Plaintiff(s) Defendant(s) Plaintiff(s) Atty. Defendant(s) Atty.IN THE CIRCUIT COURT OF THE SIXTEENTH JUDICIAL CIRCUIT KANE COUNTY, ILLINOISAFFIDAVIT FOR WAGE DEDUCTION ORDER Employer: Name: Address: City, State and Zip: Case No. on oath states: 1.I believe employeris indebted to the Judgment Debtorfor wages due or to become due. Employer's address is stated above.2.The last known address of the Judgment Debtor isName:Affiant:Atty. for Judgment Creditor: Under penalty of perjury as provided by law pursuant to 735 ILCS 5/1-109 the affiant certifies that the statements set forth herein are true and correct.Atty. Registration No.: Address: City, State and Zip: Phone: CERTIFICATE OF ATTORNEY OR JUDGMENT CREDITORNote: Non-Attorneys must also submit a copy of the underlying judgment or a certification by the Clerk of the Court that entered the judgment.I, the undersigned certify under penalties as provided by law pursuant to 735 ILCS 5/1-109 that the following information is true:1.Judgment in the above captioned case was entered on2.The amount of Judgment was3.Allowable costs previously expended:B. Original and alias summons4.Filing and summons cost for this proceedingsC. Filing and summons costs of prior supplementary proceedings5.Statutory interest due on Judgment from date aboveTOTALA. Initial Filing FeesDeduct: Total amount paid by or on behalf of the Judgment Debtor prior to this proceedingBALANCE DUE JUDGMENT CREDITORAttorney or Judgment CreditorP1-WD-003 (06/18) Page 1 of 2I request that a summons issue directed to employer and I certify that a copy of the attached Wage Deduction Notice was mailed to Judgment Debtor, by first class mail, at his/her last known address prior to filing this wage deduction proceeding.. File Stamp Attorney E-mail: American LegalNet, Inc. www.FormsWorkFlow.com INTERROGATORIES/ANSWER TO WAGE DEDUCTION PROCEEDINGSEmployer/Agent: , the undersigned, certifies under penalty of perjury that the followingAnswer is true and correct to the best of her/his knowledge and belief concerning the property of the Judgment Debtor.Debtor Name: Social Security No.: Do you pay monies to the Judgment Debtor above? Yes NoIf answer to preceding question is "No," state date Debtor was last employed:Order: State whether any funds paid to the Debtor are for disability, retirement or are in any other way exempt or subject to other CourtOne pay period equals: day(s)week(s)month(s)otherCALCULATION TO DETERMINE AMOUNT OF WITHHOLDING:(A)(Optional: A fee of $12.00 or 2% of the amount to deducted, whichever is greater, Employer keeps this fee.)INSTRUCTIONS1.Mail a copy of this Answer to the Court and mail to attorney for Plaintiff and give 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 deducted funds.Signature of Employer or Agent (Affiant)P1-WD-003 (06/18) Page 2 of 2 Plaintiff(s) Defendant(s) Plaintiff(s) Atty. Defendant(s) Atty.IN THE CIRCUIT COURT OF THE SIXTEENTH JUDICIAL CIRCUIT KANE COUNTY, ILLINOIS Employer: Name: Address: City, State and Zip: Case No. File StampSubscribed and Sworn to before me on(Date)Notary Public - Circuit ClerkPrint Name: Gross Wages minus mandatory contributions to pension or retirement plans is(B) METHOD I- 15% OF (A)(C)Enter Total FICA, State and Federal Tax and Medicare(D)Subtract (C) from (A)=(E)Enter Minimum wage per pay period(45 X federal minimum wage or the Illinois minimum hourly wage, whichever is greater)(F)Subtract (E) from (D)(G)Enter Lesser of line (B) or (F)(H)Enter Child Support of other Court Ordered Deduction, including current wage deduction, if any(I)Subtract (H) from (G)(J)Subtract Employer's Statutory Fee (735 ILCS 5/12-814)(K)Amount to be applied to judgment American LegalNet, Inc. www.FormsWorkFlow.com