Plaintiff:
Name
Plaintiff's contact information:
Civil Action File No.
Street Address
City State ZIP Code
Email Address
) ) ) ) ) ) ) ) Name ) ) ) ) ) ) ) ) )
Phone Number
Bar Number
Defendant:
Name
Street Address
City State ZIP Code
Garnishee:
Name
Street Address
N NN TNT (SE OS a OE ES OS OES SES a
City State ZIP Code
Personally appeared , who on oath says: (Print name) 1. I am the (Plaintiff) (Attorney at Law for Plaintiff) (Agent for Plaintiff). [Circle one]
2. The Plaintiff obtained a judgment against the Defendant in
Case Number in the
Court of County, , and State
no agreement requires forbearance from the garnishment which is
applied for currently.
3. The Affiant states that the Defendant is in arrears on the obligation for support in an amount equal to or in excess of one month’s obligation as decreed in the judgment for support and provides the following information:
is the amount of arrearage which exists under the judgment as of the execution of this affidavit.
Check one of the boxes below and complete the requested information:
A. [| Periodic support is owed for one obligee, or the judgment sets forth a total amount of periodic support for multiple obligees
as follows: $ is the total amount of periodic support due for , , and Name of obligee Name of obligee
Such periodic support is payable
Name of obligee ona basis. E.g., weekly, monthly The termination date of the obligation for periodic support is
Date
B. [] Periodic support is owed for mul-tiple obligees, and the judgment sets forth a different amount of periodic support for each obligee as follows:
$ is the total amount of periodic support due for , payable on a Name of obligee E.g., weekly, monthly basis, and the termination date of such obligation is ;
Date $ is the total amount of periodic support due for , payable on a Name of obligee E.g., weekly, monthly basis and the termination date of such obligation is
Date
$ is the total amount of periodic support due for , payable on a
Name of obligee E.g., weekly, monthly basis, and the termination date of such obligation is
Date
4. [] Check this box and attach a certified copy of the judgment for support hereto.
5. Upon the Affiant’s personal knowledge or belief, the sum stated herein is unpaid.
6. The Affiant believes that the Garnishee is an employer of or under periodic obligations for payment of funds to the Defendant.
This day of , 20 Affiant Print name of Affiant Sworn to and subscribed before me this day of , 20
Notary Public or Deputy Clerk of Court”