COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Approved, SCAO STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY Court address : GARNISHEE DISCLOSURE ON NON-PERIODIC GARNISHMENT FORPlaintiff(s) CHILD SUPPORT : -against- Index No. Calendar No. Original - Court 1st copy - Plaintiff 2nd copy - Garnishee 3rd copy - Defendant CASE NO. JUDICIAL SUBPOENA Court telephone no. : Defendant's (payer's) name and address : Plaintiff's (payee's) name and address : v Defendant(s) : ...................................................... Garnishee's name and address Office of Child Support FIDM Central Enforcement Unit PO Box 30355 THE PEOPLE OF THE STATE OF NEW YORK Lansing, Michigan 48909-7855 (866) 438-8117 Federal tax ID no. TO SEE INSTRUCTIONS ON OTHER SIDE 1. This disclosure is for a writ of garnishment issued on and received by garnishee on . GREETINGS: a. The garnishee mailed or delivered a copy of the writ of garnishment to the defendant on . WE COMMAND mail or deliver a copy of the writ of garnishment to the defendant. b. The garnishee was unable to YOU, that all business and excuses being laid aside, you and each of you attend before the Honorable at the , Court 2. At the time of service of the writ, garnishee: located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed a. is not indebteddate, to testify and give evidence as a witness in this action on the part of property, money, etc. or adjourned to defendant for any amount and does not possess or control defendant's the Reason: b. is indebtedYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to to defendant for non-periodic payments as follows: the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Type of account and account number if applicable result of your failure to comply. Description of property, money, negotiable instruments, etc. under garnishee's control The amount to be withheld is $ and does not exceed the amount stated in item 2. of the writ. Witness, Honorable , one of the Justices of the I declare Court instatements above are true to day best of my information, knowledge, and belief. that the the of County, , 20 Date Garnishee/Agent/Attorney signature I certify that: (Attorney must sign above and type name below) on I mailed or personally delivered a copy of this disclosure with the court. on I mailed or personally delivered a copy of this disclosure to the Office of Child Support on I mailed or personally delivered a copy of this disclosure to the plaintiff. on I mailed or personally delivered a copy ofOffice and P.O.to the defendant. this disclosure Address Attorney(s) for Telephone signature Garnishee/Agent/Attorney No.: Date Facsimile No.: DO NOT Include Your Payment With This Disclosure. SeeE-Mail Address: item 3. of the instructions for details. Mobile Tel. No.: 15 USC 1672, 15 USC 1673, MCR 3.101 FOC 98 (4/02) GARNISHEE DISCLOSURE ON NON-PERIODIC GARNISHMENT FOR CHILD SUPPORT American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. GARNISHEE INSTRUCTIONS Plaintiff(s) : JUDICIAL SUBPOENA For purposes of this writ, nonperiodic payments are any account controlled by a financial institution. The rest of these intructions -against: do not apply to garnishment of non-cash property, which needs to be sold before it can be applied toward the child support order. 1. Responsibility to Disclose: Within 14 days after being served with the writ of garnishment you must deliver or mail copies : of this completed disclosure to the court, Office of Child Support, plaintiff, and defendant. 2. Withholding Instructions: Funds or other property available at the time of service of the writ must be withheld from the defendant from the time of this disclosure. Garnishments with a higher priority than this garnishment are orders of bankruptcy Defendant(s) : . . and . . . . . . . . perfected liens. court . . . .previously . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Special Note: If you receive more than one non-periodic garnishment for child support for the same defendant on the same date and the amount of property you hold is insufficient to satisfy all of these garnishments, each non-periodic garnishment THE PEOPLE OF THE a proportionate share of the for child support shall be paidSTATE OF NEW YORK property based on the ratio the amount of the judgment in each case bears to the total of all these judgments for the defendant. TO Determine the amount to be withheld. The amount withheld cannot exceed the amount of the unpaid child support specified in item 2. of the request (form FOC 97). 3. Payment Instructions: Funds available under this writ of garnishment may not be released to the State Disbursement Unit GREETINGS: until 28 days after you were served with the writ. After 28 days, funds must be paid as ordered in this writ unless otherwise notified by the court. No further order to pay will be issued except for garnishments of property other than money. Send WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before payments to: , the Honorable at the Court located at County MiSDU of in roomPO Box 30350 the , on day of , 20 , at o'clock in the noon, and at any recessed or adjourned date,MI testify and give evidence as a witness in this action on the part of the Lansing, to 48909-7850 4. Include the following information with each payment mailed to the State Disbursement Unit under this writ: - Your failure of the defendant Social security numberto comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Michigan case number result of your failure to comply. Garnishee's name Amount withheld under the writ Witness, Honorable Court in County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com