IN THE 16th JUDICIAL CIRCUIT COURT, JACKSON, MISSOURI AT KANSAS CITY AT INDEPENDENCE Judge or Division: Case Number: Petitioner(s): Please Issue: General Execution Garnishment Sequestration (Date File Stamp) Requested Return/End Date: For: Real Estate Levy Replevin Vehicle Levy Other Personal Property Levy For Executions: 30 Days 60 Days 90 Days Bank Account Wages For Garnishments: Date Judgment Entered Against Debtor: 30 Days 60 Days 90 Days Original Amount of Judgment: 120 Days 150 Days 180 Days v. Respondent(s): Execution/Garnishment/Sequestration Application and Order (This form must be completed in full or your request will be returned unprocessed.) Amount Remaining Unpaid (To be completed by Applicant) Principal $ Interest $ Court Costs (paid by party/atty) $ To (County/City of St. Louis): Debtor Name/Address: Service Fee Paid (Including this Application) Debtor SSN (last four digits): Requested For: Attorney: Date: Missouri Bar No.: A judgment was entered on the above referenced date and remains unsatisfied. The garnishor knows or has good reason to believe that the garnishee is indebted to debtor, that the garnishee is obligated to make periodic payments to debtor, or that the garnishee has control or custody of property belonging to debtor. Signature: __________________________________________________________ Address & Telephone Number: To be completed by Applicant: Garnishee Name and Address: $ Attorney Fees $ Taxes $ Child Support/Maint under 12 wks. $ Child Support/Maint over 12 wks. $ Subtotal $ To Be Completed by Clerk Costs Due to Court $ Sheriff’s Commission $ Service Fee Unpaid Total Due $ $ Instructions for Service: Include applicable instructions such as description of property; location of bank account; for a sequestration, include political subdivision, department, and name and title of disbursing officer. Garnishee ID # (court use only): _____________ Writ of Execution (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. Mail Funds To: CIRCUIT COURT OF JACKSON COUNTY AT KANSAS CITY LOCATION P O BOX 219533 KC MO 64121-9533 INDEPENDENCE LOCATION P O BOX 219569 KC MO 64121-9569 Issue (County): (Seal) Document ID: Date Issued: Return Date: By (Clerk): 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, choices 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 (7-08) CV90 JAC 1695 06-2011 1 of 1 Rule 90.02, 452.350 RSMo American LegalNet, Inc. www.FormsWorkFlow.com