OEDKy424 (Rev. 10/06) Affidavit for Order of Wage Garnishment (Continuous or as Designated) UNITED STATES DISTRICT COURT EASTERN DISTRICT OF KENTUCKY at _______________ Case No. _________________ AFFIDAVIT FOR ORDER OF WAGE GARNISHMENT Date of Judgment: Post Judgment Int Rate: Judgment Creditor: Garnishee (Employer): Amount of Judgment: Pre-judgment Interest: Allowed Court Costs: Amount Due: $ $ $ $ % Judgment Debtor: AFFIDAVIT The undersigned affiant is counsel for Judgment Creditor, or is the Judgment Creditor, and states as follows: 1. The above named Judgment Debtor is not now nor has been at any time during the pendency of this action, in the active military service of the United States of America.. The date of the Judgment and the amount due thereon (subject to any credits due for any sums currently being processed) are stated above. The Garnishee (Employer) listed above is believed to be indebted to the Judgment Debtor. The Notice of Rights to Assert Exemption to Wage Garnishment will be sent to the Judgment Debtor within five (5) business days of sending this Affidavit to the U.S. District Court Clerk. Any garnished funds will be held by Affiant for a period of thirty (30) days from the issuance date on the employer's garnishment check. 2. 3. 4. 5. WHEREFORE: The Judgment Creditor prays for garnishment against the Judgment Debtor; that the Garnishee named herein be made a party to this action, and that the Garnishee be required to answer the Garnishment issued hereunder; and for its costs. ___________________________________________ Affiant Subscribed and sworn to before me by the above affiant this ____ day of ______________, 20_____. My commission expires:__________________________________ _____________________________________________ Notary Public, State at Large American LegalNet, Inc. www.FormsWorkFlow.com OEDKy424 (Rev. 10/06) Order of Wage Garnishment (Continuous or as Designated) UNITED STATES DISTRICT COURT EASTERN DISTRICT OF KENTUCKY at Case No. ORDER OF WAGE GARNISHMENT (CONTINUOUS OR AS DESIGNATED) Judgment Debtor: Date of Judgment: Post Judgment Int Rate: Judgment Creditor: Amount of Judgment: Pre-judgment Interest: Garnishee (Employer): To the Garnishee (Employer): You are hereby (1) restrained from paying to the Judgment Debtor, or to anyone for him, money, property, or other evidence of debt in your possession belonging to him or in which he has any interest; and (2) ordered to continuously withhold and safely keep all of said nonexempt property of the Judgment Debtor until (a) the amounts due plus interest and costs are paid in full, or (b) for only the following designated succeeding pay periods: _________. ROBERT R. CARR, CLERK By: _________________________D.C. Date_______________ AFFIDAVIT AND ANSWER OF GARNISHEE (EMPLOYER) Comes the undersigned Affiant, who after being duly sworn, states: A. The name and Social Security Number of the Judgment Debtor ("Employee") is: Name:________________________________________ S.S. #________________________ B. The date on which this Order was originally served was _________________________________________________ C. No funds are due employee because _________________________________________________________________ D. If no funds are withheld due to superior (earlier) garnishments, the number of those garnishments is: _____ E. The pay period of the remittance accompanying this return is from ________________ to ________________ F. The pay period of this employee is: (choose one) ( ) weekly ( ) semi-monthly ( ) monthly 4. Exempt Earnings: 1. Gross Earnings $_____________ (a) 75% of line 3: $________ 2. Less amounts required by law to be withheld: Federal Income Tax: $________ (b) Other Amt (below):$________ State Income Tax: $________ (c) Enter greater of (a) or (b): $______________ Occupational Tax: $________ 5. Non-exempt Disposable Earnings (Line 3 Social Security: $ ________ less Line 4(c)) $_____________ Ordered Child Support: $________ G. Remit the amount on Line 5 or the Amount Due shown Total Deductions: $______________ at the top of this Order plus interest and costs, whichever is 3. Disposable earnings (Gross Earnings less less, to the Judgment Creditor or Judgement Creditor's Total Deductions): $______________ Attorney. Subscribed and sworn to before me this ______ day of ________________, 20__. Notary Public, State at Large ________________________ ______________________________________________ Affiant Position/Title My Commission expires: __________________________ Allowed Court Costs: Amount Due: $ $ $ $ % Other Amount: The other amount referred to in line 4(b). above is: (a) for weekly pay periods, 30 times the federal minimum hourly wage; or (b) for all other pay periods, the multiple of the federal minimum hourly wage as prescribed by the U.S. Department of Labor. Important Notice to the Judgment Debtor The Judgment Creditor is garnishing a portion of your wages to pay a judgment entered against you in the above court. You may have a right to recover all or part of the money your employer has withheld from your pay. Carefully review this form and your notice of rights to assert exemption to wage garnishment you previously received. Closely examine your employer's calculations regarding any withholding pursuant to this garnishment. If you believe that your employer has withheld too much money from you, file your objection to this garnishment in the office of the U.S. District Court Clerk which issued this garnishment within 13 days of the date on the payroll check you received from which money was withheld pursuant to this garnishment. Note: The Clerk does not have forms. American LegalNet, Inc. www.FormsWorkFlow.com OEDKy424 (Rev. 10/06) Instruction to Garnishee (Employer) for Completing Affidavit & Answer to Order of Wage Garnishment (Continuous or as Designated) INSTRUCTIONS TO GARNISHEE (EMPLOYER) FOR COMPLETING AFFIDAVIT AND ANSWER TO ORDER OF WAGE GARNISHMENT (CONTINUOUS OR AS DESIGNATED) Note: You should make copies of the Order of Wage Garnishment (Continuous or as Designated) and keep them for future use. You Are Summoned and Ordered to Do the Following: 1. Complete the Affidavit and Answer on the bottom of Order under oath and send copies as directed in paragraph 2 below: (a) within 20 days from your receipt of this Order; AND (b) when you first withhold as required by this Order; AND (c) whenever the amount withheld from any later paycheck differs from the amount withheld from the last p