COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.PAYMENT TO AVOID GARNISHMENTCalendar No.To: Date of Mailing: (Name of Judgment Creditor)JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)CASE NO. (Address of Judgment Creditor)BEREA MUNICIPIAL COURTCityStateZip CodeTo avoid garnishment of PERSONAL EARNINGS of which you have given me notice I enclose $ To apply toward my indebtedness to you. The amount of the payment was computed as follows:1.Total amount of indebtedness demanded 1. $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2.Enter the amount of your personal earnings after deductions required by law earned by you during the current pay period (that is, the pay period in which this demand is received by you) 2. $3(A).Enter your pay period (weekly, bi-weekly, semi-monthly, monthly) . 3(A)THE PEOPLE OF THE STATE OF NEW YORK TO3(B).Enter the date when you present pay period ends ...3(B)4.Enter an amount equal to 25% of the amount on line (2) 4. $5(A).The current federal minimum hourly wage is $(to be filled in by Judgment Creditor).GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable(You should use the above figure to complete this portion of the form.) If you are paid weekly, enter thirty (30) times the current federal minimum hourly wage; if paid bi-weekly enter sixty (60) times the current federal minimum hourly wage; if paid semimonthly, enter sixty-five (65) times the current federal minimum hourly wage; if paid monthly, enter one-hundred thirty (130) times the current federal minimum hourly wage . 5(A). $ 5(B)Enter the amount by which the amount online (2) exceeds the amount on,line 5 (A) ..5(B). $located at County of6.. Enter the smallest of the amounts on lines 1, 4, or 5(B). Send this amount to theo'clock in the day ofnoon, and at any recessed in room, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of theJudgment Creditor along with this form after you have signed it .6. $I CERTIFY THAT THE STATEMENTS CONTAINED ABOVE ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF: X(Signature of Judgment Debtor)Your failure to 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 result of your failure to comply.(Print name and RESIDENCE address of Judgment Debtor)Zip CodeStateCity(To verify that the amount shown on line (2) is a true statement of your earnings, you must either have your employer certify below that the amount shown on line (2) is a true statement of your earnings or you may submit copies of your pay stubs for the two pay periods immediately prior to your receiving this notice.), one of the Justices of theI CERTIFY THAT THE AMOUNT SHOWN ON LINE (2) IS A TRUE STATEMENT OF THE JUDGMENT DEBTOR'S EARNINGSCourt in Witness, Honorableday of, 20 County,(Name of person Certifying this document)(Print Name of Employee)(Attorney must sign above and type name below)(TITLE of person Certifying this document)(Address of Employer or Agent) XAttorney(s) forCityStateZip Code (area code)(phone number)(Signature of Employer of Agent)I CERTIFY THAT I HAVE ATTACHED COPIES OF MY PAY STUBS FOR THE TWO PAY PERIOD IMMEDIATELY PRIOR TO MY RECEIVING THIS NOTICE.X(Signature of Judgment Debtor)Office and P.O. AddressGarn Form Payment to Avoid garnishment (O.R.C. 2716.02)Telephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com