(Revised 7/05) 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. Case No. ______ Judgment Debtor name Judgment Debtor Judgment Debtor address 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 TO PAY MONEY TO COURT With regard to the Order of Garnishment dated _____________, _______, the Garnishee, ______________________, is hereby ordered to pay to the clerk of this court the sum of $ ___________. Said Garnishee shall be discharged from liability to said defendant for money so paid. If the amount to be paid is less than the amount the Garnishee is holding pursuant to the garnishment, the Garnishee shall promptly release the balance to the defendant. The garnishee shall make its check payable to and mail to: Clerk of the District Court ______________ County Courthouse ______________________________ ______________________________ Dated: ________________________. ______________________________ Signature, Judge American LegalNet, Inc. www.USCourtForms.com Approved: _________________________________ Judgment Creditor or Attorney Signature SC# {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.} American LegalNet, Inc. www.USCourtForms.com