HomeMy WebLinkAbout1506 ,
. ASSIGNMENT OF EARNItSGS
OF RESPONSIBLE PARENT
• In consideration of the covenants entered into by the parties
to this Assignr.>;ent, and pursuant to Florida Statutes Section 409.2574
197 6 Su p ~ Q l
( PP . _JIo~E~~lc ~ I]C'rtcc r''~ - C~~u~l~-S~ePar as eu~ployee
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hereby assigns $ S ,~..dy per ~Q-e to the Department of Eealth
and Rehabilitative Services, Division of Family Services, Child Support
Enforcement Unit, as and for child support. Said employee hereby ~
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directs his employer to pay said amount directly to the Department of ~
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Health and Rehabilitative Services, from said employee's periodic ~
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earnings. This assignment is applicable. whether the earnings are to
be-paid presently or ;in the future and shall continue in force and - ~
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effect until released in~writing by the Department of Health and r
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Rehabilitative Services. -Payment of moneys pursuant to this assignment
of earnings shall serve as full acquittance of the employer's obligation
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under any contract of eLnployment up to the amount set forth. herein and-
the State warrants and represents that it shall defend and hold harc~less-~
sucl: action taken pursuant to ,said assignment of earnings.
Any person, f-irm or corporation that fails to- honor this assign
ment of earnings is liable to the Department of Health and Rehabilitative
Services in an amount, equal to 100 per century of the amount of the
assignment of earnings, plus costs, interest and reasonable attorneys
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Each payment should be accompanied by the employee's mane-,
4 --Social Security Number and the case number shown below.
.The money assigned hereb should be sent b U. S. mail
d Y y to
CLERK OF THE CIRCUIT COURT
C 1TY COURTHOUSE
~i~ rc~ Florida
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Department o ea t an lamp oyee _
Rehabilitative Services ~ ~ _ 7~
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Case No. ~7-~//-F~~; - - FILED QtJD RECORDED•
- , ~~J ~z ^ COUNTY. FLA:
43246
'79 J,~~; 3 i AM -10 ~ i 0
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