STATE OF INDIANA COUNTY OF ALLEN ) ) SS: ) IN THE ALLEN SUPERIOR COURT SMALL CLAIMS DIVISION FORT WAYNE, INDIANA _________________________________________________ Plaintiff(s) CASE NUMBER: VS. _________________________________________________ Defendant(s) _________________________________________________ Street Address _________________________________________________ City, State Zip Code VERIFIED MOTION FOR PROCEEDINGS SUPPLEMENTAL AND ORDER VERIFIED MOTION FOR PROCEEDINGS SUPPLEMENTAL Plaintiff / Plaintiff's counsel appears and states that to the best of its/his/her knowledge: 1. Plaintiff owns the judgment rendered in this case against the Defendant(s); 2. Plaintiff's judgment is unsatisfied, with a balance due on judgment, interest and costs in the amount of $ _______________________; and 3. Plaintiff has no cause to believe that levy of execution against the Defendant(s) will satisfy the judgment. Plaintiff requests that the Court issue an order notifying Defendant(s) of hearing on these proceedings and requiring the Defendant(s) to appear to testify concerning its/his/her property. I affirm, under the penalty of perjury, that the foregoing representations are true. _________________________________________________ Street Address of Plaintiff / Attorney _________________________________________________ Signature of Plaintiff / Attorney _________________________________________________ City, State Zip Code _________________________________________________ Printed Name of Plaintiff / Attorney _________________________________________________ Telephone Number Supreme Court ID Number ORDER TO DEFENDANT Plaintiff files verified motion for proceedings supplemental. Motion granted. Any prior proceedings supplemental pending against Defendant(s) ______________________________________________________ in this cause is ordered dismissed. To the Defendant(s): You are ordered to appear in this Court on _________________________________________________ at ______________ A.M./P.M. in the Allen Superior Court Small Claims Division, 1 West Superior St., Fort Wayne, IN 46802, and bring with you evidence of your income and assets. YOU ARE HEREBY NOTIFIED THAT FAILURE TO APPEAR IN COURT MAY RESULT IN YOUR BEING HELD IN CONTEMPT OF COURT AND BEING PUNISHED BY INCARCERATION IN THE COUNTY JAIL FOR A PERIOD NOT TO EXCEED NINETY (90) DAYS. Date: ________________________________________________ ______________________________________________________ Judge / Magistrate, Allen Superior Court MANNER OF SERVICE SHERIFF shall serve this Proceedings Supplemental as follows: personal service leaving a copy at dwelling or place of employment CLERK shall serve this Proceedings Supplemental as follows: __ regular mail certified mail OTHER manner of service: _____ _____ _____ personal service by attorney private process server, ______________________________ other (describe in particular and note Trial Rule) ____________________________________________________ CERTIFICATE OF SERVICE BY REGULAR MAIL I hereby certify a copy of this document was sent by U.S. mail as designated above, to the named person, at the address furnished, at Fort Wayne, Indiana. Date: __________________________________________________ 7/2015 Verified Motion for Proceedings Supplemental and Order to Defendant _______________________________________________________ Clerk of the Allen Circuit and Superior Courts American LegalNet, Inc. www.FormsWorkFlow.com CERTIFIED MAIL I hereby certify, as indicated in the date issued field, that a copy of this document was sent to the named person at the address furnished, by registered / certified mail at Fort Wayne, Indiana, return receipt requested. I hereby certify that service by registered / certified mail at Fort Wayne, Indiana, was attempted as required by law to the person and address stated on the return receipt attached; and that service [ ] was [ ] was not made, according to the information contained therein. Date Returned: ________________________ Date Issued: _________________________ _____________________________________________________________ Clerk of the Allen Circuit and Superior Courts _____________________________________________________________ Clerk of the Allen Circuit and Superior Courts ADMISSION OF SERVICE I received a copy of this document on this date ______________________________ and at this location: _____________________________________________ ______________________________________________________________. _____________________________________________________________ Signature of Party Relationship (if not the within named person) RETURN OF SERVICE BY SHERIFF OR OTHER OFFICER Enter the alphabetical letter in the space provided to indicate the type of service. I served a copy of this document as specified: ( __________ ) READING/delivering a copy (A) to the within named party: LEAVING A COPY for the within named party (B) with the SPOUSE, named: (C) with a RELATIVE, named: (D) at the RESIDENCE, located at: (E) with the EMPLOYER, named: (F) with a SECRETARY, named: (G) with the ATTORNEY, named: (H) with this person (OTHER - specify): ______________________________________________________________ Specify name of person, work supervisor, place of business, or location where copy was left. _____________________________________________________________________________________________________ and (if applicable) by sending a copy of this document by first-class mail to the last known address of the within named person as indicated: _____________________________________________________________________________________________________________________________. Last Known Address of Person Named in the document (or Change of Address) I did not serve a copy of this document because:( __________ ) (I) (J) (K) (L) (M) (N) (O) (P) (Q) the party was NOT FOUND / NO SUCH ADDRESS. the document EXPIRED. the party AVOIDED service. the party REFUSED service. the party was NO LONGER EMPLOYED at that address. the document was RETURNED by the authority of the plaintiff. the party is DECEASED. the party was UNKNOWN AT THAT ADDRESS. the party was on SICK LEAVE / LAY OFF. (R) (S) (T) (U) (V) (W) (X) (Y) the party was on VACATION. the party was NOT FOUND / VACANT. the party was NOT FOUND / MOVED. the party was NOT FOUND IN THIS BAILIWICK. INSUFFICIENT ADDRESS OR INFORMATION WAS GIVEN. they are NO LONGER IN BUSINESS. several attempts were made / UNABLE TO SERVE. of the following reason (OTHER - specif