IN THE ____ ___ JUDICIAL CIRCUIT, ___ Judge or Division: Petitioner(s): vs. Case Number: _______________________, MISSOURI Date Judgment Entered Against Debtor: Original Amount of Judgment: (Date File Stamp) Respondent(s): Please Issue: Garnishment Requested Return/End Date: 30 Days 60 Days 90 Days For: Bank Account Bond Wages 120 Days 150 Days 180 Days Other: ___________________________ Continuous (for wages only) Garnishment Application and Order (This form must be completed in full or your request will be returned unprocessed.) To (County/City of St. Louis): Amount Remaining Unpaid (To be completed by Applicant) Debtor Name/Address: Judgment Balance Total amount of the judgment awarded on the day $ judgment is entered including, but not limited to, principal, prejudgment interest, and all costs and/or fees. Debtor SSN (last four digits): XXX-XXGarnishee Name and Address: Post Judgment Interest Post Judgment Costs Service Fee for this Writ Garnishment Clerk Fee Surcharge $ $ $ $ $ $ $ $ ($ ) 10.00 Garnishee ID # (court use only): ___________________________ Taxes Child Support/Maint under 12 wks. Child Support/Maint over 12 wks. Other: ____________________________ Less Credits Creditor: Attorney: Missouri Bar No.: A judgment was entered on the above referenced date and remains unsatisfied. The garnishor knows or has reason to believe the garnishee is indebted to debtor. The garnishee is obligated to make periodic payments to debtor, or the garnishee has control/custody of money and/or bonds belonging to debtor. Signature: ____________________________________________ Date: ________________________________________________ Address & Telephone Number: TOTAL DUE $ Instructions for Service and/or Garnishee: Include applicable instructions. Requested by Applicant Make payments to: Mail Funds To: Writ of Garnishment (To be completed by Court Clerk) The State of Missouri to the Sheriff of any County in the State of Missouri Because a judgment was entered against the above debtor in this court and there is a balance, accrued interest, and costs as stated above unpaid from said judgment, you are commanded to execute this writ by following the instructions on the reverse side of this writ and on the return date shown below to certify to this court how you executed this writ. Issuing County: Document ID / Garn Number: Issue Date: Return Date (if applicable): (Seal) Issued By (Clerk): Court Address: Summons and Instructions to Garnishee To the Above-Named Garnishee: You are notified that I attach all goods, personal property, money, credit, bonds, bills, notes, checks, choses in action, or other effects and all debts owed to the above named debtor that are in your possession or charge, or under your possession or charge, or under your control from this time until the return date or a sufficient sum to satisfy the total amount of garnishment shown above. You are further notified to file your answers to the interrogatories served within ten days after the above return date. Date: Sheriff/Server: County: Service Acknowledged By: OSCA (10-15) CV92 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Court Attorney Make Checks Payable To: 15 U.S.C. 1671; Rule 90; 452.350, RSMo Sheriff or Server's Return I certify that I have served this summons/writ: By delivering a copy of the summons/writ to the garnishee. By leaving a copy of the summons/writ at the dwelling place or usual abode of each of the garnishees with _______________________________________, a person of the garnishee's family over the age of 15 years. Other ___________________________________________________________________________________ Served in __________________________ (County/City of St. Louis), MO, on ___________ (date) at _______ (time). ______________________________________ Service Fees Summons/Writ Non Est Sheriff's Deputy Salary Supplemental Surcharge Mileage $ $ $ $ $ 10.00 (______ miles @ $.______ per mile) Sheriff/Server Total Instructions to Sheriff/Server Garnishment You are commanded to summon the garnishee and attach the property subject to garnishment in the garnishee's possession or charge or under the garnishee's control between the time notice is served and the return date. Applicable Provisions Relating to Garnishments 525.030 RSMo 2. The maximum part of the aggregate earnings of any individual for any workweek, after the deduction from those earnings on any amounts required by law to be withheld, which is subjected to garnishment may not exceed (a) twenty-five per centum, or, (b) the amount by which the individual's aggregate earnings for that week, after the deduction from those earnings of any amounts required to be withheld by law, exceed thirty times the federal minimum hourly wage prescribed by section 6(a)(1) of the Fair Labor Standards Act of 1938 in effect at the time of the earnings are payable, or (c) if the employee is the head of a family and a resident of this state, ten per centum, whichever is less. The restrictions on the maximum earnings subjected to garnishment do not apply in the case of any order of any court for the support of any person, and order of any court of bankruptcy under chapter XIII of the Bankruptcy Act or any debt due for any state or federal tax. For pay periods longer than one week, the provisions of subsection 2(a) and (c) of this section shall apply to the maximum earnings subjected to garnishment for all workweeks compensated, and under subsection 2(b) of this section, the "multiple" of the federal minimum hourly wage equivalent to that applicable to the earnings subject to garnishment for one week shall be represented by the following formula: The number of workweeks or fractions thereof (x) x 30 x the applicable federal minimum wage. For the purpose of this formula, a calendar month shall be considered to consist of 4 1/3 workweeks, a semimonthly period to consist of 2 1/6 weeks. The "multiple" for any pay period longer than one week shall be computed in a manner consistent herewith. The restrictions on the maximum amount of earnings subjected to garnishment shall also be applicable to all proceedings involving the sequestration of wages of employees of all political subdivisions. The term "earnings" as used herein means compensation paid or payable for personal services, whether denominated as wages, salary, commission, bonus, or otherwise, and includes periodic payments pursuant to a pension or retirement program. 5. No employer may discharge any employee by reaso