COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : ____________ Court Index No. : ______________County ________________Tennessee Case Number NOTICE AND ORDER Calendar No. FOR : INCOME ASSIGNMENT JUDICIAL SUBPOENA Plaintiff(s) -againstPage 1 of 1 : : _____________________________________ vs. _________________________________ : Defendant(s) : Garnishee: . __________________________ . . . . . . . . . . . . . . . . . . . . ..... ............................ Employer: ___________________________ address:_____________________________________________________ THE PEOPLE OF THE STATE OF NEW YORK Notice is hereby given that you are ordered to deduct from the income of ______________________________, SocialTO Security # ___________________ restitution and court costs due in the above referenced case in the amount of $__________ per _________. Payments are to be forwarded to this office after each pay period. Checks should be made payable to GREETINGS: CourtName and mailed to: CourtName CourtAddress1 CourtAddress2 CourtCity, TN CourtZip . WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Withholding of restitution and court costs is binding upon you until the total amount listed below is paid or you , the Honorable at the Court are notified by this court. located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify court costs in accordance in this action on shall of the Withholding of restitution and and give evidence as a witnesswith this noticethe parthave priority over any other process under state law against the same wages or other income for debts, other than assignments for Child Support. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to It is your responsibilitybehalf this subpoena wasif _______________ penalty of $50 and all damages sustained as a the party on whose to notify this office issued for a maximum terminates employment with you and to provide thisof your failure to comply. result office the last known address and the name and address of the new employer if it is known. It is unlawful under TCA 35-5-501 for you to discharge any employee from employment, refuse to employ or Witness, Honorable , one of the Justices of the take disciplinary action against any employee because of income assignment. Court in County, day of , 20 The total amount of restitution and court costs due as of this date is _______________________. When this amount has been withheld, this income assignment will cease. (Attorney must sign above and type name below) Attorney(s) for Issued: ______________________ _______________________________________ Clerk / Deputy Clerk - Circuit Court Office and P.O. Address Served on employer by mailing Notice and Order for Income Assignment by certified mail return receipt requested on this date _____________________. Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com