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Employer Payment Form (Illinois)

This is a supplemental letter form for the Divorce with Minor Children packet (Illinois) that transmits an employee's child support payment to the Illinois State Disbursement Unit. The form provided here is simply a sample of what the actual form looks like.

ATTENTION EMPLOYERS: Use this form when payment is directed to the State Disbursement Unit (SDU).

State Disbursement Unit
P.O. Box 5400
Carol Stream, IL 60197-5400

This form should be sent each pay period along with your check made payable to the State Disbursement Unit (SDU).

Deductions for more than one employee for court ordered child support may be reported on the same remittance form and combined into one check.

Complete all boxes below for each employee included in your attached check to ensure proper credit at the office of the State Disbursement Unit.

For State Disbursement Unit's Use

___________________________________ Date Received___________________
Employer's Name

___________________________________ Date Processed__________________

Employer's Address: ___________________________________


City ___________________________________

State ___________________________________

Zip ___________________________________

Employee/Obligor Name ___________________________________

Court Order # ___________________________________

IV-D or Non IV-D *If Available ___________________________________

Amount Withheld ___________________________________

(For additional remittance forms, please copy this form.)

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