United States District Court for the Western District of 1st copy - Plaintiff Michigan Approved, SCAO Original - Court 2nd copy - Garnishee 3rd copy - Defendant CASE NO. GARNISHEE DISCLOSURE Court address Court telephone no. Plaintiff's name and address (judgment creditor) Defendant's name and address (judgment debtor) v Plaintiff's attorney, bar no., address, and telephone no. Garnishee's name and address 1. This disclosure is for a writ of garnishment issued on and received by garnishee on a. The garnishee mailed or delivered a copy of the writ of garnishment to the defendant on b. The garnishee was unable to mail or deliver a copy of the writ of garnishment to the defendant. 2. At the time of service of the writ, garnishee: Non-Periodic Garnishments a. is not indebted to defendant for any amount and does not possess or control defendant's property, money, etc. Reason: b. is indebted to defendant for non-periodic payments as follows: Description of property, money, negotiable instruments, etc. under garnishee's control Type of account and account number if applicable . . The amount to be withheld is $ and does not exceed the amount stated in item 2. of the writ. c. Withholding is exempt because: Periodic Garnishments d. is not obligated to make periodic payments to the defendant during the 91 day period. Reason: not employed. other e. is obligated to make periodic payments to the defendant during the 91 day period as follows: Payments are for earnings non-earnings specify nature of payment (see instructions on back) Payments are made A higher priority writ/order weekly. is bi-weekly. is not semi-monthly. monthly. other: frequency of payment currently in effect. Case number (If a higher priority writ/order is in effect, complete the following) Date issued Date served Name of court that issued higher priority writ/order Withholding under this writ will begin immediately if sufficient funds are available. will not begin immediately because defendant is laid off. sick. on leave. other: specify I declare that the statements above are true to the best of my information, knowledge, and belief. Date Garnishee/Agent/Attorney signature I certify that: on on on Date I mailed or personally delivered a copy of this disclosure with the court. I mailed or personally delivered a copy of this disclosure to the plaintiff/attorney. I mailed or personally delivered a copy of this disclosure to the defendant. Garnishee/Agent/Attorney signature DO NOT Include Your Payment With This Disclosure. MC 14 (6/05) GARNISHEE DISCLOSURE American LegalNet, Inc. www.FormsWorkFlow.com 15 USC 1672, 15 USC 1673, MCR 3.101