IN THE 7th JUDICIAL CIRCUIT COURT, , MISSOURI CLAY COUNTY (Court Needs Original + 2 Copies) Judge or Division: Case Number: Execution Number: Garnishee’s Name/Address: Petitioner(s): vs. Respondent(s): Judgment Debtor’s Name/Address: (Date File Stamp) Interrogatories to Garnishee Instructions: You are to answer interrogatories under oath within ten (10) days after the return of date of the writ and mail the original to: Clay County Circuit Clerk Attn: Accounting Dept 11 South Water Liberty, MO 64068 and a copy to the attorney for the judgment creditor (or the judgment creditor individually if there is no attorney) stated on page 2 of this form. 1. At the time of service of garnishment or at any time thereafter until the return date stated in the summons of garnishment, have you had in your possession or under your control any property, money (excluding wages, salary, and commissions), or other effects of the judgment debtor? If so, state what property, how much, of what value, and what money or effects. Answer: 2. At the time of service of the garnishment, or at any time thereafter until the return date stated in the summons of garnishment, did you owe the judgment debtor any money (including wages, salary, and commissions), or do you owe the judgment debtor any now? Answer: If not yet due: When will it become due? If amount owed judgment debtor is for wages, salary, or commission state: a. Amount owed after deductions required by law $ ____________________. (Deductions required by law are limited to federal, state, and city income and earnings taxes and FICA taxes.) b. Amount withheld pursuant to the garnishment $ _____________________. OSCA (01-11) CV110 (CLAY 07-06-2012) 1 of 2 Rules 90.07, 90.13, 525.130, 525.140 RSMo American LegalNet, Inc. www.FormsWorkFlow.com 3. Is the judgment debtor still within your employ? Yes No If not, state the date his/her employment terminated. Answer: 4. At the time of service of the garnishment, or any time thereafter until the return date stated in the summons of garnishment, will you or have you since become or are you now bound in any contract to pay the judgment debtor money not yet due? Yes No If so, state the amount to be paid out and when due and payable. Answer: 5. Do you know of any person or entity, other than the judgment debtor, who claims an ownership interest in any property, money or effects of the judgment debtor or any amounts owed to the judgment debtor as disclosed by you in answer to interrogatories 1, 2, and 4? If so please provide the name and address of each such person or entity and identify the property, money or effects of the judgment debtor in which each such person or entity claims an interest? Answer: 6. If garnishee is a bank or other financial institution, state whether at the time the writ of garnishment was served or at any subsequent time did the debtor have funds on deposit in an account in which all funds are deposited electronically on a recurring basis and reasonably identified as being funds on deposit that are exempt from garnishment pursuant to Section 513.430.1(10)(a), (b), or (c), RSMo. Yes No If so, identify each account, state the reason for the believed exemption, and identify the entity electronically depositing those funds which are not attachable pursuant to Section 513.430.1(10)(a), (b), or (c), RSMo. Answer: The undersigned, being duly sworn, on oath states that he/she has read the foregoing interrogatories and the answers given are true to the best of affiant’s knowledge and belief, and that no exempt funds have been or will be attached. _____________________________________________ Signature of Garnishee The foregoing answers to interrogatories were subscribed and sworn to me on ______________________________ Date ______________________________________________ Notary Public My commission expires: ________________________________ Attorney for Judgment Creditor: OSCA (01-11) CV110 (CLAY 07-06-2012) 2 of 2 Rules 90.07, 90.13, 525.130, 525.140 RSMo American LegalNet, Inc. www.FormsWorkFlow.com