|
|
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) | $
|
____________________ |
____________________ |
____________________ |