SSN:

As amended court order number (1) requested, we have changed the amount that we take out of (2) Social Security payments beginning (3) . We will withhold $ (4) a month. We will send the new amount to (5) no later than the 15th of each month.

If you have any questions, please write to us at the above address.

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  The PSC will send this notice when we can comply with the amended order as written,

   

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  Fill-ins:

  1. (1) 

     case/civil action number

  2. (2) 

     beneficiary's name, possessive in format: John Smith's

  3. (3) 

     month and year

  4. (4) 

     new dollar amount being withheld

  5. (5) 

     name of person/place receiving the garnished payments