Writ Of Execution And Notice Of Levy On Permanent Fund Dividend {CIV-502}

09208 IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA AT Writ of Execution and Notice of Levy on Permanent Fund Dividend by Certified Mail 1. Full Name of Judgment Debtor: First DOB 2. Case Number Case Name Name of Judgment Creditor To: Department of Revenue Judgment creditor recovered a judgment against judgment debtor in this court in the amount shown below. This debt is for: child support ordered by the court or by a child support enforcement agency court ordered restitution in a criminal or delinquency case a defaulted Alaska education loan court ordered fine a civil judgment (1) against a minor or (2) against a parent or legal guardian of an unemancipated minor for destruction of property by the minor under AS 34.50.020 a debt to a state agency a domestic violence rehabilitation program required by the court or a parole board unpaid rent or damages owed to a landlord by an eligible individual who was a tenant of the landlord. The lease was entered into after September 14, 2014. court ordered forfeiture of an appearance or performance bond under AS 12.30.075 other You are notified that the Alaska Permanent Fund dividend to which the debtor is entitled is levied upon and garnished in an amount not exceeding the total amount due listed below.* You are commanded to send to the clerk of the above-named court that portion of the dividend levied upon which is not exempt from execution. CLERK OF COURT BY: Date STATEMENT OF AMOUNT DUE as of Total Judgment Minus Amt. Paid to Date on Judgment Balance ............................................................................ + Accrued Interest to October 15 ** Minus Amt. Paid to Date on Interest Interest Balance .............................................................. + Accrued Costs (incl. cost of serving this writ: fee + postage) Minus Amt. Paid to Date on Costs Costs Balance ................................................................ + Last SSN Date of Judgment vs. Deputy Clerk (SEAL) *TOTAL AMOUNT DUE **Interest will be recalculated if any payments are received before the PFD is seized CIV-502 (6/16)(cs) WRIT OF EXECUTION ON PFD Server Code ­ Date ­ Writ Civil Rule 69(a), (f) & (i); AS 09.35.030 AS 43.23.065; Adm. Bulletin 68 American LegalNet, Inc. www.FormsWorkFlow.com 09208