Fill and Sign the Execution Levy on Earnings Minnesota Judicial Branch Form

- 1 - STATE OF MINNESOTA DISTRICT COURT COUNTY OF JUDICIAL DISTRICT FAMILY COURT DIVISION In Re the Marriage of: Court File No. , Judgment Creditor, , NOTICE OF THIRD PARTY Judgment Debtor, LEVY AND DISCLOSURE , Third Party, PL EA SE T A KE N O TIC E th at p urs u an t to M in n eso ta S ta tu te s, s e ctio ns 5 51.0 4 a n d 5 51.0 6, th e u nders ig ned , a s a tto rn ey f o r th e ju dgm en t c re d ito r, h ere b y m ak es d em an d a n d le v ie s e x ecu tio n up on a ll e arn in gs d ue a n d o w in g b y y ou ( u p to $ ) to th e ju dgm en t d eb to r f o r th e a m ount o f th e j u dgm en t s p ecif ie d b elo w . A c o py o f t h e w rit o f e x ecu tio n i s su ed b y t h e C ourt i s e n clo se d . T he un paid j u dgm en t b ala n ce i s .T his le v y a tta ch es a ll u npaid n onex em pt d is p osa b le e arn in gs o w in g o r to b e o w ed b y y ou an d e arn ed o r to b e e arn ed b y th e ju dgm en t d eb to r b efo re a n d w ith in th e p ay p erio d in w hic h th e writ o f e x ecu tio n is s e rv ed a n d w ith in a ll s u bse q uen t p ay p erio ds w hose p ay day s o ccu r w ith in th e 70 d ay s a fte r t h e s e rv ic e o f t h is l e v y.In r e sp ondin g to th is le v y, y ou a re to c o m ple te th e a tta ch ed d is c lo su re f o rm a n d w ork sh eet an d m ail it to th e u nders ig n ed a tto rn ey f o r th e ju dgm en t c re d ito r, to geth er w ith y our c h eck p ay ab le to th e a b ove-n am ed ju dgm en t c re d ito r, fo r th e n on-e x em pt a m ount o w ed b y y ou to th e ju dgm en t de b to r o r f o r w hic h y ou a re o blig ate d to th e ju dgm en t d eb to r, w ith in th e tim e lim its s e t f o rth in th e afo re m en tio ned s ta tu te s. - 2 - Date d : N am e: T itle : A ddre ss: A ddre ss: C ity , S ta te , Z ip : P hone: F ax : E -M ail: A tto rn ey R eg . N o.: - 3 -DIS C LO SU RED EFIN IT IO NS "E A RN IN GS": For th e p urp ose o f ex ecu tio n , "e arn in gs" m ean s co m pen sa tio n p aid o r pa y ab le to a n e m plo yee f o r p ers o nal s e rv ic es o r c o m pen sa tio n p aid o r p ay ab le to th e p ro ducer f o r th e sa le o f ag ric u ltu ra l p ro ducts ; m ilk o r m ilk p ro ducts ; o r fru it o r o th er h ortic u ltu ra l p ro ducts pro duce d w hen t h e p ro duce r i s o pera tin g a f a m ily f a rm , a f a m ily f a rm c o rp ora tio n, o r a n a u th oriz ed farm co rp ora ti o n, as d efin ed in se ctio n 5 00.2 4, su bdiv is io n 2 , w heth er d en om in ate d as w ag es, sa la ry , c o m mis sio n, b onus, o r o th erw is e , a n d in clu des p erio dic p ay m en ts p urs u an t to a p en sio n o r re tir e m en t." D IS PO SA BLE E A RN IN GS": M ean s th at p art o f th e e arn in gs o f a in div id ual re m ain in g afte r th e d ed uctio n fro m th o se e arn in gs o f a m ounts re q uir e d b y la w to b e w ith held . (A m ounts re q uir e d by la w to be w ith held do not in clu de it e m s su ch as health in su ra n ce, ch arita b le co ntr ib utio ns, o r o th er v olu n ta ry w ag e d ed uctio ns.)" P A YDAY": F or th e p urp ose o f e x ecu tio n, " p ay day (s )" m ean s th e d ate (s ) u pon w hic h th e em plo yer p ay s e arn in gs to th e ju dgm en t d eb to r in th e o rd in ary c o urs e o f b usin ess. If th e ju dgm en t de b to r h as n o r e g ula r p ay day , p ay day (s ) m ean s t h e 1 5th a n d t h e l a st d ay o f e ach m onth .T H E T H IR D P A RTY /E M PL O YER M UST A NSW ER T H E F O LLO W IN G Q UEST IO NS:1. D o y ou n ow o w e, o r w ith in 7 0 d ay s f ro m th e d ate o f th e e x ecu tio n le v y w as s e rv ed o n yo u, w il l y ou o r m ay y ou o w e m oney t o t h e j u dgm en t d eb to r f o r e arn in gs? Y es N o 2. D oes t h e j u dgm en t d eb to r e arn m ore t h an $ p er w eek ? ( T his a m ount i s t h e f e d era l min im um w ag e p er w eek .)Y es N o IN ST R U CTIO N S F O R C O M PL ETIN G