W/E Form Rev. 4/6/2011 UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT : : : : : : : : Docket No. WAGE EXECUTION To the Marshal of the District of Connecticut or to any person authorized to serve process under the Federal Rules of Civil Procedure - - Greetings: WHEREAS the (insert name and address of party making application) on the day of , 20 , recovered judgment against the Judgment Debtor (insert name) whose last known address is before the United States District Court for the District of Connecticut for the sum of $ plus costs of $ and interest as appears of record; AND WHEREAS, the said Judgment Debtor (insert name) failed to comply with said judgment, as appears of record by the American LegalNet, Inc. www.FormsWorkFlow.com application of (insert name) moving that this execution issue; AND WHEREAS, execution remains to be done on the total unpaid judgment, including costs and interest, in the amount of $ . These are, therefore, by the authority of the United States of America, to command you, that of any amount of debt accruing by reason of personal services due said (insert name of party making application) as may not exceed the amount of execution as calculated in the attached “Wage Execution Notice to Employer”, within your precinct or jurisdiction, you cause to be levied, paid, and satisfied unto the said (insert name of party making application) , with interest from the said date of judgment on the total unpaid judgment to the date when this execution is satisfied, and you own fees. You are further commanded to serve with this execution two copies of the “Wage Execution Notice to Employer” and “Wage Execution Exemption and Modification Claim Form”, that are accompanied herewith. (Insert name of Judgment Debtor) last known employer is: (insert name and address) Make service hereof within one year of this date, and due return hereof with your doings thereon, within thirty days from satisfaction hereof. Dated at day of , Connecticut, this , 20 . ROBERTA D. TABORA, Clerk By Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com