Rule 68 - Dissolution of Marriage
Rule 68 - Form 1469 - Application for Income Withholding
IN THE CIRCUIT COURT OF JACKSON COUNTY, MISSOURI
AT KANSAS CITY AT INDEPENDENCE
No.
VS.
APPLICATION FOR INCOME WITHHOLDING
TRUSTEE CASE NON-TRUSTEE CASE
Please issue a Notice of Income Withholding:
NAME AND ADDRESS OF EMPLOYER/PAYOR: DEBTOR’S/OBLIGOR’S NAME AND ADDRESS
DATE OF JUDGMENT ORDERING
SUPPORT AND/OR MAINTENANCE:
CHILD SUPPORT MAINTENANCE
AMOUNT ORDERED: AMOUNT ORDERED:
$ per $ per
AMOUNT OF DELINQUENCY: AMOUNT OF DELINQUENCY:
$ $
(INCOME WITHHOLDING IS NOT AUTHORIZED UNLESS (INCOME WITHHOLDING IS NOT AUTHORIZED UNLESS DELINQUENCY EQUALS OR EXCEEDS ONE MONTH’S DELINQUENCY EQUALS OR EXCEEDS ONE MONTH’S TOTAL OBLIGATION) TOTAL OBLIGATION)
I, Judgment Creditor in the above case, upon my oath state that the foregoing information is true and complete.
REQUESTED BY
_____________________________________ ____________________________________
NAME OF CREDITOR/ATTORNEY SIGNATURE
_____________________________________ ____________________________________
ADDRESS PHONE
_____________________________________ ____________________________________
CITY STATE ZIP DATE
Subscribed and sworn to before me this date.
_____________________________________ _____________________________________
DATE NOTARY/DEPUTY COURT ADMINISTRATOR
NOTICE TO CREDITOR: If the order was entered prior to August 13, 1996, or if it does not contain a notice advising the debtor that his income is subject to withholding, as required by Section 452.350 R.S. Mo., and when the Court Administrator is not Trustee, this application must be sworn to before a notary or deputy. Advisory notices must first have been mailed to the judgment creditor and judgment debtor before a Notice of Income Withholding can be directed to the employer. After the expiration of fifteen (15) days from the date of mailing those notices you must apply for income withholding on Circuit Court Form 1469, at which time a Notice of Income Withholding will be mailed to the employer/payor, if authorized. A $7.00 fee is due for mailing this notice. ORIGINAL
CIRCT 1469 - 7/92 (File in Court’s Case File Folder)