Affidavit For Order Of Wage Garnishment Form
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4Affidavit for Order of Wage Garnishment (Continuous or as Designated)
U
S
D
C
NITED
TATES
ISTRICT
OURT
WESTERN
D
K
ISTRICT OF
ENTUCKY
at
_______________
Case No. _________________
AFFIDAVIT FOR ORDER OF WAGE GARNISHMENT
Judgment Debtor:
Date of Judgment:
Post Judgment Int Rate:
%
Judgment Creditor:
Amount of Judgment:
$
Pre-judgment Interest:
$
Garnishee (Employer):
Allowed Court Costs:
$
Amount Due:
$
AFFIDAVIT
The undersigned affiant is counsel for Judgment Creditor, or is the Judgment Creditor, and states
as follows:
1.
The above named Judgment Debtor is not now nor has been at any time during the pendency of this
action, in the active military service of the United States of America..
2.
The date of the Judgment and the amount due thereon (subject to any credits due for any sums currently
being processed) are stated above.
3.
The Garnishee (Employer) listed above is believed to be indebted to the Judgment Debtor.
4.
The Notice of Rights to Assert Exemption to Wage Garnishment will be sent to the Judgment Debtor
within five (5) business days of sending this Affidavit to the U.S. District Court Clerk.
5.
Any garnished funds will be held by Affiant for a period of thirty (30) days from the issuance date on the
employer's garnishment check.
WHEREFORE: The Judgment Creditor prays for garnishment against the Judgment Debtor; that
the Garnishee named herein be made a party to this action, and that the Garnishee be required to answer the
Garnishment issued hereunder; and for its costs.
___________________________________________
Affiant
Subscribed and sworn to before me by the above affiant this ____ day of ______________, 20_____.
My commission expires:__________________________________
_____________________________________________
Notary Public, State at Large
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