|
|
|
| Name of Defendant |
|
|
|
|
| Address |
|
| ____________________ |
| No. ________ |
| Defendant
|
Plaintiff's attorney
|
| Address
|
Address
|
|
|
|
| (Signature), Clerk |
| Service, First Person | $
|
|
Additional Persons |
$
|
|
Persons Not Found |
$
|
| Mileage:
miles |
$
|
| ________ |
| Total | $
|
| No. ________ |
| Defendant
|
Plaintiff's attorney
|
| Address
|
Address
|
|
|
|
| ____________________ |
| (Signature), Clerk |
| Service, First Person | $
|
|
Additional Persons |
$
|
|
Persons Not Found |
$
|
| Mileage:
miles |
$
|
| ________ |
| Total | $
|
| ____________________ |
| (Signature), Garnishee |
| ________________________ |
| pay the defendant-employee $127.50 |
| pay the defendant-employee $255.00 |
| period pay the defendant-employee $276.25 |
| pay the defendant-employee $552.50 |
| pay the defendant-employee 75% of |
| the defendant-employee's disposable earnings |
| pay the defendant-employee 75% of |
| the defendant-employee's disposable earnings |
| pay the defendant-employee 75% of |
| the defendant-employee's disposable earnings |
| pay the defendant-employee 75% of |
| the defendant-employee's disposable earnings |
| (c)Total gross earnings due for the period or periods covered by (b) are | $
|
| (d)Average gross earnings for normal pay period as designated in (b) are | $
|
| (1)Federal social security tax | $
|
| (2)Federal income tax | $
|
| (3)State income tax | $
|
| (4)Railroad retirement tax | $
|
| Total | $
|
| (f)Disposable earnings for the pay period or periods covered by (b) are (c minus e) | $
|
| (g)I am subtracting from the disposable earnings in (f) an amount subject to an income withholding order for support | $
|
| (h)In accordance with the instructions accompanying this answer form, I have determined that the amount which may be paid to defendant is | $
|
| (i)I am holding from the amount in (h) an administrative fee in the amount of | $
|
| (j)After paying to defendant the amount stated in (h) less the administrative fee in (i), I am holding the remainder of defendant's disposable earnings in the amount of | $
|
| Available disposable earnings from (j) | $
|
| Amount of claim | $
|
| Difference paid to the defendant in addition to amount shown in (g) | $
|
| ____________________ |
|
|
|
| Name of Defendant |
|
|
|
|
| Address |
|
| ____________________ |
|
|
|
| Name of Defendant |
|
|
|
|
| Address |
|
| ____________________ |
| Defendant
|
Plaintiff's attorney
|
| Address
|
Address
|
|
|
|
| Amount of claim ______ |
| ____________________ |
| one |
| pay the defendant-employee $127.50 |
| pay the defendant-employee $255.00 |
| pay the defendant-employee $276.25 |
| pay the defendant-employee $552.50 |
| pay the defendant-employee 75% of |
| the defendant-employee's disposable earnings |
| pay the defendant-employee 75% of |
| the defendant-employee's disposable earnings |
| pay the defendant-employee 75% of |
| the defendant-employee's disposable earnings |
| pay the defendant-employee 75% of |
| the defendant-employee's disposable earnings |
| (c)Total gross earnings due for the pay period or periods covered by (b) are | $
|
| (d)Average gross earnings for normal pay period as designated in (a) | $
|
| (1)Federal social security tax | $
|
| (2)Federal income tax | $
|
| (3)State income tax | $
|
| (4)Railroad retirement tax | $
|
| Total | $
|
| (f)Disposable earnings for the pay period or periods covered by (b) are (subtract (e) from (c)) | $
|
| (g)I am subtracting from the disposable earnings in (f) an amount subject to an income withholding order for support | $
|
| (h)In accordance with the instructions accompanying this answer form, I have determined that the amount which may be paid to defendant is | $
|
| (i)I am withholding from the amount in (h) an administrative fee in the amount of | $
|
| (j)After paying to defendant the amount stated in (h) less the administrative fee in (i), I am holding the remainder of defendant's disposable earnings in the amount of | $
|
| Available disposable earnings from (j) | $
|
| Amount of claim | $
|
| Difference paid to the defendant in addition to amount shown in (g) | $
|
| ____________________ |
| ____________________ |
| ____________________ |