Illinois > Local County > Dupage > Garnishment
Affidavit For Wage Deduction Order 2316 - Illinois
| Affidavit For Wage Deduction Order Form. This is a Illinois form and can be used in Garnishment Dupage Local County . |
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AFFIDAVIT FOR WAGE DEDUCTION ORDER 2316 (Rev. 04/06) UNITED STATES OF AMERICA STATE OF ILLINOIS COUNTY OF DU PAGE IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT PLAINTIFF / PETITIONER CASE NUMBER VS. DEFENDANT / RESPONDENT RETURN DATE AND (21 to 40 days after date of issuance of Summons) EMPLOYER File Stamp Here AFFIDAVIT FOR WAGE DEDUCTION ORDER _______________________________________________________________________________ on oath states: 1. I believe employer __________________________________________________ is indebted to the Judgment Debtor, ____________________________________________________ for wages due or to become due. Employer's address: 2. The last known address of the Judgment Debtor is: I request that a summons be issued to the employer. Furthermore, I certify that a copy of the wage deduction notice was mailed to the Judgment Debtor by First Class Mail, at the judgment debtor's last known address prior to the filing of this wage deduction proceeding. PRO SE Name: Affiant: DuPage Attorney Number: Attorney for: Address: City/State/Zip: Telephone Number: Sworn and Subscribed before me Date: Notary Public CERTIFICATE OF ATTORNEY OR JUDGMENT CREDITOR I, the undersigned, certify under penalties as provided by law pursuant to 735 ILCS 5/1-109 that the statements set forth in this instrument are true and correct. / / 1. Judgment in the above captioned case was entered on ___________________ 2. The amount of Judgment .............................................................................. $ 3. Allowable costs previously expended: a) Initial filing fee ................................................................................ $ b) Original and alias summons ............................................................ $ c) Filing and summons costs of prior supplementary proceedings ..... $ 4. Filing and summons costs for this proceeding ............................................. $ 5. Interest due on Judgment to date .................................................................. $ TOTAL $ DEDUCT: Total amount paid by or on behalf of the Judgment Debtor prior to this proceeding ............................................... $ BALANCE DUE JUDGMENT CREDITOR $ Judgment Creditor / Attorney NOTE: FOUR (4) COPIES OF THIS AFFIDAVIT MUST BE SERVED ON THE EMPLOYER Answers to Interrogatories on reverse side hereof are to be filed on or before the return date CHRIS KACHIROUBAS, CLERK OF THE 18TH JUDICIAL CIRCUIT COURT © п¹» ï ±º î American LegalNet, Inc. WHEATON, ILLINOIS 60189-0707 www.USCourtForms.com Case Number: Return Date: WAGE DEDUCTION INTEROGATORIES / ANSWERS 1. Were any wages, salary or commissions due the Judgment Debtor, __________________________________ when you were served the Wage Deduction Summons? 2. State any facts affecting the wage deductions: Prior garnishment, etc.: (Identify prior garnishment or support of spouse or dependant children.) Date of last employment: ____________________ / / 3. Your answer under oath is to be filed with the Clerk of the Circuit Court on or before the return date on the summons. Mail to: Clerk of the Circuit Court, Box 707, Wheaton, IL 60189-0707. Your failure to answer will cause judgment for amount due to date be entered against the employer. (735 ILCS 5/12-807) 4. Judgment Debtor is paid: Weekly Bi-weekly Semi-monthly Monthly Other: CALCULATION TO DETERMINE AMOUNT OF WITHHOLDING (A) Gross Wages minus mandatory contributions to pension or retirement plan: $ (B) METHOD I - 15% of Line (A): ..................................................................... $ hourly wage prescribed by Section 4 of the Minimum Wage Law (A) (B) (C) METHOD II - the greater of (a) the amount that the weekly disposable earnings exceeds the minimum hourly wage or (b) the minimum (1) Enter Total FICA, State and Federal Tax and Medicare: $ (2) Subtract Line (1) from Line (A): $ $ (C) (D) (E) (F) (G) (H) (3) Enter Minimum Wage per pay period: $ (4) Subtract Line(3) from Line (2): (enclose negative amount in parenthesis) (D) Enter the lesser of Line (B) or Line (C): ......................................................... $ (E) Enter Child Support or other Court Ordered Deduction: ................................ $ (F)* Subtract Line (E) from Line (D): (enclose negative amount in parenthesis) $ (G) Subtract Employer's Statutory Fee (735 ILCS 5/12-814): ..............................$ (whichever is greater; $12.00 or 2% of the amount to be deducted) (H) Amount to be applied to judgment: ................................................................ $ further order of Court. * Line (F) is the amount to be withheld from the employee's paycheck each pay period after the date of service of Summons and not to be disbursed until INSTRUCTIONS 1. Fill out and sign the certificate below. 2. Mail a copy of this Answer to the Court and the Plaintiff's attorney, and give a copy to the Defendant. 3. You will recieve a copy of a Court Order instructing you how to proceed and where to send any withheld funds. THIRD PARTY EMPLOYER CERTIFICATION Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure (735 ILCS 5/1-109), the under-signed certifies that the statements set forth in this instrument are true and correct and that I have either mailed or hand delivered a copy of this completed Interogatories / Answer to the Defendant. / / Date: ____________________ Signature of Employer / Agent: Print full name clearly: Fax Number: Phone Number: CHRIS KACHIROUBAS, CLERK OF THE 18TH JUDICIAL CIRCUIT COURT © п¹» î ±º î American LegalNet, Inc. WHEATON, ILLINOIS 60189-0707 www.USCourtForms.com
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