Affidavit For Garnishment Non-Wage Form - Lake County, Illinois
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1
2IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT
LAKE COUNTY, ILLINOIS
)
)
Plaintiff(s) )
vs.
)
Gen No:
)
)
Defendant(s)
)
)
)
Garnishee
)
AFFIDAVIT FOR GARNISHMENT
NON-WAGE
_______________________________________ the affiant below, on oath states that:
1. Judgment was entered on_________________________________ 20 _______ , for the judgment creditor
____________________________ and against the judgment debtor ________________________________
for $ ________________________ and costs.
2. $ ________________ has been paid on the judgment.
3. There is unpaid on the judgment:
A. The amount of Judgment was: ......................................................... $ _________________
B. Allowable costs previously expended:
a. Initial filing fee .............................................................................. $ _________________
b. Original and alias summons ......................................................... $ _________________
c. Filing and summons cost of prior supplementary proceeding ..... $ _________________
C. Filing and summons cost for this proceeding................................... $ _________________
D. Statutory interest due on Judgment from date above .................... $ _________________
TOTAL UNPAID AMOUNT $ _________________
4. I believe garnishee _____________________________________________ is indebted to the judgment
debtor or has in his possession, custody or control property belonging to him or in which he has an interest.
5. The last known address of the judgment debtor is ________________________________________________
_______________________________________________________________________________________
6. I request that summons be issued and directed to the garnishee.
I, the undersigned certify under penalties as provided by law pursuant to section 1-109 of the Code of Civil Procedure of the
Illinois Compiled Statutes that the statements set forth in this instrument are true and correct.
_____________________________________________
Prepared by:
Signature
Attorney's Name: ___________________________________
Address: __________________________________________
City: ______________________________ State: __________
Phone: ______________________Zip Code: _____________
ARDC: ____________________________________________
Fax: ______________________________________________
E-mail address: _____________________________________
171-3 (Rev 1/14)
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