(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 (Support Judgment) (A.R.S. § 12-1598.16(K)) Phone: _______________________________________________ (6) Garnishee: Name: Address: City, State, Zip Code: Phone(s): Attorney: 1. This non-exempt 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. Do you owe the judgment debtor any earnings for this pay period? (11) [ ] Yes [ ] No FORM 13 NONEXMPT ERN STMT SUPPORT 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 deductions required by law . . . . . . . . . . . . . . . . . . . . . . . . . . . . (13) $ ____________________ Judgment debtor’s disposable income: line (12) minus line (13) . . . . . . . . . . . (14) $ ____________________ Enter amounts withheld pursuant to a garnishment or levy served before this garnishment that was for support of a person . . . . . . . . . . . . . . . . . . . . . . (15) $ ____________________ Enter amounts withheld pursuant to a garnishment or levy served before this garnishment that was not for support of a person . . . . . . . . . . . . . . . . . . (16) $ ____________________ Line (15) plus line (16) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (17) $ ____________________ Line (14) minus line (17). . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (18) $ ____________________ Line (18) minus $5. . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (19) $ ____________________ The amount shown on line (18) is the amount you should withhold for this pay period. The amount shown on line (19) is the amount you deliver to the judgment creditor. (20) (21) Copy provided to judgment debtor on: Copy provided to judgment creditor on: Date: Date: By: [ ] Mail [ ] Hand delivery (22) __________________________ Date FORM 13 NONEXMPT ERN STMT SUPPORT By: [ ] Mail [ ] Hand delivery ________________________________________________ Garnishee or Authorized Agent Page 2 of 2 5/17/07 American LegalNet, Inc. www.FormsWorkflow.com