Print Form ‰ Daley Center ‰ District 2 ‰ District 3 Citation to Discover Assets to Third Party (Wages) ‰ District 4 ‰ District 5 Clear Form ‰ District 6 (Rev. 5/08/09) CCM 0638 A IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS MUNICIPAL DEPARTMENT/ ________________ DISTRICT _________________________________________________ Plaintiff(s), v. _________________________________________________ Defendant(s), _______________________ Defendant’s Social Security Number and _________________________________________________ Third Party Respondent. } Court Date: ___________________________ No. ________________________________ CITATION TO DISCOVER ASSETS TO THIRD PARTY (WAGES) To: ____________________________________________ YOU ARE REQUIRED to appear or file your answer to this Citation on the form appearing on the reverse side or attached on ________________________, _________ before 9:30 a.m. in Courtroom _____________ located at: ‰ Richard J. Daley Center, Room 601, Chicago, IL 60602 ‰ District 3: 2121 Euclid, Rolling Meadows, IL 60008 ‰ District 5: 10220 S. 76th Ave., Bridgeview, IL 60455 ‰ District 2: ‰ District 4: ‰ District 6: 5600 Old Orchard Rd., Skokie, IL 60077 1500 Maybrook Dr., Maywood, IL 60153 16501 S. Kedzie Pkwy., Markham, IL 60426. Judgment was entered on _________________________________ in favor of Plaintiff _____________________________________ and against Defendant(s) _________________________________________________________ in this Court under the above case in the sum of $ __________________________. There is now due, less credit and off-set, the sum of $ __________________________. Further sums may become due as costs and interest accrue. YOU ARE TO INFORM the court of property and wages and other money you may hold belonging to Defendant ____________________________ or to which s/he may be entitled or which may thereafter be acquired by or become due to him or her. YOU ARE PROHIBITED from making or allowing any transfer or other disposition of, or interfering with, any property not exempt from execution or garnishment belonging to Defendant or to which s/he may be entitled or which may thereafter be acquired by or become due to him or her, and from paying over or otherwise disposing of any moneys not so exempt which are due or to become due to Defendant, up to double the amount of the balance due, until further order of court or termination of the proceeding, whichever occurs first. THE COURT MAY PUNISH YOU if you violate the restraining provision of this citation as and for contempt, and the court may enter judgment against you for either the amount of the unpaid portion of the judgment and costs allowable under this section or the amount of the value of the property transferred, whichever is less. 735 ILCS 5/2-1402(f)(1). Failure to answer this Citation may also result in entry of judgment against you for the balance due. 735 ILCS 5/2-1402(c)(4); 735 ILCS 5/12-807(a). WARNING: YOUR FAILURE TO APPEAR OR FILE AN ANSWER IN COURT AS HEREIN DIRECTED MAY CAUSE YOU TO BE ARRESTED AND BROUGHT BEFORE THE COURT TO ANSWER TO THE CHARGE OF CONTEMPT OF COURT, WHICH MAY BE PUNISHABLE BY IMPRISONMENT IN THE COUNTY JAIL. CERTIFICATION BY JUDGMENT CREDITOR OR ATTORNEY FOR JUDGMENT CREDITOR Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure (735 ILCS 5/1-109), the undersigned certifies that the above information regarding the amount of the judgment, the date of the judgment, or its revival date, the balance due thereon, the name of the Court and the number of the case is true and correct. Atty. No. ______________________ Name: _____________________________________________________ Signature: _______________________________________ Address: __________________________________________________ City/State/Zip: _____________________________________________ Telephone ______________________ FAX: ______________________ Clerk of the Court __________________________________ Seal of Court (OVER) DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS (Rev. 5/08/09) CCM 0638 B Employer/Agent: ______________________________________________________________ Court Date: ____________________ Defendant's Name: ________________________________ S.S. No. - _______________ Case