IN THE CHANCERY COURT OF SHELBY COUNTY TENNESSEE Plaintiff vs. Docket No. ___________________ Defendant MOTION AND AFFIDAVIT FOR INSTALLMENT PAYMENTS AND AUTOMATIC STAY OF EXECUTION ON JUDGMENT Comes now _______________________________, Judgment Debtor, who, pursuant to TCA §26-2-216, would move this Honorable Court to set installment payments in the amount of _________________ to be paid (check one) Weekly Bi-Weekly Monthly Semi- monthly on judgment and costs totaling _____________________ with payments to begin on ____________________, 20____. In support of this motion, the Judgment Debtor states that there has been no previous motion to set monthly payments and that the Debtor is entitled to an automatic stay on execution against wages pending the outcome of hearing on this motion. Further, Judgment Debtor states that there are no other sources of income and no property or assets which can be encumbered or sold to make payment on the debt other than wages as cited below. Name and Address of Employer Gross Income/Net Income Per Name: Address City, State, Zip Code Phone No. American LegalNet, Inc. www.USCourtForms.com VERIFICATION AND OATH Comes now _____________________________________________, judgment debtor, and makes oath, subject to the penalty of perjury, that the information in this Motion and Affidavit for Installment Payment and Automatic Stay is true to the best of my information and belief. State of Tennessee County of Shelby Sworn to and subscribed before me this ____ day of _________________, 20____ Deputy Clerk & Master/Notary Public My Commission Expires: Form 00-03/04 2 American LegalNet, Inc. www.USCourtForms.com