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IN THE SUPERIOR COURT OF ARIZONA, YAVAPAI COUNTY

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Name:
Mailing Address:
Daytime Telephone
Representing Self, Without a Lawyer
IN THE SUPERIOR COURT OF ARIZONA, YAVAPAI COUNTY
Regarding the matter of
1300DO
ATLAS #:
Petitioner
REQUEST TO STOP
and
[ ] ORDER OF ASSIGNMENT
[ ] INCOME WITHHOLDING ORDER
Respondent
THIS FORM DOES NOT AFFECT YOUR EXISTING SUPPORT ORDER.
THIS FORM ONLY APPLIES TO THE ORDER OF ASSIGNMENT/INCOME WITHHOLDING
ORDER.
I, , ask the court to Stop the [ ] Order of Assignment
[ ] Income Withholding Order dated
, because:
[ ] All past-due amounts and interest have been paid and the person required to pay child support is
no longer obligated to pay child support because:
[ ] Child is 18 and not attending high school or a certified high school equivalency program
[ ] Child(ren) has/have been adopted and all past-due amounts have been paid. ( I have
attached a copy of the Adoption Order)
[ ] Child(ren) is/are deceased. (I have attached a copy of the child’s Death Certificate.)
[ ] Child is 19.
[ ] Child is married.
[ ] Child legal decision-making has been changed by order of this Court.
[ ] All past-due amounts have been paid and the person required to pay spousal support is no longer
obligated to pay spousal support;
[ ] The parties have reconciled and remarried (I have attached a copy of the Marriage Certificate),
AND/OR the court case that ordered the support payment(s) has been dismissed.
[ ] The person ordered to pay support is deceased. (I have attached a copy of the Death
Certificate)
[ ] There are multiple active Orders of Assignment/Income Withholding Orders for the same child(ren)
and/or spouse-this case number and case number(s)
(certified copy
of order attached if from another Court);
For Clerk’s Use Only
Superior Court of Arizona in Yavapai County Page 1 of 2 DRSWA11f
January 2013
[ ] I REQUEST THE COURT to order the Support Payment Clearinghouse to hold any payments received
on this [ ] CHILD SUPPORT [ ] SPOUSAL SUPPORT obligation until after the hearing on:
[ ] Current support payments [ ] Past due payments
Date Requesting Party
STATE OF ARIZONA )
County of ) ss.
SUBSCRIBED AND SWORN or affirmed before me this date , 20 ,
By .
My Commission Expires:
Notary Public
Superior Court of Arizona in Yavapai County Page 2 of 2 DRSWA11f
January 2013
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IN THE SUPERIOR COURT OF ARIZONA, YAVAPAI COUNTY

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Completed 16 March 2022

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