(1) [ ] JUSTICE COURT___________________________, COUNTY OF ______________________________________ (2) [ ] MUNICIPAL COURT _______________________, COUNTY OF ______________________________________ (3) [ ] ARIZONA SUPERIOR COURT, COUNTY OF _____________________________________________________ (4) Petitioner/Plaintiff [ ] Judgment Creditor [ ] Judgment Debtor Name: Address: (7) Case No.:_______________________________ City, State, Zip Code: Phone(s): (5) Respondent/Defendant [ ] Judgment Debtor [ ] Judgment Creditor Name: ________________________________________________ Address:_______________________________________________ City, State, Zip Code: ____________________________________ GARNISHEE’S NONEXEMPT EARNINGS STATEMENT (NOT FOR SUPPORT OF A PERSON) (A.R.S. §§ 12-1598.11 & 12-1598.16(J)) Phone(s): ______________________________________________ (6) Garnishee: Name: Address: City, State, Zip Code: Phone(s): Attorney: 1. This Nonexempt Earnings Statement covers the following pay period: (8) _______________________________ to _______________________________. 2. Do you currently employ the judgment debtor? (9) [ ] Yes [ ] No 3. If no, what was the last date on which the judgment debtor worked for you? (10)__________________________________. 4. Is the judgment debtor owed any earnings for this pay period? (11) [ ] Yes [ ] No FORM 12 NONEXMPT EARN STMT NFS Page 1 of 2 5/17/07 American LegalNet, Inc. www.FormsWorkflow.com Case No. (7)______________________________________ WITHHOLDING WORKSHEET Judgment debtor’s gross earnings (pre-tax) for this pay period . . . . . . . . . (12) $ _____________________ Judgment debtor’s disposable earnings (gross minus deductions required by law) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (13) $ _____________________ 25% of line (13) (or other percentage ordered by the Court) . . . . . . . . . . . (14) $_____________________ Judgment debtor’s pay period: (15) (check one) [ ] Weekly (factor = 30) [ ] Biweekly (factor = 60) [ ] Semimonthly (factor = 65) [ ] Monthly (factor = 130) Current federal minimum wage: (16) $ ___________________/hr. Line (16) multiplied by factor selected in (15) . . . . . . . . . . . . . . . . . . . . . (17) $__________________ Line (13) minus line (17) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (18) $ _________________ Amount from line (14) or line (18), whichever is smaller . . . . . . . . . . . . . (19) $ _________________ Amount withheld for other court-ordered assignment for support of a person or other garnishment or levy for collection of taxes . . . . . . . . . . . . (20) $ _________________ Line (19) minus line (20), this is the amount withheld . . . . . . . . . . . . . . . . (21) $ _________________ Line (21) minus employer’s $5.00 processing fee . . . . . .. . . . . . . . . . . . . . (22) $ _________________ The amount shown on line (21) is the amount you should withhold for this pay period. The amount shown on line (22) is the amount you deliver to the judgment creditor. (23) (24) Copy provided to judgment debtor on: Copy provided to judgment creditor on: Date: Date: By: [ ] Mail [ ] Hand delivery (25) __________________________ Date FORM 12 NONEXMPT EARN STMT NFS By: [ ] Mail [ ] Hand delivery ____________________________________ Garnishee or Authorized Agent Page 2 of 2 5/17/07 American LegalNet, Inc. www.FormsWorkflow.com