(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 Pursuant to Chapter 61 of Kansas Statutes Annotated Type of Service Requested: ____________________ by ______________________ REQUEST FOR GARNISHMENT (To Attach Earnings) The judgment creditor requests that the court issue an Order of Garnishment (To Attach Earnings) for the judgment debtors listed below in the amount of the judgment(s) shown below. Case No Judgment Debtor Name Garnishee’s Name Judg Amount * and Address and address 98-12345 John Doe 123 Cherry Lane Cherry, KS 00000 000-00-0001 ABC, Inc. 100 Main St. Cherry, KS 00000 $______ 98-12345 Jane Doe 123 Cherry Lane Cherry, KS 00000 000-000-0002 XYZ, Inc. 500 Main St. Cherry, KS 00000 $______ 97-54321 Bob Smith 123 Easy St. Somewhere, KS 00001 000-00-0003 Betty’s Diner $______ 300 Elm St. Somewhere, KS 00001 The purpose of the Garnishment is _____________________. * The judgment amount is the current balance due and may also include costs, fees, interest and any other items included in the judgment. I hold a good faith belief that the party to be served with this garnishment order has, or will have, assets of the judgment debtor(s). American LegalNet, Inc. www.USCourtForms.com Dated: _________________, _______. ________________________________ 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.} Note: If this form is filed on paper, you must submit copies in a number equal to the number of requests for garnishment. American LegalNet, Inc. www.USCourtForms.com