(Revised 7/12) To be used on and after July 1, 2010. WRITTEN EXPLANATION OF GARNISHEE222S COMPUTATION OF EARNINGS WITHHELD (Chapter 61) Judgment Creditor: Judgment Creditor Judgment Debtor: Judgment Debtor Garnishee: Garnishee Garnishee=s address Garnishee=s county {Garnishee=s fax phone number (if known)} {Garnishee=s e-mail address (if known)} Court Case No: Case No. 1. If the judgment debtor (employee) terminated employment before the first day of the payroll period for which this form is made, complete the following section and sign and date the form at the bottom. The Judgment debtor (employee) terminated employment on (date) 2. If the above paragraph does not apply you must complete the rest of this form. 3. Read carefully the attached Instructions to Garnishee. 4. You must complete this form for each payroll period for the judgment debtor, that ends while the garnishment order remains in effect. Only one form needs to be completed for each payroll period for the judgment debtor. 5. This Written Explanation form covers the following pay period: start date: end date: 6. The normal pay period for employee is (designate one): weekly every two weeks semi-monthly monthly . 7. Total gross earnings due for the pay period covered by this form are: .................................................................................................................... $. 8. Amounts required by law to be withheld for the pay period or periods covered are: (1) Federal FICA (includes social security tax and medicare tax) .................. $. (2) Federal income tax ..................................................................................... $. (3) State income tax......................................................................................... $. (4) Railroad Retirement Tax ........................................................................... $. TOTAL DEDUCTIONS .......................................................................................... $. (Deduct only those items listed above) American LegalNet, Inc. www.FormsWorkFlow.com 9. Disposable earnings for the pay period covered are: ....................................... $. (7 minus 8) See the attached Instructions to Garnishee to determine amount of disposable earnings to be withheld. 10. I am subtracting from the disposable earnings in 9 pursuant to an income withholding order for support the amount of ............................................................................................. $. 11. I am subtracting from the disposable earnings in 9 pursuant to a lien which has priority over garnishments under the law the following amount: type of lien .................................................................................................................... $. 12. In accordance with the instructions accompanying this form, I have determined that the amount which may be paid to employee is ......................................................................... $. 13. I am holding from the amount in 12 an administrative fee in the amount of . $. See attached Instructions to Garnishee for amount of the administrative fee that can be retained. 14. After paying to the employee the amount stated in 12 less the administrative fee in 13, and deducting any amount shown in 10 and 11, I am holding the remainder of the employee's disposable earnings in the amount of ................................................................................................................ $. 15. I will pay the amount held in 14 to the following judgment creditors: Case No. Name Address Amount A. $ B. $ C. $ D. $ I will continue to withhold earnings as long as the garnishment order remains in effect. As the earnings are withheld, I will promptly pay thereafter the earnings as they are withheld to the judgment creditors entitled thereto, unless I receive prior to such payment an order of the court to the contrary. Judgment Debtor Name & Address: If more space is needed, attach separate sheet. American LegalNet, Inc. www.FormsWorkFlow.com 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 , . Garnishee RETAIN THE ORIGINAL OF THIS FORM WITH YOUR NORMAL PAYROLL RECORDS. YOU DO NOT NEED TO FURNISH A COPY OF THIS FORM TO ANY PARTY UNLESS REQUESTED TO DO SO. IF REQUESTED TO FURNISH A COPY OF THIS FORM, MAKE A COPY OF THE ORIGINAL AND SEND THE COPY, ALONG WITH THE AFFIDAVIT, IN RESPONSE TO THE REQUEST. American LegalNet, Inc. www.FormsWorkFlow.com