(Revised 7/10) File Stamp Date Case Number ________ Prepared by: Filer’s name, SC# Filer’s address Filer’s phone number {Filer’s fax phone number} {Filer’s e-mail address} Attorney for Judgment Creditor In The District Court of ______ County, Kansas Judgment Creditor name Judgment Creditor vs. Judgment Debtor name Judgment Debtor address Case No. ______ Judgment Debtor Garnishee name Garnishee Garnishee’s address Garnishee’s county {Garnishee’s fax phone number (if known)} {Garnishee’s e-mail address (if known)} Pursuant to Chapter 61 of Kansas Statutes Annotated Type of Service Requested: ___________________ by _____________________ ORDER OF GARNISHMENT (To Attach Earnings) To the above-named Garnishee: The amount of the unsatisfied balance under this judgment, as of the date this Order is issued, is: $________________________________. Complete the attached Answer under penalty of perjury as set forth in the instructions. The attached Instructions to Garnishee are incorporated by reference. You are ordered as a garnishee to follow the attached instructions as if they were set forth in this Order. This order of garnishment has the effect of attaching the nonexempt portion of the judgment debtor’s earnings for all pay periods which end while the order is in effect. The order takes effect the day it is served on you. This order of garnishment is a continuing order and remains in effect until the judgment against the judgment debtor has been paid or the garnishment is released, whichever occurs sooner. American LegalNet, Inc. www.FormsWorkFlow.com This order also constitutes an order of the court directing the garnishee to pay to the judgment creditor all earnings which are to be withheld under this order. You are ordered to withhold and pay the earnings in accordance with the attached instructions. If you fail to comply with the terms of this order and the attached instructions, the judgment creditor may file a motion for judgment against you for the amount of judgment against the judgment debtor or such other amount as the court shall order, including the expenses and attorney fees of the judgment creditor. If you fail to make payment of funds as required under this order and the attached instructions, the judgment creditor may file a motion for judgment against you for contempt or such amount as the court shall order, including the expenses and attorney fees of the judgment creditor. Dated this _____ day of _______________, _____. BY ORDER OF THE COURT {If applicable, include the following: This is a communication from a debt collector. This is an attempt to collect a debt and any information obtained will be used for that purpose.} RETURN ON SERVICE OF GARNISHMENT ORDER I hereby certify that I have served this garnishment order in the following manner: (1) Personal Service. By delivering a copy of the garnishment order along with two copies of the answer form to each of the following persons on the dates indicated: ___________________ _______________, ______ ___________________ _______________, ______ (Name) (Date) (2) Agent Service. By delivering a copy of the garnishment order along with two copies of the answer form to each of the following agents authorized by appointment or by law to receive service of process on the dates indicated: ____________________ _______________, ______ ____________________ _______________, ______ (Name) (Date) (3) Service by Return Receipt Delivery. By causing to be delivered on the _____ day of _______________, ______, a copy of the garnishment order along with two copies of the answer form by return receipt delivery to each of the following persons at the following address:_______________________________________________________________________ ______________________________________________________________________________ _______________________________________________________________________________ with such delivery made by the following person or entity: _______________________________. Attached hereto is a copy of the return receipt evidencing such delivery. American LegalNet, Inc. www.FormsWorkFlow.com (4) Return Receipt Delivery Refused. By mailing on the _____ day of _______________, _____, a copy of the garnishment order along with two copies of the answer form to each of the following persons at the following address: (5) Mail Service. By mailing on the _____ day of _______________, ______, a copy of the garnishment order, along with two copies of the answer form by first class mail to each of the following persons at the following addresses:___________________________________________ ______________________________________________________________________________ _______________________________________________________________________________ (6) Telefacsimile communication. By faxing on the _____ day of _______________, _____, at ____ o’clock _.m., a copy of the garnishment order, along with two copies of the answer form, to t h e f o l l o w i n g persons:________________________________________________________________ Number of transmitting machine: _____________________ Number of receiving machine: ______________________ (7) Internet electronic mail. By e-mailing on the _____ day of _______________, _____, at ____ o’clock _.m., a copy of the garnishment order, along with a copy of the answer form, to the f o l l o w i n g p e r s o n s a t t h e f o l l o w i n g e - m a i l addresses:_____________________________________________ ______________________________________________________________________________ _______________________________________________________________________________ Transmitting person’s e-mail address: __________________________ (8) No Service. The following persons were not served: ______________________________________________________________________________ Pursuant to K.S.A. 53-601, as amended, I declare under the penalty of perjury that the foregoing is true and correct. EXECUTED on __________________, ______. _______________________________ Signature, Sheriff or Process Server Attach the following: Instructions to Garnishee Answer of Garnishee Written Explanation American LegalNet, Inc. www.FormsWorkFlow.com