STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE FOURTH JUDICIAL CIRCUIT CLINTON COUNTY, CARLYLE, ILLINOIS ) ) Case No. Plaintiff ) vs. ) ) ) Address of employer: Defendant ) ) ) Employer ) Wage Deduction Summons To the employer: the Office of the Clerk of this Court, Clinton County Circuit Clerk, 850 Fairfax Street, Carlyle, IL 62231, on or before (21 to 40 days after issuance of summons). However, if this summons is served on you less than 3 days before that date, you must file answers to the interrogatories on or before a new return date, to be set by the court, not less than 21 days after you were served with this summons. This proceeding applies to non-exempt wages due at the time you were served with this summons and to wages which become due thereafter until the balance due on the judgment is paid. IF YOU FAIL TO ANSWER, A CONDITIONAL JUDGMENT BY DEFAULT MAY BE TAKEN AGAINST YOU FOR THE AMOUNT OF THE JUDGMENT UNPAID. FEDERAL AGENCY EMPLOYERS: Effective upon service of this summons and pursuant to 5 USC 552(a), you are to commence to pay over deducted wages to the attorney for the judgment creditor in accordance with 735 ILCS 5/12-808. To the officer: This summons must be returned by the officer or other person to whom it was given for service, with indorsement of service and fees, if any, immediately after service. If service cannot be made, this summons shall be returned so indorsed. This summons may not be served later than the above date. Witness: , Clerk of the Circuit Court (Seal of court) By: Deputy Name: Attorney for: Address: City, State, Zip: American LegalNet, Inc. www.FormsWorkFlow.com ( Service and return $ ( Miles $ ( Total $ I certify that I served this summons on defendants as follows: A. Individual defendants personal: (The officer or other person making service, shall (a) identify as to sex, race, and approximate age of the defendant with whom the summons was left, and (b) state the place where (whenever possible in terms of an exact street address) and the date and time of the day when the summons was left with the defendant.) B. Individual defendants abode: By leaving a copy and a copy of the complaint at the usual place of abode of each individual defendant with a person of the family or a person residing there, of the age of 13 years or upwards, informing that person of the contents of the summons. (The officer or other person making service, shall (a) identify as to sex, race, and approximate age of the person, other than the defendant, with whom the summons was left; and (b) state the place where (whenever possible in terms of an exact street address) and the date and time of day when the summons was left with such person.) and also by sending a copy of the summons and of the complaint in a sealed envelope with postage fully prepaid, addressed to each individual defendant at his or her usual place of abode, as follows: Name of Defendant Mailed Address Date of mailing C. Corporation defendants: By leaving a copy and a copy of the complaint with the registered agent, officer or agent of each defendant corporation, as follows: Defendant Corporation Registered agent, officer or agent Date of service D. Other service: , Sheriff of County By: , Deputy American LegalNet, Inc. www.FormsWorkFlow.com