Fillable Garnishment Or Court Order Information Form printable pdf download

Garnishment Or Court Order Information Form

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Garnishment Or Court Order Information Form

Client Code:

Sent By:

Special

Your four digit

Instructions:

company code

Company Name:

Phone Number

Specify New or Changed Order

Specify Type Of Order

Employee Number

SSN

Employee Name

Custodial Parent or

Cause Number

Expiration Date

Plaintiff

ISETS Number

FIPS Number

Do Not Create

Note: Payment checks are

Payment Check

created each payroll unless

otherwise indicated.

Make Check

Payable to:

Court Fees:

Include complete

address.

Please choose a withholding option/calculation below:

Child Support

Not More Than the % of DI here.

Support Amount

Amount Exempt

IRS Levy

Goal Amount

Per Pay Period

Garnishment

Weekly: if DI is greater than $290.00 take 25%.

Less than $290.00 but greater than $217.50 take the difference.

Goal Amount

If DI is less than $217.50 is Exempt.

BiWeekly: If DI is greater than $580.00 take 25%.

If less than $580.00 but greater than $435.00 take the difference

Goal Amount

If DI less than $435.00 is Exempt

Semi-Monthly: if DI is greater than $628.33 take 25%

If less than $628.33 but greater than $471.25 take the difference

Goal Amount

If DI is less than $471.25 is Exempt

Monthly: If DI is greater than $1256.67 take 25%

If DI is less than $1256.67 but greater than $942.50 take the difference

Goal Amount

If DI is less than $942.50 is Exempt

Flat Amount

Amount

Goal Amount

Other

calculation:

Please explain

Client is responsible for accuracy and verification of the information provided. Court

FOR INTERNAL USE ONLY:

ordered deductions are the employer's responsibility.

Received: ____/____/____ Processed by: _____________

Signature:

Process Run Number: _______

Garnishment Or Court Order Information Form

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