Affidavit for Garnishment (Non-Wage) - Municipal (6/30/08) CCM 0057 A IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS MUNICIPAL DEPARTMENT/ ________________ DISTRICT ____________________________________________________ Plaintiff(s), v. ____________________________________________________ Defendant(s), and ____________________________________________________ Garnishee. } No. _________________________________________ Court Date _________________________________ (21 to 40 days after date of issuance of summons) AFFIDAVIT FOR GARNISHMENT (NON-WAGE) I, the undersigned, certify under penalties as provided by law under 735 ILCS 5/1-109, that the following information is true: 1. I believe Garnishee, ______________________________________________________________ is indebted to the Judgment Debtor, ____________________________________________________ or holds, possesses or controls property other than for wages, belonging to Judgment Debtor. 2. The last known address of the Judgment Debtor is __________________________________________________ ______________________________________________________________________________________________ 3. I request that a summons issue directed to Garnishee. CERTIFICATE OF ATTORNEY OR JUDGEMENT CREDITOR NOTE: Non-Attorneys must also submit a copy of the underlying Judgment or a certification by the Clerk of the Court that entered the Judgment. 1. Judgment in this case was entered on _______________________________, __________ 2. 3. Amount of Judgment Allowable costs previously expended: $ _________________ a. Initial filing fee $ _________________ b. Original and alias summons $ _________________ c. Previous supplementary proceedings - Filing and summons cost $ _________________ 4. Filing and summons cost for this garnishment $ _________________ 5. Interest at 9% pursuant to statute $ _________________ 6. Total $ _________________ 7. Deduct: Total amount paid on the Judgment $ _________________ 8. Balance Due Judgment Creditor $ _________________ Atty. No. ______________________ Name: ____________________________________________ Atty. for: __________________________________________ Address: __________________________________________ City/State/Zip: ______________________________________ Telephone _________________________________________ ______________________________________________ Signature of Attorney or Judgment Creditor ______________________________________________ Print Name FAX: ______________________________________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS (OVER) (6/30/08) CCM 0057 B ANSWER OF GARNISHEE DEFENDANT This first section must be filled out by the judgment creditor. Garnishee/Respondent: ________________________________________________________________ Court Date: _________________________ Defendant’s Name: _________________________________________SS No. xxx-xx-______________ Case No.____________________________ Judgment Balance: $ ______________________________ This is a garnishment: Freeze up to the Judgment Balance. INTERROGATORIES 1. On the date of service of the garnishment summons, did you have in your possession, custody or control any personal property or monies belonging to the judgment debtor? Yes No IF THE ANSWER IS “YES” GO TO NEXT QUESTION. IF “NO” GO TO INSTRUCTIONS. 2. Is this an IRA account? Or have all of the deposits made during the past 90 days been electronically deposited and identified as exempt Social Security, Unemployment Compensation, Public Assistance, Veteran’s Benefits, Pension or Retirement or by a source drawing from any other statutory exemptions? Yes No IF THE ANSWER IS “YES” GO TO NEXT QUESTION. IF “NO” GO TO INSTRUCTIONS. Yes 3. Is/Are the account(s)’ current balance equal to or less than the total of the exempt deposits? No IF YOU ANSWERED “YES” TO ALL 3 QUESTIONS AND FUNDS IN THE ACCOUNT(S) ARE EXEMPT, DO NOT FREEZE THE FUNDS AND GO TO “INSTRUCTIONS” BELOW. 4. ACCOUNT BALANCE AMOUNT WITHHELD A) Savings Account $ ________________________ $ __________________________ B) Check/MMA/Now Account $ ________________________ $ __________________________ C) Certificate of Deposit $ ________________________ $ __________________________ D) Trust Account/Other $ ________________________ $ __________________________ (Describe) _______________________________________________ Yes No E) Safety Deposit F) Land Trust No. ___________________________________________________________ G) Less Right of Offset for Loans $ __________________________ TOTAL AMOUNT FROZEN: $ __________________________ 5. List all joint account holders or adverse claimants: Name ______________________________ Name ____________________________ Name ____________________________________ Address ____________________________ Address __________________________ Address __________________________________ ____________________________ __________________________ __________________________________ Account Type Checking CD Savings Account Number ___________________ Account Type Checking CD Savings Account Number ___________________ Account Type Checking CD Savings Account Number ___________________ INSTRUCTIONS (1.) Fill out and sign the certification below. (2.) This Answer must be filed at least three (3) days before the court date to assure timely processing. (3.) Fax or mail a copy of this Answer to (i) the Court, (ii) Plaintiff’s attorney and (iii) Judgment Debtor. If filing in the First Municipal District, you may fax to (312) 603-6522 or mail to the Clerk of the Court, Richard J. Daley Center, 50 W. Washington street, Room 602, Chicago, IL 60602. (4.) You will receive a copy of a Court Order by fax or mail instructing you how to proceed and where to send any withheld funds. CERTIFICATION Under the penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned certifies that the statements set forth in this instrument are true and correct and that I have mailed this Answer to Defendant(s). Date: ________________________________ Print Agent Name: ___________________________________________ Respondent Name: _________________________________________ Signature of Agent: __________________________________________ Address: __________________________________________________ Telephone: ________________________________________________ FAX: _____________________________________________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS