IN THE CIRCUIT COURT OF THE SIXTEENTH JUDICIAL CIRCUIT KANE COUNTY, ILLINOIS Case No. Plaintiff(s) Defendant(s) Plaintiff(s) Atty. Judgment Debtor Employer: Name: Address: City, State, Zip: Defendant(s) Atty. File Stamp CERTIFICATE OF JUDGMENT BALANCE PURSUANT TO WAGE GARNISHMENT Pursuant to 735 ILCS 5/12-808.5, be advised that the amount of the Judgment previously entered in this case remaining unsatisfied as of the end of the immediately preceding calendar quarter is set forth below. The Employer is required to hand deliver or post by first class mail a copy of this Certificate to the Judgment Debtor at his/her last known address. The undersigned hereby certifies that the amount cited is the balance due on the Judgment as of the last day of the most recent calendar quarter. Balance Due: Date: Attorney for Judgment Creditor or Pro Se Creditor Name: Attorney for: Atty. Registration No.: Address: City, State and Zip: Phone: Attorney E-mail: P1-WD-005 (11/12) American LegalNet, Inc. www.FormsWorkFlow.com