Superior Court of the District of Columbia Civil Division Small Claims and Conciliation Branch Building B, 510 4th Street N.W., Room 120 Washington, D.C. 20001 Telephone (202)879-1120 , Plaintiff vs. SC No. , Defendant WRIT OF ATTACHMENT OTHER THAN WAGES, SALARY AND COMMISSIONS , Garnishee: To: You are hereby notified that any non-exempt money, property or credits other than wages, salary and commissions of the above named defendant are seized by this Writ of Attachment, and you are required to hold it and not pay or surrender it to the defendant or to anyone else without an Order from the Court, subject to the following limitations: (1) The maximum amount which may be seized is the “TOTAL BALANCE DUE” as shown on this Writ; (2) This Writ covers only the property of the defendant that is in your possession or control on the date that the Writ was served, including sums which you unconditionally owe to the defendant at the time the Writ is served but which you have not yet posted to the defendant’s account (Consumers United Ins. Co. v. Smith, 644 A.2d 1328, 1356 & n.34); and (3) No funds shall be attached or garnished from an account that consists solely of direct deposited benefits that are exempt under federal or District of Columbia law, including Social Security, Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), Veterans’ Benefits, Civil Service Retirement, Black Lung, Railroad Retirement, Disability, Unemployment, Public Assistance/TANF benefits or Worker’s Compensation. Within ten (10) days after this Writ is served upon you, you are required to answer UNDER PENALTIES OF PERJURY the following interrogatories (on the back of this Writ). You must file in this Court one copy of this paper with your answers written thereon. You also must serve copies, by mail or other means, upon the plaintiff and upon the defendant. If you fail to do so, judgment may be entered against you for the entire amount of the plaintiff’s claim, with interest and costs. Judgment was entered herein on , . THE AMOUNT NOW DUE on the judgment is as follows: $ Original amount of judgment (excluding costs and attorney’s fees) $ Less total credits $ Net $ * Plus accrued interest, on $ , at % per annum for period from to $ Plus court costs due, including Writ of Attachment $ Plus attorney’s fees, if allowed by judgment $ TOTAL BALANCE DUE AS OF CLERK OF THE COURT _____________________________/___________ Attorney for Party / Pro Se Party By: Date Telephone No. ____________________________ Deputy Clerk Date Issued: * If this attachment does not satisfy the judgment, the interest will continue to accrue on the remaining unpaid balance. American LegalNet, Inc. www.FormsWorkflow.com INTERROGATORIES TO BE ANSWERED BY GARNISHEE (D.C. Code § 16-552) Defendant’s Name: Case Number: Garnishee may assert any defense that the Garnishee may have to the attachment, as well as any defense that the defendant could assert. (D.C. Code § 16-519) (1) Were you indebted to the defendant either at the time of the service of this Writ or between the time of such service and the filing of your answer to the interrogatory? Yes ____ No ____ If yes, explain: ___________________________________________________________________________________________ (2) Were you in possession or control of any property in which the defendant has an interest at the time of the service of this Writ or between the time of such service and the filing of your answer to the interrogatory? (“Property” includes money, goods and credits.) Yes ____ No ____ If yes, describe the property: ___________________________________________________________________________________________ (a) Do the funds in your possession or control consist solely of direct deposited benefits which are statutorily exempt from garnishment under federal or D.C. law? Yes ____ No ____ If yes, specify the exemption: □ □ □ (b) Social Security (SSA) Veterans’ (VA) Retirement or pension □ □ Unemployment Worker’s compensation The defendant’s account is (check one): □ a solely owned account containing $ □ a joint account held with (name and address) □ □ Public assistance/TANF Other: _____________________ funds. containing $ funds. I swear/affirm under the penalties of perjury that the answers to the above interrogatories are, to the best of my knowledge and belief, true and correct as to every material matter. Garnishee Signature Title Printed Name Date SUBSCRIBED AND SWORN TO before me this day of , 20__. NOTARY PUBLIC My commission expires: _________________________. American LegalNet, Inc. www.FormsWorkflow.com