AGREEMENT FOR JUDGMENT DOCKET NUMBER Trial Court of Massachusetts Small Claims Session AND FOR PAYMENT ORDER COURT DIVISION PLAINTIFF(S) WHO ARE PARTIES TO THIS AGREEMENT VS. DEFENDANT(S) WHO ARE PARTIES TO THIS AGREEMENT REQUESTED DATE OF PAYMENT REVIEW * Check here if defendant has moved and write new address above or on back of court copy * * No payment review requested JUDGMENT FOR PLAINTIFF(S). It is hereby agreed that in this small claim the Court may enter a judgment for the plaintiff(s) named above and against the defendant(s) named above for: $ $ _____________ COSTS $ * Plus PREJUDGMENT INTEREST from ___________________ (date) _____________ DAMAGES _____________ ATTORNEY FEES at the 12% statutory rate or the _______% contractual rate * Prejudgment interest is waived by the plaintiff. (if authorized by contract or statute) * Postjudgment interest is waived by the plaintiff. PAYMENT ORDER. It is also agreed that the Court may enter a payment order that requires the defendant(s): * to pay the plaintiff(s) the total amount of the judgment on or before __________________________________ (date). * to pay the plaintiff(s) $ ______________ each * week * month beginning on ________________ (date) until the total amount of the judgment is paid in full. This payment order will not be satisfied with any exempt income listed on pg. 2 of this form. * REVISED PAYMENT ORDER. In this small claim the Court has already entered a judgment and it is hereby agreed that the Court may revise that payment order as follows: This payment order will not be satisfied with any exempt income listed on pg. 2 of this form. * SATISFIED IN FULL. It is also agreed that this claim or judgment has already been satisfied in full. (By court rule plaintiff(s) must file an acknowledgment of satisfaction with the court when the judgment has been paid in full.) * JUDGMENT FOR DEFENDANT(S). It is hereby agreed that in this small claim the Court may enter a judgment for the defendant(s) named above, and the plaintiff(s) shall take nothing on this claim. * DISMISSAL. It is hereby agreed that the Court may enter a judgment dismissing this small claim. * JUDGMENT ON COUNTERCLAIM. It is also agreed that the Court may enter the following judgment on the counterclaim brought by the above-named defendant(s) against the above-named plaintiff(s): OTHER PROVISIONS OR COMMENTS Upon acceptance by the Court, a judgment and payment order will be entered in accordance with the above terms and will be enforceable as an order of the Court. X SIGNATURE OF PLAINTIFF(S) OR ATTORNEY FOR PLAINTIFF(S) PRINT NAME ____________________ DATE X SIGNATURE OF DEFENDANT(S) OR ATTORNEY FOR DEFENDANT(S) PRINT NAME _ __________________ DATE RECORD OF COURT REVIEW (For optional use by magistrate) * To be entered as court’s judgment and/or payment order. * Agreement was submitted in open court and Rule 7(a) inquiry made of defendant(s) as to any payment order. X CLERK-MAGISTRATE / ASST. CLERK DC-SC-8 (4/11) www.mass.gov/courts/districtcourt American LegalNet, Inc. www.FormsWorkFlow.com INCOME THAT IS EXEMPT FROM PAYMENT ORDERS 1. ALL INCOME FROM THE FOLLOWING SOURCES is exempt by law from any payment order: • Unemployment Benefits (G.L. c. 151A, § 36) • Workers Compensation Benefits (G.L. c. 152, § 47) • Social Security Benefits (42 U.S.C. § 401) • Federal Old-Age, Survivors & Disability Insurance Benefits (42 U.S.C. § 407) • Supplementary Security Income (SSI) for Aged, Blind & Disabled (42 U.S.C. § 1383[d][1]) • Other Disability Insurance Benefits up to $400 weekly (G.L. c. 175, § 110A) • Emergency Aid for Elderly & Disabled (now G.L. c. 117A) • Veterans Benefits Federal Veterans Benefits (38 U.S.C. § 5301[a]) Special Benefits for Certain WW II Veterans (42 U.S.C. § 1001) Medal of Honor Veterans Benefits (38 U.S.C. § 1562) State Veterans Benefits (G.L. c. 115, § 5) • Transitional Aid to Families with Dependent Children (AFDC) Benefits (G.L. c. 118, §10) • Maternal Child Health Services Block Grant Benefits (42 U.S.C. § 701) • Other public assistance benefits (G.L. c. 235, § 34, fifteenth) 2. In addition, A PORTION OF WAGES OR EMPLOYMENT-BASED RETIREMENT PAYMENTS is exempt by law from any payment order. The exempt amount is $400 or 85% of your weekly gross earnings, whichever is greater. Massachusetts law exempts the greater of 85% of the debtor’s gross earnings or 50 times the greater of the Federal minimum wage ($7.25 as of 7/24/09) or the Massachusetts minimum wage ($8.00 per G.L.c. 151, § 1) for each week or portion thereof. (G.L. c. 224, § 16 & c. 246, § 28). The Federal exemption (15 U.S.C. § §1671-1677) is not applicable as it will always be less than the Massachusetts exemption. DEFENDANT’S WORKSHEET FOR CALCULATING EXEMPT AMOUNT OF WAGES OR EMPLOYMENT-BASED RETIREMENT PAYMENTS Write the amount of your “weekly gross earnings” here = $ _____________ If your weekly gross earnings are less than $400, enter the amount of your weekly gross earnings If your weekly gross earnings are $400–$470, enter $400 If your weekly gross earnings are more than $470, enter 85% of your weekly gross earnings DC-SC-8-Obverse (4/11) $ This is the amount of your weekly gross earnings that is exempt from any payment orders. www.mass.gov/courts/districtcourt American LegalNet, Inc. www.FormsWorkFlow.com