HB 2371
| 27 | Defendant | Plaintiff's attorney | |
| 28 | Address | Address | |
| 29 |
| Amount of claim ______ |
HB 2371
HB 2371
HB 2371
HB 2371
| ____________________ |
| one |
HB 2371
| 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 |
HB 2371
| pay the defendant-employee 75% of |
| the defendant-employee's disposable earnings |
| pay the defendant-employee 75% of |
| the defendant-employee's disposable earnings |
| 24 | (c)Total gross earnings due for the pay period or periods covered by(b) are | $ | |
| 25 | (d)Average gross earnings for normal pay period as designated in (a) | $ |
| 28 | (1)Federal social security tax | $ |
| 29 | (2)Federal income tax | $ |
| 30 | (3)State income tax | $ |
| 31 | (4)Railroad retirement tax | $ |
| 32 | Total | $ |
| 34 | (f)Disposable earnings for the pay period or periods covered by (b)are (subtract (e) from (c)) | $ |
HB 2371
| 7 | (g)I am subtracting from the disposable earnings in (f) an amountsubject to an income withholding order for support | $ | |
| 8 | (h)In accordance with the instructions accompanying this answerform, I have determined that the amount which may be paid to defendantis | $ | |
| 9 | (i)I am withholding from the amount in (h) an administrative fee inthe amount of | $ | |
| 10 | (j)After paying to defendant the amount stated in (h) less the ad-ministrative fee in (i), I am holding the remainder of defendant's dispos-able earnings in the amount of | $ |
| 14 | Available disposable earnings from (j) | $ | |
| 15 | Amount of claim | $ | |
| 16 | Difference paid to the defendant in addition to amount shown in (g) | $ |
| ____________________ |
HB 2371
HB 2371
HB 2371
| ____________________ |
HB 2371
HB 2371
HB 2371
| ____________________ |