DANNY J_VOPAT DISTRICT COURT TRUSTEE 607 SE QUINCY SUITE 200 TOPEKA KS 6660300000 (785) 235-0400 0129200215 IN THE SHAWNEE COUNTY DISTRICT COURT OF KANSAS SITTING AT TOPEKA, DIVISION 02 In the Matter of the Marriage of:/or Case No. 96D 000217 HAL RICHARDSON Petitioner 1 and/vs. CLAUDINE DOMBROWSKI Respondent 1 On this 19 day of October, 2001, it is ordered that this income withholding order shall be binding upon the debtor's present employer or other payor of income and upon any subsequent employer or payor upon whom it is served, and that: 1. This order shall be served on the employer or payor of the debtor, CLAUDINE DOMBROWSKI, social security number 511-74-9645, with the notice and answer forms appropriate to the nature of the periodic payments made to the debtor by the employer or payor. 2. An employer or payor (including a self-employed debtor) who is served a copy of this order shall withhold from debtor’s disposable income (or from payments otherwise owed to the debtor) $225.00 per month to be applied: $225.00" per month for current child support. $ per month for current spousal support. $ per month for past due child support. S$ per month for past due spousal support. Withholding by an employer is subject to the limitation given in paragraph 3 below. Paragraph 3 does not apply if withholding is from income other than earnings. 3. If withholding is from earnings, the total withheld from disposable income shall be prorated over all pay periods within each month and cannot be more than 50% of the debtor’s total disposable income for each month. 4, Until further order of the court, the employer or payor shall continue withholding from the debtor’s income as instructed. Notice and instructions concerning the rights and duties of the employer or payor are stated on the accompanying notice and answer forms and are incorporated by reference into this order. 0129200215 Efil PG 1 5. The employer or payor shall return a completed copy of theattached answer to the court at the address given in Paragraph 6 below when the first payment is sent or as soon as possible if no income is withheld. All payments shall be identified with the debtor’s name and the court case number. Unless otherwise instructed on the answer form, payments from the employer or payor on the answer form, shall be sent and made payable to the Kansas Payment Center Child Support Division PO Box 758599 Topeka KS 66675-8599 as Case Number SN96D 000217. The Clerk of the District Court shall credit payments to the debtor’s record and forward the payments to the appropriate person or office. The support order does not require the person whose income is affected by this Income Withholding Order to provide group health insurance for this child. Please advise of any lapse in coverage by use of the Notice of Change Form included in this package. Nothing in this order shall be construed as a restriction, restraint, or bar to other means of collecting past due support ({f any).” This order supercedes any previous Withholding Order and/or Wage Assignment entered in the above entitled case. Hon, Judge Richard D. Anderson DISTRICT COURT JUDGE, DIVISION 02 E47520¥120 PREPARED AND SUBMITTED BY: DANNY J VOPAT EMPLOYER/PAYOR: PLEASE NOTE THE, DATE THIS ORDER WAS SERVED ON YOU DATE: Withholding must begin no later than 14 calendar days after the date of service. Bmployer: CLAUDINE DOMBROWSKI PO BOX 984 MANHATTAN, KS 66505 0129200215 Efil PG 2