Request To Make Payments Form - Tennessee Page 4
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4Certificate of Service:
(How I gave this paper to the Plaintiff/Creditor)
I certify that I (check one box)
hand delivered or
mailed by first-class mail, properly addressed, a true and correct copy of this paper to the person
listed below at the address below:
Name of Who You Are Giving This To (The creditor’s lawyer or the plaintiff/creditor if no lawyer)
Address of the Lawyer or the Creditor (Include City, State and Zip Code)
on ___________________________________.
(Date you mailed/hand-delivered the copy)
______________________________________
Sign Your Name
IMPORTANT!
Take any proof that supports your case to the hearing, including: witnesses, photos, papers, receipts,
etc. The court will not accept written statements from witnesses. The person must go to court in
person. If you think a witness may not want to go to court, ask the clerk for subpoena forms.
Complete the subpoena as soon as possible so the sheriff can serve them before court.
The court and clerks are not allowed to give you legal advice, even if you don’t have a lawyer. This
form is a public record. It is not legal advice. The law may change and it is best to consult with a
lawyer if possible.
DO NOT FILL OUT THIS SECTION BELOW. THE JUDGE WILL FILL THIS SECTION OUT AT COURT.
The court denies this Request because (judge will check all that apply):
The defendant did not prove s/he has the right to make payments.
The defendant did not go to the court hearing for this case. This
Request is dismissed.
The defendant must pay court costs of: $
The court approves this Request because the defendant proved s/he has the right to make
payments. Garnishment will end, and the defendant will pay as follows:
Payments of: $
, on the
day of each (month, week, other):
starting (date):
until (date of final payment):
,
Payments will be made to (check one): Plaintiff or his/her lawyer Court Clerk
The Plaintiff did not show up to court (Default)
This decision was made by (check one):
After a court hearing.
By agreement of the parties.
□ a.m.
A review of this decision is set for
_________________________ at (
(Date)
Time) ____________
□ p.m.
(Location)____________________________________________________________________
Judge’s signature:
Date:
December 2012
Request to Make Payments
Page 4 of 4
Approved by the Tennessee Supreme Court
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