STATE OF INDIANA
COUNTY OF DELAWARE )
)
) SS:
IN THE DELAWARE CIRCUIT COURT NO.______
CAUSE NO: 18CO____________________________
___________________________
Plaintiff
vs.
___________________________
Defendant
ORDER ON VOLUNTARY WAGE ASSIGNMENT
TO: ____________________________
____________________________
____________________________
Employer Name and Address
Pursuant to the Voluntary Wage Assignment filed herein, by defendant, you are hereby ordered
to deduct from the salary or wages of defendant, ____________________________, the amount
set forth and to forward the same to the Delaware County Clerk, P.O. Box 1089, Muncie, IN 47308,
such withholding to be effective commencing with the first full pay period following
receipt hereof.
Payments are to continue on a weekly or bi-weekly basis until further order of this Court. This
order rescinds and replaces any previous Order of this Court.
DATED this _____ day of ______________________________________, 20___.
___________________________________________________
JUDGE, DELAWARE COUNTY CIRCUIT COURT #______