No.: ______________________ Defendant's Address: ____________________________________________________________________________________________ CERTIFICATION OF MAILING BY JUDGMENT CREDITOR OR ATTORNEY FOR JUDGMENT CREDITOR Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure (735 ILCS 5/1-109), I certify that I mailed by regular first-class mail a copy of the citation and citation notice to Defendant at the address shown above on _____________________, _________. Signature: _________________________________________________ Name: ________________________________ INTERROGATORIES/ANSWER TO THIRD PARTY CITATION TO DISCOVER ASSETS (WAGES) Do you pay any money to the Defendant listed above? ‰ Yes ‰ No If terminated, date ____________________________, IF YOUR ANSWER IS "NO," GO TO "RESPONDENT CERTIFICATION" Of the funds paid to the debtor, are any of those funds: _________. ‰ Subject to prior court ordered deduction (including child/spouse support) Case Number, State, County __________________________________. ‰ Disability? ‰ Retirement? ‰ Otherwise exempt? (Describe __________________________________________________________). CALCULATION TO DETERMINE AMOUNT OF WITHHOLDING (Note: If income varies, withholding must be recalculated for every pay period.) Do you pay debtor: ‰ Every week ‰ Every two weeks ‰ Semi-monthly ‰ Monthly (A) Gross wages per paycheck minus mandatory contributions to pensions or retirement plan ‰ Other (B) 15% of (A) = (C) Enter total FICA, State Tax, Federal Tax and Medicare (D) Subtract (C) from (A) = ___________________________ (A) _________________ (B) _________________ (C) _________________ 0.00 (D) _________________ (E) If debtor is paid every week, enter $360.00 If debtor is paid every two weeks, enter $720.00 If debtor is paid semi-monthly, enter $780.00 If debtor is paid monthly, enter $1560.00 If other, multiply 45 times state minimum wage (currently $8.00) times number of weeks in pay period (E) _________________ (F) Subtract (E) from (D) (Enclose a negative number in parentheses, e.g., ($50.00)) 0.00 (F) _________________ IF LINE "F" IS ZERO OR A NEGATIVE NUMBER, DO NOT WITHHOLD ANY WAGES. GO TO “INSTRUCTIONS” BELOW. (G) Enter the Lesser of Line (B) or (F) 0.00 (G) ________________ (H) Enter Child Support or other Court Ordered Deduction (H) ________________ (I) Subtract (H) from (G) (Enclose a negative number in parentheses, e.g., ($50.00)) 0.00 (I) _________________ LINE "I" MUST BE WITHHELD AS OF THE DATE OF SERVICE AND HELD UNTIL FURTHER COURT ORDER. IF LINE "I" IS ZERO OR A NEGATIVE NUMBER, DO NOT WITHHOLD ANY WAGES. GO TO “INSTRUCTIONS” BELOW. _________________ (J) Subtract Employer's Statutory Fee (2% of line "I"). See 735 ILCS 5/12-814. (J) (K) Amount to be applied to Judgment (K) _________________ INSTRUCTIONS 1. Complete the Interrogatories/Answer to the Third Party Citation to Discover Assets (Wages). 2. Complete and sign the certification at the bottom of this page. 3. Fax or mail a copy of this Answer to the Court and Plaintiff's attorney and give a copy to the Defendant. If filing in the First Municipal District, either fax it to (312) 603-6522 or mail to the Clerk of the Court, Richard J. Daley Center, 50 West Washington Street, Room 602, Chicago, Illinos 60602. To assure timely processing, the Answer should be received at least three days before the Court Date. 4. You will receive a copy by fax or mail of a Court Order instructing you how to proceed and where to send any withheld funds. RESPONDENT CERTIFICATION Under the penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure (735 ILCS 5/1-109), the undersigned certifies that the statements set forth in this instrument are true and correct and that I have either mailed or hand delivered a copy of this completed Interrogatories/Answer to the Clerk, Plaintiff’s attorney and Defendant. Address: ______________________________ Date: _______________________________ _____________________________________ Signature of Employer/Agent: ______________________________________________ Telephone: ____________________________ Print full name clearly: ___________________________________________________ FAX: _________________________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS