Employer Withholding Notice
Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when
sending the payment. The paydate/date of withholding is the date on which amount was withheld from
the employee’s wages. You must comply with the law of the state of employee’s/obligor’s principal place
of employment with respect to the time periods within which you must implement the withholding order
and forward the support payments. Aka LDOC
Employee/Obligor with Multiple Support Withholdings: If there is more than one Order/Notice to
Withhold Income for Child Support against this employee/obligor and you are unable to honor all support
Order/Notices due to Federal or State withholding limits, you must follow the law of the state of
employee’s/obligor’s principal place of employment. You must honor all Order/Notices to the greatest
extent possible. (see #10 below)
Termination Notification: You must promptly notify the Child Support Enforcement Agency or payee
when the employee/obligor no longer works for you. Please provide the information requested and
return a complete copy of this Order/Notice to the Child Support Enforcement Agency or payee. (Note:
Please use the enclosed TERMINATION OF EMPLOYMENT NOTICE.)
EMPLOYEE’S/OBLIGOR’S NAME: __________________________CASE IDENTIFIER____________
DATE OF SEPARATION FROM EMPLOYMENT: ___________________________________________
LAST KNOWN HOME ADDRESS: NEW EMPLOYER’S ADDRESS:
_______________________________________
__________________________________________
_______________________________________
__________________________________________
_______________________________________
__________________________________________
ORDER INFORMATION: This Order/Notice is based upon an order for support
order__________________from _____________________. You are required by law to deduct these
amounts from the employee’s/obligor’s income until further notice. You do n