SUGGESTION FOR SUMMONS IN GARNISHMENT Commonwealth of Virginia Va. Code § 8.01-511 CASE NO. RETURN DATE ................................................................................................................................................ General District Court CITY OR COUNTY ORIGINAL JUDGMENT DATE OF JUDGMENT DATE EXECUTION ORDERED SUGGESTION FOR SUMMONS IN GARNISHMENT .......................................................................................................... JUDGMENT CREDITOR'S NAME STATEMENT $ .............................. Judgment Principal .............................. Credits (see reverse) .............................. Interest at ______ % to return date .............................. Judgment Costs .............................. Attorney's Fee .............................. Garnishment Costs CITY OR COUNTY WHERE JUDGMENT ENTERED .......................................................................................................... STREET ADDRESS .......................................................................................................... CITY STATE ZIP MAXIMUM PORTION OF DISPOSABLE EARNINGS SUBJECT TO GARNISHMENT .......................................................................................................... TELEPHONE NUMBER $ .............................. Total Balance Due [ ] Support (if not specified, then 50%) [ ] 50% [ ] 55% [ ] 60% [ ] 65% [ ] State Taxes, 100% If none of the above are checked, then § 34-29(a) applies (a plain-language interpretation of this section is on the reverse of the SUMMONS). .......................................................................................................... JUDGMENT CREDITOR'S ATTORNEY'S NAME .......................................................................................................... STREET ADDRESS The garnishee shall rely on this amount. .......................................................................................................... I request the Clerk to summon the Suggested Garnishee to answer this suggestion. This is a garnishment against (check only one) [ ] the judgment debtor's wages, salary or other compensation. [ CITY STATE ZIP ] some other debt due or .......................................................................................................... TELEPHONE NUMBER property of the judgment debtor, specifically .......................................................................................................................................................................... I have reason to believe that there is a liability on the suggested garnishee because of the execution on the "ORIGINAL JUDGMENT" described above. I certify that: [ ] (1) The summons is based upon a judgment upon which a prior summons has been issued but not fully satisfied; or [ ] (2) No summons has been issued upon this judgment creditor's suggestion against the same judgment debtor within a period of eighteen months, other than a summons which was based upon a judgment upon which a prior summons has been issued but not fully satisfied; or [ ] (3) The summons is based upon a judgment granted against a debtor upon a debt due or made for necessary food, rent, or shelter, public utilities including telephone service, drugs, or medical care supplied the debtor by the judgment creditor or to one of his or her lawful dependents, and that it was not for luxuries or nonessentials; or [ ] (4) The summons is based upon a judgment for a debt due the judgment creditor to refinance a lawful loan made by an authorized lending institution; or [ ] (5) The summons is based upon a judgment on an obligation incurred as an endorser or comaker upon a lawful note; or [ ] (6) The summons is based upon a judgment for a debt or debts reaffirmed after bankruptcy. I hereby certify that the last known address of the defendant is as shown at right. [ ] I represent that I have made a diligent, good faith effort to secure the social security number of the judgment debtor and have been unable to do so. ........................................................................ DATE SUBMITTED .......................................................................................................... JUDGMENT DEBTOR'S NAME .......................................................................................................... STREET ADDRESS .......................................................................................................... CITY STATE ZIP .......................................................................................................... SOCIAL SECURITY NUMBER TELEPHONE NUMBER .......................................................................................................... SUGGESTED GARNISHEE'S NAME (SEE NOTE BELOW) .......................................................................................................... STREET ADDRESS .......................................................................................................... CITY STATE ZIP .......................................................................................................... _____________________________________________________________________ TELEPHONE NUMBER [ ] JUDGMENT CREDITOR [ ] AGENT [ ] ATTORNEY WARNING: Any judgment creditor who knowingly gives false information in a Suggestion for Garnishment shall be guilty of a class 1 misdemeanor. If garnishee is judgment debtor's employer, please furnish employer's name, and state whether it is a corporation, or one or more persons trading under a fictitious or trade name. American LegalNet, Inc. www.FormsWorkFlow.com FORM DC-450 (FRONT) 07/12 INSTRUCTIONS TO JUDGMENT Show how these credits were computed on this side of this form or on an attached sheet of paper. You should show: -- Date and amount of each payment. -- How interest is computed. -- How payments are credited. FORM DC-450 (REVERSE) 4/84 American LegalNet, Inc. www.FormsWorkFlow.com