STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE 22nd JUDICIAL CIRCUIT McHENRY COUNTY ________________________________________Plaintiff Vs. Case Number___________________________________________ Return Date________________________________________ *21 to 40 days after date of issuance of summons ________________________________________Defendant and ________________________________________Employer AFFIDAVIT FOR WAGE DEDUCTION ORDER _______________________________________________________________________________ on oath states: 1. I believe employer ________________________________________________________________ is indebted to the Judgment Debtor ______________________________________________________________________________ for wages due or to become due. Employer's address is ______________________________________________________ ________________________________________________________________________________________________ The last known address of the Judgment Debtor is ________________________________________________________ _________________________________________________________________________________________________ 2. I request that a summons issue directed to employer and I certify that a copy of the attached Wage Deduction Notice was mailed to the Judgment Debtor, by first class mail, at his/her last known address prior to filing of this wage deduction proceeding. Affiant: _________________________________________________________ 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. Name ________________________________________________________ Attorney for ___________________________________________________ Address ______________________________________________________ City, State, Zip _________________________________________________ Telephone _____________________________________________________ CERTIFICATE OF ATTORNEY OR JUDGMENT CREDITOR Note: Non-Attorneys must also submit a copy of the underlying judgment or a certification by the Clerk of 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 on the ____________ day of ________________________, 20_________ 2. The amount of Judgment was ................................................................................$___________________________________ 3. Allowable costs previously expended: a. Initial filing fee ..................................................................................................$___________________________________ b. Original and alias summons...............................................................................$___________________________________ c. Filing and summons costs of prior supplementary proceedings ........................$___________________________________ 4. Filing and summons cost for this proceeding .........................................................$___________________________________ 5. Statutory interest due on Judgment from date above..............................................$___________________________________ TOTAL ...................................................................................................................$___________________________________ DEDUCT: Total amount paid by or on behalf of the Judgment Debtor prior to this proceeding.....................................................................................$___________________________________ BALANCE DUE JUDGMENT CREDITOR....................................................$___________________________________ _____________________________________________________ Attorney or Judgment Creditor CV-AFF3 (revised 12-01-2006) Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE 22nd JUDICIAL CIRCUIT McHENRY COUNTY ________________________________________Plaintiff Vs. Case Number___________________________________________ Return Date________________________________________ *21 to 40 days after date of issuance of summons ________________________________________Defendant and ________________________________________Employer INTERROGATORIES/ANSWER TO WAGE DEDUCTION PROCEEDINGS Employer/Agent:____________________________________________________, certifies under penalty of perjury that the following Answer is true and correct to the best of his/her knowledge and belief concerning the property of the Judgment Debtor. Debtor Name:________________________________________________________ Social Security Number:____________________ Do you pay monies to the Judgment Debtor listed above? Yes ___________________ No____________________ State whether any funds paid to the Judgment Debtor are for disability, retirement or are in any other way exempt or subject to other Court Order:_________________________________________________________________________________________________ One pay period equals: _______________ day(s) _______________ week(s) _______________ month(s) CALCULATION TO DETERMINE AMOUNT OF WITHHOLDING (A) (B) Gross Wages minus mandatory contributions to pension or retirement plans is ....(A) ________________________________ METHOD I 15% of (A).....................................................................................(B) ________________________________ METHOD II (C) Enter total FICA, State and Federal Tax and Medicare...................................(C) ________________________________ (D) Subtract (C) from (A) =...................................................................................(D) ________________________________ (E) Enter Minimum wage per pay period (45 x Federal minimum wage) or (45 x Illinois minimum wage), whichever is greater ...................................(E)_________________________________ Subtract (E) from (D) .............................................................................................(F) ________________________________ Enter the lesser of Line (B) or (F) ..........................................................................(G) ________________________________ Enter Child Support or other Court Ordered Deductions .......................................(H) ________________________________ Subtract (H) from (G) .............................................................................................(I)