STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE FOURTH JUDICIAL CIRCUIT CLINTON COUNTY, CARLYLE, ILLINOIS ) Plaintiff ) vs. ) Case No. ) ) Return Date: Defendant ) and ) ) 21 to 30 days after date of issuance of summons ) Garnishee ) Affidavit for Garnishment Non-Wage , on oath states: 1. Judgment was entered in this case on , in favor of judgment creditor and against judgment debtor for $ and costs. 2. $ has been paid on the judgment. 3. There is unpaid on the judgment $ principal $ costs $ interest $ TOTAL 4. I believe garnishee is indebted to the judgment debtor other than for wages, or has in his/her/its possession, custody or control property belonging to the judgment debtor or in which judgment debtor has an interest. 5. The last known address of the judgment debtor is I request that summons be issued and directed to the garnishee. Signed and sworn to before me , SEAL Notary Public CERTIFICATE OF CLERK OF COURT OR ATTORNEY I certify that judgment was entered as stated in paragraph 1 above. Clerk of Court or Attorney for Judgment creditor Name: Attorney for: Address: City, State, Zip: Telephone: NOTE: Four (4) copies of this affidavit must be served on the garnishee answer to interrogatories on reserve side hereof to be filed 21 to 3 0 days after service of summons. American LegalNet, Inc. www.FormsWorkFlow.com Return Date: Case No. INTERROGATORIES/ANSWERS TO GARNISHEE Agent of Garnishee, , certifies under penalty of perjury that with regard to the property of the judgment debtor, the garnishee files the following answer to this garnishment and on the date of service of garnishment summons had possession of the following property of the judgment debtor, 1. At the time of service of the garnishment summons, did you have in your custody or control any personal property or monies belonging to the judgment debtor or in which he/she had an interest? Yes No Circle one or more of the following and indicate the amount held: (A) Savings Account (Amount withheld) $ (B) Checking and/or Now Account (Amount withheld) $ (C) Certificate of Deposit (Amount held) $ (D) Money Market Account (Amount held) $ (E) Trust Account (Amount held) $ (F) Safety Deposit Box $ (G) Adverse Claimant Name & Address: (H) Other Personal Property (Describe): Sub Total $ Less right of offset for other loans $ Less deduction of fees limited by 205 ILCS 5/48.1(g) $ Total $ According to the business records kept by the garnishee, we show the above accounts to be held in the name(s) of others in addition to the defendant. Their name(s) and address are as follows: Name(s): Address: and we show all funds held as of (as of date of service of summons). The agent of the garnishee certified under penalties as provided by law pursuant to 735 ILCS 5/1-109 that the answers to the interrogatories are true. I further certify that I have mailed to the address indicated on the reverse side, a copy of the completed interrogatories, to the judgment debtor. Agent for Garnishee INSTRUCTIONS 1. A copy of this Answer must be filed with the Clerk of the Court, a copy mailed to attorney for Plaintiff and mail a copy to the Defendant. 2. You will receive a copy of a Court Order by fax or mail instructing you how to proceed and where to send withheld funds. Garnishee/Agent: Agent Name: Employer Name: Clerk of the Circuit Court Address: Clinton County Courthouse City/State/Zip: 850 Fairfax St., Room 220 Phone: Carlyle, IL 62231 American LegalNet, Inc. www.FormsWorkFlow.com