Dorothy Brown, Clerk of the Circuit Court of Cook County, Illinois þ cookcountyclerkofcourt.orgPage 1 of 4 þ Plaintiff(s),v. Defendant(s),XXX-XX- þ Respondent.Case No. þ þ (21 to 40 days after date of issuance of summons) I, the undersigned, certify under penalties as provided by law under 735 ILCS 5/1-109, that the following information is true.1. I believe Respondent þ is indebted to the JudgmentDebtor þ for wages due or to become due.2. The last kno .3. I request that a summons issue directed to Respondent. þ 1. Judgment in this case was entered onþ .2. Amount of Judgment $ þ þ 3. Allowable costs previously expended:a. þ þ b. Original and alias summons $ þ þ c. Filing and summons costs of prior supplementary proceedings $ þ þ 4. Filing and summons cost for this garnishment $ þ þ5. Interest at 9% pursuant to statute $ þ þýýýýýýýýýýýýý 6. Total $ þ 7. þ Total amount paid by or on behalf of the Judgment Debtor beforeþ $ þ þ 8. Balance due Judgment Creditor $ þ þ Dorothy Brown, Clerk of the Circuit Court of Cook County, Illinois þ cookcountyclerkofcourt.orgPage 2 of 4 þ Employer/Agent: þ Court Date: þ Defendant222s Name: þ þ SSN. xxx-xx- þ þ Case No. þ Defendant222s Address þ þ Attorney or Judgment Creditor Signature Print Name Atty. No.: þ Atty Name: þ þ Atty. for: þ þ Address: þ þ City: þ þ State: þ Zip: þ Telephone: þ Primary Email: þ þ Do you pay any money to the Defendant listed above? þ þ Yes þ No þ If terminated, date: þ .Of the funds paid to the debtor, are any of those funds: Subject to prior court ordered deduction (including child/spouse support) Case Number,State, County þ . Disability? þ þ Retirement? þ þ Otherwise exempt? (Describe þ )CREDITORUnder penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure (735 ILCS Defendant at the address shown above on þ .Signature: þ þ Name: þ Dorothy Brown, Clerk of the Circuit Court of Cook County, Illinois þ cookcountyclerkofcourt.orgPage 3 of 4 þ 1. 2. 3. www.cookcountyclerkofcourt.org and proceed with the eFile process.Do you pay debtor: þ Every week þ Every 2 weeks þ þ Semi-monthly þ Monthly þ þ Other þ A. Gross wages per paycheck minus mandatory contributions to pensions or retirement plan þ $ þ þ B. 15% of (A) = $ þ þ C. Enter total FICA, State Tax, Federal Tax and Medicare $ þ þ D. Subtract (C) from (A) = $ þ þ E. If debtor is paid every week, enter $371.25If debtor is paid every two weeks, enter $742.50If debtor is paid semi-monthly, enter $804.37If debtor is paid monthly, enter $1,608.75If other, multiply 45 times state minimum wage (currently $8.25)times number of weeks in pay period þ $ þ þ F. Subtract (E) from (D) (Enclose a negative number in parentheses, e.g., ($50.00)) $ þ þ G. Enter the Lesser of Line (B) or (F) $ þ þ H. Enter Child Support or other Court Ordered Deduction $ þ þ I. Subtract (H) from (G) (Enclose a negative number in parentheses, e.g., ($50.00)) $ þ þ J. Subtract Employer222s Statutory Fee (2% of line 223I224). See 735 ILCS 5/12-814. $ þ þ K. Amount to be applied to Judgment $ þ þ Dorothy Brown, Clerk of the Circuit Court of Cook County, Illinois þ cookcountyclerkofcourt.orgPage 4 of 4 þ Under the penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure (735 correct and that I have either mailed or hand delivered a copy of this completed Interrogatories/Answer to the Clerk, Plaintiff222s attorney and Defendant. Date: þ Employer/Agent Signature: þ Employer/Agent: þ Address: þ City: þ þ State: þ Zip: þ Telephone: þ Primary Email: þ