IN THE CIRCUIT COURT OF THE FIFTEENTH JUDICIAL CIRCUIT OGLE COUNTY, ILLINOIS _______________________________________ Plaintiff/Judgment Creditor, vs. _______________________________________ Defendant/Judgment Debtor and ) ) ) ) ) ) ) ) ) ) Case No. Return Date: (21 to 40 days after date of issuance of summons) Employer AFFIDAVIT FOR WAGE DEDUCTION ORDER 1. 2. , on oath states: is indebted to the judgment debtor I believe employer Employer’s address: The last know address of the judgment debtor is: for wages due or to become due. I request that a summons issue to the employer. I certify that a copy of the Wage Deduction Notice was mailed to the judgment debtor, by first class mail, at the last know address prior to the filing of this wage deduction affidavit. Name: Attorney for: Address: City/State/Zip: Phone: Affiant: U n d er pen alties of perjury as provid ed by law pu rsu an t to 7 3 5 ILC S 5 /1 -1 0 9 th e affian t certified th at th e statemen t set forth h erein are tru e a n d c o r re c t 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 the court that entered the judgment. I, the undersigned certify under the 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 ________day of ___________________________,20 2. 3. The amount of Judgment 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 costs for this proceeding 5. Interest due on Judgment to date TOTAL DEDUCT: Total amount paid by or on behalf of the Judgment debtor prior to this garnishment BALANCE DUE JUDGMENT CREDITOR $_______________________________ $_______________________________ $_______________________________ $_______________________________ $_______________________________ $_______________________________ $_______________________________ $_______________________________ $_______________________________ ___________________________________________ Attorney or Judgment Creditor NOTE: Four (4) Copies of this affidavit must be served on the employer . Answer to interrogatories on page 2 are to be filed prior to the return court date occ26 Page 1 American LegalNet, Inc. www.FormsWorkFlow.com INTERROGATORIES/ANSWER TO WAGE DEDUCTION PROCEEDINGS Return Date:_________________________________ Case No.__________________________________ 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 No.__________________________ Do you pay monies to the judgment debtor listed above? 9 Yes 9 No State whether any funds paid to the 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)__________________months(s) CALCULATION TO DETERMINE AMOUNT OF WITHHOLDING (A) Gross Wages minus mandatory contributions to pension or retirement plans is (A) (B) Method I 15% of (A)= (B) Method II (C) Enter total FICA, State and Federal Tax and Medicare (C) (D) Subtract (C) from (A)= (E) Enter Minimum Wage per pay period (F) Substract (E) from (D) (G) Enter the lesser of line (B) or (F) (H) Enter Child Support of other Court Ordered Deduction (I) Substract (H) from (G) (J) Substract Employer’s Statutory Fee (section 5/12-814) (K) Amount to be applied to judgment (D) (E) (F) (G) (H) (I) (J) (K) Line I is the amount to be withheld from employee’s paycheck as the date of service of Summons and not disbursed until further order of Court. Signature of Employer INSTRUCTIONS 1. 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 Employer/Agent: Agent Name: Employer Name: Address: City/State/Zip: Phone: Fax:________________________________________ Ogle County Circuit Clerk 106 South Fifth Street Suite #300 Oregon, Illinois 61061 Note: A copy of this Answer should be mailed to the Court, Attorney for Plaintiff or Judgment Creditor and to the Defendant. occ26 Page2 American LegalNet, Inc. www.FormsWorkFlow.com