________________________________
Social security number: __________________________________
Employer's name: __________________________________
Employer's address: __________________________________
__________________________________
B. The total support owed is $__________ per month.
C. ________________________ (name of paying party) agrees to
this support being withheld from wages of the above
employer.
IT IS ORDERED THAT:
The paying parent's employer (including all future employers
or income providers) shall withhold support as follows
(describe amount and purpose for which wages will be
withheld): ________________________________________________
__________________________________________________________.
The employer shall mail or transfer the amount withheld within
seven (7) days of the date the paying parent receives a pay
check to:
_______________________________________________ (name of
person or entity and address).
IT IS SO ORDERED.
____________________ _______________________________
Date District judge
APPROVED:
Mother's signature: ________________________________
Address: ________________________________
________________________________
________________________________
Telephone: ________________________________
Father's signature: ________________________________
Address: ________________________________
________________________________
________________________________
Telephone: ________________________________
1. See Paragraph C of Domestic Relations Form 4A-205
NMRA for an explanation of the Wage Withholding
Order.
[Approved, effective November 15, 2002.]