IN THE 21ST JUDICIAL CIRCUIT COURT, ST. LOUIS COUNTY, MISSOURI Judge or Division: Petitioner(s): Case Number: Please Issue: General Execution Garnishment Sequestration (Date File Stamp) For: Real Estate Levy Replevin Requested Return/End Date: 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.) To (County/City of St. Louis): Debtor Name/Address: Amount Remaining Unpaid (To be completed by Applicant) Principal $ Interest $ Court Costs (paid by party/atty) $ Service Fee Paid (Including this Application) $ Date: Missouri Bar No.: 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 $ $ $ Debtor SSN (last four digits): Requested For: Attorney: 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: 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. Remittance must include: Case Number & Execution/Garnishment Number. Mail Funds To: Office of the Circuit Clerk, P.O. Box 16994, Clayton, MO 63105-6994 Issue (County): Date Issued: By (Clerk): Document ID: Return Date: 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 (04-11) CV90 CCCDT228-WS 02/14 1 of 2 Rule 90.02, 452.350 RSMo American LegalNet, Inc. www.FormsWorkFlow.com 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 Total ______________________________________ Sheriff/Server $ $ $ $ $ 10.00 (______ miles @ $.______ per mile) Instructions to Sheriff/Server General Execution You are commanded to execute this writ by levying upon the debtor's property. 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. Sequestration on Public Employer You are commanded to take into your possession, any and all moneys, checks, drafts, warrants, vouchers, or other evidence of indebtedness, for salary, wages, fees or earnings for services rendered by said debtor now due and payable, or which shall hereafter become due and payable from the date of this writ to the return day thereof, now in the hand of said paying, disbursing or audit officer, or that shall come into his/her hands before the return day of this writ, or so much thereof as shall be necessary to satisfy the amount of judgment debt, interest, costs and fees due and allowed by law for serving this writ, and issue therefore your receipt; that you endorse in the name of said debtor, any and all such checks, drafts, warrants, vouchers, or other evidence of indebtedness, and convert the same into cash; that you serve a true copy of this writ upon the paying, disbursing or auditing officer; and that you certify to this court the manner in which you execute this writ. 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