(Revised 7/09) File Stamp Date Case Number ________ Prepared by: Filer’s name, SC# Filer’s address Filer’s phone number {Filer’s fax phone number} {Filer’s e-mail address} Attorney for Judgment Creditor In The District Court of ______ County, Kansas Judgment Creditor name Judgment Creditor vs. Judgment Debtor name Judgment Debtor address {Judgment Debtor SSN/TIN} Case No. ______ Judgment Debtor Garnishee name Garnishee Garnishee’s address Garnishee’s county {Garnishee’s fax phone number (if known)} {Garnishee’s e-mail address (if known)} Pursuant to Chapter 61 of Kansas Statutes Annotated Type of Service Requested: ___________________ by ____________________ ORDER OF GARNISHMENT (To Attach Other Than Earnings) To the above named Garnishee: The attached Instructions to Garnishee are incorporated by reference. You are ordered as a garnishee to follow the attached instructions as if they were set forth in this Order. If you are indebted to the judgment debtor, complete the attached Answer under penalty of perjury as set forth in the instructions. If you are a bank, savings and loan association, credit union or finance company, and are holding any funds, credits or indebtedness belonging to or owing the judgment debtor, the amount to be withheld by you pursuant to this order is not to exceed $__________________________. If you fail to complete and send your answer as required in the instructions, the judgment creditor may file American LegalNet, Inc. www.FormsWorkFlow.com a motion for judgment against you for the amount of judgment against the judgment debtor or such other amount as the court shall order, including the expenses and attorney fees of the judgment creditor. Dated this _____ day of _______________, _____. BY ORDER OF THE COURT _____________________________ Signature or Seal {If applicable, include the following: This is a communication from a debt collector. This is an attempt to collect a debt and any information obtained will be used for that purpose.} RETURN ON SERVICE OF GARNISHMENT ORDER I hereby certify that I have served this garnishment order in the following manner: (1) Personal Service. By delivering a copy of the garnishment order along with two copies of the answer form to each of the following persons on the dates indicated: ___________________ _______________, ______ ___________________ _______________, ______ (Name) (Date) (2) Agent Service. By delivering a copy of the garnishment order along with two copies of the answer form to each of the following agents authorized by appointment or by law to receive service of process on the dates indicated: ____________________ _______________, ______ ____________________ _______________, ______ (Name) (Date) (3) Service by Return Receipt Delivery. By causing to be delivered on the _____ day of _______________, ______, a copy of the garnishment order along with two copies of the answer form by return receipt delivery to each of the following persons at the following address: with such delivery made by the following person or entity: _______________________________. Attached hereto is a copy of the return receipt evidencing such delivery. (4) Return Receipt Delivery Refused. By mailing on the _____ day of _______________, _____, a copy of the garnishment order along with two copies of the answer form to each of the following persons at the following address: (5) Mail Service. By mailing on the _____ day of _______________, ______, a copy of the garnishment order, along with two copies of the answer form, by first class mail to each of the following persons at the American LegalNet, Inc. www.FormsWorkFlow.com following addresses: (6) Telefacsimile communication. By faxing on the _____ day of _______________, _____, at ____ o’clock _.m., a copy of the garnishment order, along with two copies of the answer form, to the following persons:________________________________________________________________ Number of transmitting machine: _____________________ Number of receiving machine: ______________________ (7) Internet electronic mail. By e-mailing on the _____ day of _______________, _____, at ____ o’clock _.m., a copy of the garnishment order, along with a copy of the answer form, to the following persons at the following e-mail addresses: Transmitting person’s e-mail address: __________________________ (8) No Service. The following persons were not served: _________________________________________________________________________________ Pursuant to K.S.A. 53-601, as amended, I declare under the penalty of perjury that the foregoing is true and correct. EXECUTED on __________________, ______. _______________________________ Signature, Sheriff or Process Server American LegalNet, Inc. www.FormsWorkFlow.com