(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 Pursuant to Chapter 61 of Kansas Statutes Annotated Type of Service Requested: ___________________ by _____________________ REQUEST FOR GARNISHMENT (To Attach Other Than Earnings) The judgment creditor requests that the court issue an Order of Garnishment (To Attach Other Than Earnings) for the judgment debtors listed below in the amount of the judgment(s) shown below. Case No Judgment Debtor Name and Address 98-12345 John Doe 123 Cherry Lane Cherry, KS 00000 000-00-0001 Jane Doe 123 Cherry Lane Cherry, KS 00000 000-000-0002 Bob Smith 123 Easy St. Somewhere, KS 00001 000-00-0003 Garnishee's Name and Address ABC, Inc. 100 Main St. Cherry, KS 00000 XYZ, Inc. 500 Main St. Cherry, KS 00000 Judg Amount * $______ Amount to be Withheld (110%) $______ Judgment Creditor 98-12345 $______ $______ 97-54321 Betty's Diner $______ 300 Elm St. Somewhere, KS 00001 $______ * The judgment amount is the current balance due and may also include costs, fees, interest and any other items included in the judgment. American LegalNet, Inc. www.USCourtForms.com If this Garnishment is to attach funds, credits or indebtedness held by a bank, savings and loan association, credit union or finance company, the amount to be withheld is indicated above, which is 110% of the amount of judgment creditor's claim, in the case of prejudgment garnishment, or 110% of the amount of the current balance due under the judgment, in the case of postjudgment garnishment. 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). 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