PLEASE ANSWER NOTICE TO EMPLOYER: GARNISHMENTS ARE IN EFFECT FOR EACH PAY PERIOD FOR 180 DAYS FROM DATE OF SERVICE. What is the total gross pay before any deductions ____________(a) (b) How much is deducted from pay for Social Security and Federal Income Tax? ____________(b) (c) Subtract (b) from (a). This is disposable earnings. ____________(c) (d) Are wages paid once every week, once every two weeks, once a month, or two times per month? (FMW = Federal minimum hourly wage) If once every week, enter 30 X FMW (d1) ____________(d1) Case ID: SHELBY COUNTY COURT OF GENERAL SESSIONS (a) EXECUTION BY GARNISHMENT PLAINTIFF: PLT ADDRESS: vs. If once every two weeks, enter 30 X FMW X 2 (d2) ____________(d2) If two times per month, enter 30 X FMW X 2.166667 (d3) ____________(d3) If once per month, enter 30 X FMW X 4.333334 (d4) ____________(d4) (e) (f) _____________(e) DEFENDANT: DFT SSN: Subtract (d1,2,3 or 4) from(c). If (e) is $0 or less, STOP. NO WAGES MAY BE WITHHELD. If (e) is more than $0, go on to (g). _____________(f) DFT ADDRESS: (g) Divide disposable earnings (c) by 4. _____________(g) GARNISHEE: (h) Enter the lesser of (f) or (g). _____________(h) (i) How many children does the debtor have under the age of sixteen (16) living in Tennessee? _____________(i) (j) Multiply (i) by $2.50 per week [$5.00 if wages are paid every two weeks, $5.42 if paid two times a month; and $10.83 if paid once per month]. _____________(j) (k) Subtract (j) from (h). This is the amount of wages to withhold. If this amount is $0 or less, nothing should be withheld from wages. _____________(k) No Longer Employed Terminated________________ Holding _____________________ Nothing Due Employed No Account Will Honor Net Earnings Less Than Exemptions I certify under penalty of perjury that the above information is true and correct on this __________day of _______ 20_____. Garnishee & Title ____________________________________ Remit Funds to : General Sessions Civil Court P O Box 3824 Memphis, TN 38173 GSHEE ADDRESS: ATTORNEY: CONTACT: Judgment: Interest: Court Cost: Total Of Garnishment: State of Tennessee County of Shelby County AFFIDAVIT (Amended 7/08) Came to hand, in order to satisfy a judgment obtained in General Sessions Court on balance in the sum of Dollars debt, and cost of suit, came to hand same day and executed as commanded on: ________________________________Name ________________________________Title JUDGMENT for the PLAINTIFF______________________ _________________________________________________ and against the GARNISHEE _________________________ _________________________________________________ for ______________________________________Dollars for which Scire facias may issue. This the _____ day of _______________ , 20_____. Having first been duly sworn according to law, I hereby make oath that the following information is true to the best of my knowledge, information and belief. Creditor____________________________ Issued by: ________________________________D. C. Edward L. Stanton, Jr., Clerk Pro Tempore On_________________, 20____ _________________________________________ JUDGE DIV. ___________ American LegalNet, Inc. www.FormsWorkFlow.com