Illinois > Local County > Cook > Civil
Affidavit For Wage Deduction Summons CCM 0050 - Illinois
| Affidavit For Wage Deduction Summons Form. This is a Illinois form and can be used in Civil Cook Local County . |
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2821 Affidavit for Wage Deduction Summons (This form replaces CCG 0050 A) IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS _____________ DEPARTMENT/ _____________ DISTRICT Print Form Clear Form (Rev. 6/06/07) CCM 0050 A _____________________________________________________ Plaintiff(s), v. _____________________________________________________ Defendant(s), and _____________________________________________________ Employer. } No. ______________________________________ Court Date __________________________ (21 to 40 days after date of issuance of summons) AFFIDAVIT FOR WAGE DEDUCTION SUMMONS I, the undersigned, certify under penalties as provided by law under 735 ILCS 5/1-109, that the following information is true. 1. I believe employer ________________________________________________________________________ is indebted to the Judgment Debtor _____________________________________________________________________________ for wages due or to become due. 2. The last known address of the Judgment Debtor is _________________________________________________________ _____________________________________________________________________________________________________________________. 3. I request that a summons issue directed to employer. CERTIFICATE OF ATTORNEY OR JUDGMENT CREDITOR Note: Non-Attorneys must also submit a copy of the underlying Judgment or a certification by the Clerk of the Court that entered the Judgment. 1. Judgment in this case was entered on _______________________________________, _________. 2. 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 cost for this garnishment 5. Interest due on Judgment Total DEDUCT: Total amount paid by or on behalf of the Judgment Debtor prior to this garnishment BALANCE DUE JUDGMENT CREDITOR Atty. No. _________________ Name: _________________________________________________ Attorney for: ____________________________________________ Address: ________________________________________________ City/State/Zip: ___________________________________________ Telephone: ______________________ FAX:__________________ $ ____________________ $ ____________________ $ ____________________ $ ____________________ $ ____________________ 0.00 $ ____________________ $ ____________________ $ __________________ $ __________________ Signature: ________________________________________ Attorney or Judgment Creditor Print Name: _____________________________________ (OVER) DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS (Rev. 6/06/07) CCM 0050 B Employer/Agent: ______________________________________________________________ Court Date: ____________________ Defendant's Name: ________________________________ S.S. No. XXX-XX- _______________ Case No.: ______________________ Defendant's Address: ____________________________________________________________________________________________ CERTIFICATION OF MAILING BY JUDGMENT CREDITOR OR ATTORNEY FOR JUDGMENT CREDITOR Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure (735 ILCS 5/1-109), the undersigned certifies that s/he mailed by regular first-class mail a copy of the wage deduction notice to Defendant at the address shown above on ___________________________, _________. Signature:_________________________________________________ Name: ___________________________________ INTERROGATORIES/ANSWER TO WAGE DEDUCTIONS PROCEEDINGS Do you pay any money to the Defendant listed above? Yes No If terminated, date ____________________________, _________. IF YOUR ANSWER IS "NO," GO TO "INSTRUCTIONS" BELOW Are any funds paid to the debtor subject to or for: Prior court ordered deduction (including child/spouse support) Case Number, State, County _____________________________________. Disability Retirement Otherwise exempt (Describe ______________________________________________________________). CALCULATION TO DETERMINE AMOUNT OF WITHHOLDING (Note: If income varies, withholding must be recalculated for every pay period.) Do you pay debtor: Every week Every two weeks Semi-monthly Monthly (A) Gross wages per paycheck minus mandatory contributions to pensions or retirement plan (B) 15% of (A) = (C) Enter total FICA, State Tax, Federal Tax and Medicare (D) Subtract (C) from (A) = Other ___________________________ (A) ________________ (B) ________________ (C) ________________ (D) ________________ (E) If debtor is paid every week, enter $337.50 If debtor is paid every two weeks, enter $675.00 If debtor is paid semi-monthly, enter $731.25 If debtor is paid monthly, enter $1,462.50 If other, multiply 45 times state minimum wage (currently $7.50) times number of weeks in pay period (F) Subtract (E) from (D) (Enclose a negative number in parentheses, e.g., ($50.00)) IF LINE "F" IS ZERO OR A NEGATIVE NUMBER, WITHHOLD NO WAGES GO TO "INSTRUCTIONS" BELOW (E) ________________ (F) ________________ (G) ________________ (H) ________________ (I) _________________ (G) Enter the LESSER of Line (B) or (F) (H) Enter Child Support or other Court Ordered Deduction (I) Subtract (H) from (G) (Enclose a negative number in parentheses, e.g., ($50.00)) IF LINE "I" IS ZERO OR A NEGATIVE NUMBER, WITHHOLD NO WAGES, GO TO "INSTRUCTIONS" BELOW LINE "I" MUST BE WITHHELD AS OF THE DATE OF SERVICE AND HELD UNTIL FURTHER COURT ORDER (J) Subtract Employer's One-Time Statutory Fee (the greater of $12.00 or 2% of the amount on line "I". See 735 ILCS 5/12-814) (J) _________________ (K) Amount to be applied to Judgment INSTRUCTIONS 1. Fill out and sign the certification below. 2. Fax or mail a copy of this Answer to the Court and Plaintiff's attorney and give a copy to the Defendant. If filing in the First Municipal District, you may fax it to (312) 603-6522 or mail it to the Clerk of the Court, Richard J. Daley Center, 50 West Washington Street, Room 602, Chicago, Illinos 60602. To assure timely processing, the Answer should be received at least three days before the Court Date. 3. You will receive a copy of a Court Order by fax or mail instructing you how to proceed and where to send any withheld funds. (K) ________________ EMPLOYER CERTIFICATION Under the penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure (735 ILCS 5/1-109), the undersigned certifies that the statements set forth in this instrument are true and correct and that I have eithe
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