IN THE SUPERIOR COURT OF THE

STATE OF WASHINGTON IN AND FOR THE

COUNTY OF  . . . . . . . . .

 . . . . . . . . . . . .

No.  . . . . . . . . . . . .

Obligee

vs.

ANSWER

 . . . . . . . . . . . .

TO WAGE

Obligor

ASSIGNMENT ORDER

 . . . . . . . . . . . .

Employer

1. At the time of the service of the wage assignment order on the employer, was the above-named obligor employed by or receiving earnings or other remuneration for employment from the employer?

Yes  . . . . . . No  . . . . . . (check one).

2. Are there any other attachments for child support or maintenance currently in effect against the obligor?

Yes  . . . . . . No  . . . . . . (check one).

3. If the answer to question one is yes and the employer cannot comply with the wage assignment order, provide an explanation:

I declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.

. . . .

. . . .

Signature of employer

Date and place

. . . .

. . . .

. . . .

Signature of person

Address for future notice

answering for employer

to employer

. . . .

Connection with employer