General Sessions Court Madison County Jackson, Tennessee M OTION FOR INSTALLMENT PAYMENTS page 1 of 1 Case Number vs. Date of notice to Plaintiff: Date of notice to Garnishee: Clerk/Deputy: Hearing: Reset for: Comes the Defendant(s) pursuant to Tennessee Code Annotated 24726-2-216 and would move this Honorable Court to reduce the judgment heretofore entered in this cause in the amount of to installment payments in the amount of per . In support of this motion the Defendant(s) would offer the Affidavit of Income and Property attached hereto. Defendant(s) would further allege that the payment schedule is the maximum payment Defendant(s) can reasonably make on said judgment. Defendant(s) would allege there are no other sources of income other than the wages from the employer set forth in said Affidavit. Defendant(s) further acknowledges that if a previous agreement to pay the judgment by installment payments has been entered, the filing of this motion does not stay the issuance, execution or return of any writ of garnishment against wages or salary due to the Plaintiff or any satisfaction or payment of or upon such judgment. Date: Defendant signature JUDGMENT This cause came to be heard upon Defendant's Motion for Installment Payments on the judgment entered in this cause, and upon Agreement of the parties Hearing Default Defendant(s) having shown good cause that they are entitled to the relief sought, the judgment in this cause is commuted to installment payments in the sum of $ to be paid each , beginning , and further execution by garnishment is hereby stayed. Payments to be made directly to Plaintiff or Plaintiff222s attorney/agent Payments to be made through the Clerk of the Court Defendant222s Petition is hereby dismissed: Defendant(s) having failed to show good cause for the Petition; Defendant(s) having failed to appear and support the Petition Costs are taxed to Defendant(s). Date: Judge Attorney for Plaintiff: Attorney for Defendant: Name: Name: Address: Address: Telephone: Telephone: American LegalNet, Inc. www.FormsWorkFlow.com General Sessions Court Madison County Jackson Tennessee A FFIDAVIT OF I NCOME AND P ROPERTY Case Number vs. Comes now the Defendant(s) and, subject to the penalty of perjury, makes oath and says that the following facts are true and that there is NO OTHER source of income or property other than that described below: 1. Full name: Address: City: State/Zip: Phone: Soc. Sec. No. Date of birth: Employer: Phone # 2. List all dependents: Name Age Relationship 3. List all income from any source: $ per/wk /mo , from : $ per/wk /mo , from : $ per/wk /mo , from : I receive CHILD SUPPORT in the sum of $ per . 4. List all bank accounts: ACCOUNT BANK/SOURCE BALANCE Checking $ Savings $ Other: $ Other: $ 5. List all debts: CREDITOR/ADDRESS BALANCE $ $ $ $ $ 6. List all monthly household expenses: Rent/Mortgage: $ Utilities: $ Health Insurance: $ Transportation Cost: $ Food: $ Clothing: $ Other: $ $ $ $ TOTAL $ 7. List all land/house/real estate/property you own: DESCRIBE VALUE $ $ $ $ 8. List all personal property/cars/trucks/ furniture/stocks/bonds/tools/equipment you own and its total value: DESCRIBE VALUE Cars $ Trucks $ Other $ $ $ $ 9. List all assets/property sold or transferred in the last six months: DESCRIBE VALUE $ $ $ $ $ 10. The last income tax I filed was for and it reflected an income of $ and I attach a copy hereto or will file the same within seven days. LIST ALL PROPERTY YOU CLAIM TO BE EXEMPT PURSUANT TO LAW: All clothing for myself and my family; all receptacles for said clothing; family portraits; family Bible; school books; and VERIFICATION AND OATH: Comes now the Petitioner(s) / Defendant(s) and makes oath, subject to the penalty of perjury, that the information in this Motion for Installment Payment is true to the best of Petitioner's knowledge, information and belief. Defendant(s) Sworn to and subscribed before me on Clerk/Deputy Clerk/Notary Public Commission Expires: American LegalNet, Inc. www.FormsWorkFlow.com