WAGE EXECUTION PROCEEDINGS APPLICATION, ORDER, EXECUTION JD-CV-3 Rev. 2-15 C.G.S. §§ 31-58(j), 52-350a, 52-361a, 52-356d, 29 U.S.C. 206(a)(1) APPWEX STATE OF CONNECTICUT SUPERIOR COURT www.jud.ct.gov Instructions Employer: See Page 2 for instructions *APPWEX* WAGEEX *WAGEEX* Proper Officer 1. Leave one signed copy with employer. 2. Make return on signed original. 3. Leave one copy of Modification and Exemption Claim form (JD-CV-3a) with employer and fill in "Date of Service" on form. Judgment Creditor or Attorney 1. Unless filing electronically, prepare original and four copies. 2. Attach form JD-CV-3a to this form, or include with execution as one PDF electronic form. 3. Present original and 3 copies to clerk of court. 4. Keep one copy for your file. Clerk 1. Issue execution by signing original. 2. Enter any court ordered limitation at the bottom of section II on page 2. 3. Return original and 2 copies if on paper. 4. Retain/scan copy for court file. Name and mailing address of Judgment Creditor or Attorney (To be completed by Judgment Creditor or Attorney) ADA NOTICE The Judicial Branch of the State of Connecticut complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation in accordance with the ADA, contact a court clerk or an ADA contact person listed at www.jud.ct.gov/ADA. Address of court (Number, street, and town) (Fold) G.A. J.D. Housing Session Date of judgment Docket number Name(s) and address(es) of Judgment Creditor(s) Name(s) and address(es) of Judgment Debtor(s) Application Name and address of employer of Judgment Debtor (If known) Telephone number of employer (if known) 1. Amount of judgment (Include where applicable, prejudgment interest and attorney's fees) 2. Amount of costs and fees 5. Total amount unpaid (Subtract 4 from 3) 3. Total amount of judgment, costs and fees (Add 1 and 2) 4. Total amount paid (If any) 6. Application fee for wage execution (If not waived by the court) 7. Application fees paid for prior executions on this judgment Check if applicable 8. Other Court ordered postjudgment costs and fees 9. Total of lines 5, 6, 7 and 8 Postjudgment interest was ordered by the Court The above-named Judgment Creditor(s) recovered a judgment against the above-named Judgment Debtor(s). The Judgment Debtor(s) has/have failed to pay the total amount due on that judgment. Pursuant to the Connecticut General Statutes, the Court listed above entered an order that the judgment be paid by the above-named Judgment Debtor(s) in the following installment payments: The amount of was ordered to be paid in (weekly, monthly, or other) installment payments. *See Note below (Note: This is not the amount the employer must pay. Employer must pay the amount of execution calculated on page 2 of this form. The court ordered that installment payments begin on The Judgment Debtor(s) failed to comply with the Installment Payment Order (commencement date) Execution Therefore, the Judgment Creditor(s) applies/apply for this execution upon the wages of the Judgment Debtor(s) for the remaining amount due on the judgment shown in line 9 above Signed (Judgment Creditor or Attorney) On (Date) Telephone Number File date For Court Use Only X To: Any Proper Officer By the authority of the State of Connecticut, you are ordered to cause any wages due to the Judgment Debtor(s), not exceeding the Amount of Execution calculated on page 2, to be paid to the Judgment Creditor(s) until the judgment is satisfied, including postjudgment interest as ordered by the court, if applicable, plus the application fee(s) and other Court ordered postjudgment costs and fees, and your own fees or until the execution is modified or set aside. Serve this execution within one year of this date, and make return of service to this courtwithin thirty days from satisfaction of the execution. Signed (Assistant Clerk of said court) On (Date) American LegalNet, Inc. www.FormsWorkFlow.com X Page 1 of 2 WAGE EXECUTION PROCEEDINGS Important Notice To Employer You are being served with a wage execution, a court order requiring you to withhold non-exempt wages from a person employed by you. This execution is being served on you because your employee, the Judgment Debtor (on page 1), has had a judgment entered against him/her by the Superior Court requiring him/her to pay judgment, costs and fees to the Judgment Creditor (on page 1) and has not made payment of the total amount of the judgment plus any costs and fees as shown on page 1. This notice is to inform you of the actions you must take in order to comply with the law regarding wage executions. Please read each section carefully. I. You must notify the employee -- Your employee has certain legal rights which may allow him/her to request the court to change or stop this execution upon his/her wages. A notice of his/her rights and how to get a hearing in court is attached to the second copy of the wage execution given to you by the officer. You must complete your portion of the wage execution and your portion of the exemption and modification claim form and deliver or mail, postage prepaid, a copy of these papers to your employee immediately so that your employee can make any claims allowed by law. II. Execution not effective for 20 days -- This execution is not effective until after 20 days from the day the officer served these papers on you. No money should be deducted from your employee's wages until the first wages you pay to your employee after the 20-day period ends. If your employee elects within the 20-day period to make a claim to the court that his/her wages are partially or totally exempt from execution to pay this judgment or he/she seeks to have the amount of this execution changed, wages are not to be withheld from the employee until the court decides the claims or determines the rights of your employee in this case. If you are not notified that your employee has filed papers with the court, the execution is to be enforced after 20 days from the date of service on you. III. Stay of execution -- No earnings claimed to be exempt or subject to a claim for modification may be withheld from any employee until determination of the claim by the court. IV. Only one execution issued under section 52-361a of the General Statutes is to be satisfied at a time -- You must make deductions from your employee's wages and pay over the withheld money against only one execution issued under General Statutes section 52-361a at a time. If you are