Affidavit For Wage Deduction Order {20C}

IN THE CIRCUIT COURT OF THE TWELFTH JUDICIAL CIRCUIT WILL COUNTY, ILLINOIS _______________________________________ Plaintiff vs _______________________________________ Defendant and _______________________________________ Employer CASE NO: ________________________________ RETURN DATE: ___________________________ (21 to 40 days after date of issuance of summons) TIME & LOCATION: 9:00 a.m.; 14 W. Jefferson Street, Joliet, Illinois 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 is: _____________________________________________________________________________________________. 2. The last known address of the judgment debtor is: _________________________________________________________ _________________________________________________________________________________________________. I request that Circuit Court Clerk issue summons to the employer, I certify that a copy of the wage deduction notice was mailed to the judgment debtor, by first-class mail, at the last known address prior to the filing of this wage deduction affidavit. Attorney or Party, if not represented by Attorney Name _____________________________________ ARDC # ___________________________________ Firm Name _________________________________ Attorney for ________________________________ Address ____________________________________ City & Zip Code _____________________________ Telephone __________________________________ Affiant: ____________________________________________ Under penalty of perjury as provided by the law pursuant to 735 ILCS 5/1-109 the affiant certifies that the statements set forth herein are true and correct. Date: __________________________________, 20 _________ 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. I, the undersigned certify under penalties as provided by law pursuant to 735 ILCS 5/1-109 that the following information is true: 1. Judgment in the above captioned case was entered on the ___________ day of ____________________, 20 _____. 2. The amount of the Judgment was $ _______________________________________ 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 ________________________________________________________ (Attorney or Judgment Creditor) $ _______________________________________ $ _______________________________________ (OVER) *NOTE: Four (4) copies of this Affidavit must be served on the employer. Answer to interrogatories on the reverse side hereof to be filed prior to the above stated Return Date. (SEE REVERSE SIDE) American LegalNet, Inc. www.FormsWorkFlow.com 20C (Revised 12/16) INTERROGATORIES/ ANSWER TO WAGE DEDUCTION PROCEEDINGS Returned Date: _______________________________ Case No. ____________________________________ Employer/ Agent: ________________________________________, certifies under penalty of perjury that the following Answer is true and correct to the best of her/his knowledge and belief concerning the property of the judgment debtor. Debtor Name: _____________________________________________ Social Security Number: _____________________________ XXX-XXYES NO Do you pay monies to the judgment debtor listed above? State whether any funds paid to the debtor are for disability, retirement or are in any other way exempt or subject to other Court Order: _________________________________________________________________________________________________ One Pay Period equals: ______________________ day(s) _____________________ week(s) _________________________month(s) CALCULATION TO DETERMINE AMOUNT OF WITHHOLDING: (A) Gross Wages minus mandatory contributions to pension or retirement plan: (B) METHOD I - 15% of (A): (A) $________________________________ (B) $________________________________ (C) METHOD II - the greater of (a) the amount that the weekly disposable earnings exceeds the minimum hourly wages or (b) the minimum hourly wage prescribed by Section 4 of the Minimum Wage Law (1) Enter Total FICA, State and Federal Tax and Medicare: $_______________________ (2) Subtract Line (1) from (A): $_______________________ (3) Enter Minimum Wage per pay period: $_______________________ (C) $________________________________ (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 of 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): (2% of the amount to be deducted) (D) $________________________________ (E) $________________________________ (F) $________________________________ (G) $________________________________ (H) $________________________________ (H) Amount to be applied to judgment *Line (F) is the amount to be withheld from employee's paycheck each pay period after the date of service of Summons and not to be disbursed until further order of Court. THIRD PARTY EMPOYER CERTIFICATION 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 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 Interrogatories/Answer to the Defendant. Date: ________________________, 20 ______ Phone Number: _________________________ Fax Number: ___________________________ Signature of Employer/Agent: _________________________________________ Print full name clearly: _______________________________________________ INSTRUCTIONS 1. 2. Mail a copy