T H E E A RN IN GS D IS C LO SU RE A . If y our a n sw er to e ith er q uestio n 1 o r 2 is " N o," th en y ou m ust s ig n th e a ffir m atio n o n pag e 2 a n d re tu rn th is d is c lo su re to th e ju dgm en t c re d ito r's a tto rn ey w ith in 2 0 d ay s a fte r it w as se rv ed o n y ou, a n d y ou d o n ot n eed t o a n sw er t h e r e m ain in g q uestio ns:B . If y our a n sw ers to b oth q uestio ns 1 a n d 2 a re " Y es," y ou m ust c o m ple te th is f o rm a n d th e E arn in gs D is c lo su re W ork sh eet a s f o llo w s:F or e ach p ay day th at fa lls w ith in 7 0 d ay s fro m th e d ate th e e x ecu tio n le v y w as s e rv ed o n you, Y OU M UST c alc u la te th e a m ount o f e arn in gs to b e re ta in ed b y c o m ple tin g s te p s 3 th ro ugh 2 2 o n p ag e 2 , a n d e n te r t h e a m ounts o n t h e E arn in gs D is c lo su re W ork sh eet. U PO N REQ UEST , T H E E M PL O YER M UST P R O VID E T H E D EB TO R W IT H I N FO RM ATIO N AS T O H OW T H E C A LC U LA TIO NS R EQ UIR ED B Y T H IS D IS C LO SU RE W ER E MA DE. - 4 - Each p ay day , y ou m ust re ta in th e a m ount o f e arn in gs lis te d in c o lu m n I o n th e E arn in gs Dis c lo su re W ork sh eet.Y ou m ust p ay th e atta ch ed earn in gs an d re tu rn th is E arn in g D is c lo su re F orm an d th e Ea rn in gs D is c lo su re W ork sh eet to th e ju dgm en t c re d ito r's a tto rn ey a n d d eliv er a c o py to th e ju dgm en t d eb to r w it h in t e n d ay s a fte r t h e l a st p ay day t h at f a lls w ith in t h e 7 0-d ay p erio d.If th e ju dgm en t is w holly s a tis fie d o r if th e ju dg m en t d eb to r's e m plo ym en t e n ds b efo re th e ex pir a tio n o f th e 7 0 -d ay p erio d, y our d is c lo su re a n d r e m itta n ce s h ould b e m ad e w ith in te n day s a fte r t h e l a st p ay day f o r w hic h e arn in gs w ere a tta ch ed . F or s te p s 3 t h ro ugh 1 1, " c o lu m ns" r e fe rs t o c o lu m ns o n t h e E arn in gs D is c lo su re W ork sh eet.3 . CO LU M N A . Ente r t h e d ate o f j u dgm en t d eb to r's p ay day .4. CO LU M N B . Ente r j u dgm en t d eb to r's g ro ss e arn in gs f o r e ach p ay day .5. CO LU M N C . Ente r j u dgm en t d eb to r's d is p osa b le e arn in gs f o r e ach p ay day .6. CO LU M N D . Ente r 2 5 p erc en t o f d is p osa b le e arn in gs ( M ultip ly C olu m n C b y . 2 5.)7 . CO LU M N E . Ente r h ere 4 0 tim es th e h ourly fe d era l m in im um w ag e ($ ____) tim es th e nu m ber o f w ork w eek s in clu ded in e ach p ay day . (N ote : If a p ay p erio d in clu des d ay s in e x cess o f w hole w ork w eek s, th e a d ditio nal d ay s s h ould b e co unte d a s a fra ctio n o f a w ork w eek e q ual to th e n um ber o f w ork d ay s in excess o f a w hole w ork w eek d iv id ed b y th e n um ber o f w ork d ay s in a no rm al w ork w eek .)8 . CO LU M N F . Subtr a ct th e a m ount in C olu m n E f ro m th e a m ount in C olu m n C , a n d e n te r he re .9 . CO LU M N G . Ente r h ere th e le sse r o f th e a m ou nt in C olu m n D a n d th e a m ount in C olu m n F.10 . CO LU M N H . Ente r h ere a n y a m ount c la im ed b y y ou a s a s e to ff, d efe n se , lie n , o r c la im , o r an y a m ount c la im ed b y a n y o th er p ers o n a s a n e x em ptio n o r a d vers e i n te re st wh ic h w ould re d uce th e a m ount o f e arn in gs o w in g to th e ju dgm en t d eb to r. (N ote : A ny in deb te d ness to y ou in cu rre d w ith in te n d ay s p rio r to y our re ceip t o f th e fir s t e x ecu tio n le v y o n a d eb t m ay n ot b e s e t o ff a g ain st th e ea rn in gs o th erw is e s u bje ct to th is le v y. A ny w ag e a ssig nm en t m ad e b y th e ju dgm en t d eb to r w ith in te n d ay s p rio r to y our re ceip t o f th e fir s t e x ecu tio n lev y o n a d eb t i s v oid .) Y ou m ust als o d esc rib e y our cla im (s ) an d th e cla im s o f o th ers , if k now n, in th e sp ace pro vid ed b elo w th e w ork sh