IN THE CIRCUIT COURT OF THE 20TH JUDICIAL COUNTY ST. CLAIR COUNTY, ILLINOIS _______________________Plaintiff vs. Case No.__________________________ _______________________Defendant and Return Date_______________________ (21 to 40 days after date of issuance of summons) _______________________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. 2. The last known address of the judgment debtor is_________________________________________ ________________________________________________________________________________ I 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 of this wage deduction proceeding. Name__________________________________ Affiant_____________________________________ Attorney 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 Address______________________________City______________________State ________Zip _______ Telephone No(_____)___________________ Attorney Bar No.____________________ 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 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 for Judgment Creditor American LegalNet, Inc. www.FormsWorkflow.com IN THE CIRCUIT COURT OF THE 20th JUDICIAL CIRCUIT ST. CLAIR COUNTY, ILLINOIS Case Number_____________________ Return Date_______________ 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___________________________ Do you pay monies to the judgment debtor listed above? Yes_______ 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)_____________month(s) CALCULATION TO DETERMINE AMOUNT OF WITHHOLDING: (A) Gross Wages minus mandatory contributions to pension or retirement plan 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) = (D)_________________ (E) Enter minimum wage per pay period (45 x $8.00 per week) (E)_________________ (F) Subtract (E) from (D) (F)_________________ (G) Enter the lesser of Line (b) or (f) (G)_________________ (H) Enter Child Support of other Court Ordered Deduction (H)_________________ (I) Subtract (H) from (G) (I)_________________ (J) Subtract Employer's Statutory Fee (§5/12 - 814) (J)_________________ (K) Amount to be applied to judgment (K)_________________ Line K is the amount to be withheld from employee's paycheck as of 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_______________________________ Clerk of the Circuit Court St. County Courthouse Employer Name____________________________ 10 Public Square Belleville, IL 62220 Address__________________________________ ________________________________ Street Phone____________________________________ ________________________________ City, State, Zip Fax______________________________________ NOTE: A Copy of this Answer should be mailed to the Court, Attorney for Plaintiff or Judgment American LegalNet, Inc. Creditor and to the Defendant. www.FormsWorkflow.com