SSN:

We are writing to you about court order number (1) .

In an earlier letter, we told you that we might have to take money out of (2) Social Security payments to satisfy the court order. (3) order us to take money out to collect child support, alimony, or court ordered victim restitution. Therefore, we will reduce the monthly payments (4) .

 

What We Will Take Out

We will take out (5) from each monthly payment to collect what (6) . You will receive a check for $ (7) each month beginning with the check you receive around (8) .

 

If You Disagree With The Decision

If you disagree with the decision of (9) , you will need to contact them directly, or have a lawyer do this for you. They can be contacted at:

•  

  (10)

   

If You Have Any Questions

3901C

• •

  This letter should be sent to the beneficiary/payee when the Court sets a garnishment amount or percentage that is no more than federal or state limits and withholding begins.

• •

  Refer to NL 00703.005E for 3901C text.

   

Fill-ins:

1. (1) 

   case/civil action number

2. (2) 

   “your”/beneficiary's full name, possessive in format: Robert L. Smith's

3. (3) 

   name of court or public official/agency in format: Baltimore County Court

1. (5) 

   money amount or percentage of withholding

2. (6) 

   “you owe”/beneficiary's title and last name “owes,” in format: Mr. Smith owes

3. (7) 

   adjusted monthly benfit amount

4. (8) 

   month/day/year new payment will arrive

5. (9) 

   name of court or public official/agency in format: the Baltimore County Court

6. (10) 

   address of court or public official/agency