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Affidavit Of Service Of Notice To Withhold Income For Child Support (Illinois)

This form is a supplement to the Legal Separation packet in Illinois. The form provided here is simply a sample of what the actual form looks like.

STATE OF ILLINOIS

IN THE CIRCUIT COURT OF THE ___________ JUDICIAL CIRCUIT
__________________ COUNTY

IN RE THE MARRIAGE OF: )

) No. _______-____-_______

______________________)
Plaintiff, )

and )

______________________)
Defendant. )

AFFIDAVIT OF SERVICE OF NOTICE TO WITHHOLD INCOME FOR CHILD SUPPORT

I, _________________________ state the following:

1. That a copy of the Notice To Withhold Income For Child Support entered has been delivered

to: ______________________________________

by mailing it by certified mail, return receipt requested, with postage prepaid

at ________________________, Illinois.

2. That service was made on _______________________ by certified mailing.

Served by: _________________________________

This form must be filed with the Clerk of the Court following service of a Notice To Withhold Income For Child Support. Attach the green receipt card to this form and file with the Clerk of the Court.

Under penalties as provided by law pursuant to Section 5/1-109 of the Illinois Code of Civil Procedure, the undersigned certifies that the statements set forth in this instrument are true and correct.

_________________, Plaintiff


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INSTRUCTIONS FOR FILLING OUT THIS FORM
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Introduction: Your name.

Paragraph 1: First blank: The employer to which you sent the Notice To Withhold Income For Child Support.
Third blank: City from which you mailed the Notice to Withhold Income For Child Support

Paragraph 2: The day, month, and year on which the Notice To Withhold was received by the employer (will be on the green return receipt sent to you by the Post Office).

Served by blank: Your name.

Sign your name on the blank line above where it says "Plaintiff" and print your name below the signature.

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