eet a n d s ta te th e n am e(s ) a n d a d dre ss(e s) o f th ese pe rs o ns.E nte r z ero in C olu m n H is th ere a re n o c la im s b y y ou o r o th ers w hic h w ould re d uce th e am ount o f e arn in gs o w nin g t o t h e j u dgm en t d eb to r. 1 1 . CO LU M N I . Subtr a ct th e a m ount in C olu m n H f ro m th e a m ount in C olu m n G a n d e n te r he re . T his is th e a m ount o f e arn in gs th at y ou m ust r e ta in f o r th e p ay day f o r - 5 - whic h th e ca lc u la tio ns w ere m ad e. The to ta l o f all am ounts en te re d in Colu m n I is th e am ount to b e re m itte d to th e atto rn ey fo r th e ju dgm en t cr e d ito r. A FFIR M ATIO N I, N am e ( p ers o n s ig nin g A ffir m atio n), a m t h e t h ir d p arty /e m plo yer o r I a m a u th oriz ed b y t h e th ir d p arty /e m plo yer to c o m ple te th is e arn in gs d is c lo su re , a n d h av e d one s o tr u th fu lly a n d to th e be st o f m y k now le d ge. D ate d : _ ______ __________ _____ _____________________________ S ig natu re_ ____________________________T itle_ ____________________________T ele p hone N um ber - 6 - EA RN IN GS D IS C LO SU RE W ORK SH EET ___________________________ Ju dgm en t D eb to r's N am e A B C P ay day G ro ss D is p osa b le D ate E arn in g s Earn in gs1 . _ __ _____________ $ ________________ $ ________________2 . _ __ _____________ $ ________________ $ ________________3 . _ __ _____________ $ ________________ $ ________________4 . _ __ _____________ $ ________________ $ ________________5 . _ __ _____________ $ ________________ $ ________________6 . _ __ _____________ $ ________________ $ ________________7 . _ __ _____________ $ ________________ $ ________________8 . _ __ _____________ $ ________________ $ ________________9 . _ __ _____________ $ ________________ $ ________________ 1 0 . _ _ ______ ________ $ ________________ $ ________________ D E F 2 5 % o f 4 0 X M in . C olu m n C C olu m n C W ag e m in us1 . _ __ _____________ $ ________________ $ ________________2 . _ __ _____________ $ ________________ $ ________________3 . _ __ _____________ $ ________________ $ ________________4 . _ __ _____________ $ ________________ $ ________________5 . _ __ _____________ $ ________________ $ ________________6 . _ __ _____________ $ ________________ $ ________________7 . _ __ _____________ $ ________________ $ ________________8 . _ __ _____________ $ ________________ $ ________________9 . _ __ _____________ $ ________________ $ ________________ 1 0 . _ _ ______ ________ $ ________________ $ ________________ G H I L esso r o f S et o ff, L ie n C olu m n G C olu m n D A dvers e m in us a n d I n te re st, o r C olu m n H C olu m n F O th er C la im s 1. _ __ _____________ $ ________________ $ ________________2 . _ __ _____________ $ ________________ $ ________________3 . _ __ _____________ $ ________________ $ ________________4 . _ __ _____________ $ ________________ $ ________________5 . _ __ _____________ $ ________________ $ ________________6 . _ __ _____________ $ ________________ $ ________________7 . _ __ _____________ $ ________________ $ ________________8 . _ __ _____________ $ ________________ $ ________________ - 7 - 9. _ __ _____________ $ ________________ $ ________________ 1 0. _ _______________ $ ________________ $ ________________ T O TA L O F C O LU M N I $ ________________ * If y o u e n te re d a n y a m ount in C olu m n H f o r a n y p ay day (s ), y ou m ust d esc rib e b elo w e ith er y our c la im s, or th e c la im s o f o th ers . F or a m ounts c la im ed b y o th ers , y ou m ust b oth s ta te th e n am es a n d a d dre sse s o f th ese pe rs o ns, a n d t h e n atu re o f t h eir c la im , i f k now n. _ __ ___ ___________ _______________ ____________ ____ ________________ ____________ __ ___ ___________ _______________ ____________ ____ ________________ ____________ __ ___ ___________ _______________ ____________ ____ ________________ ____________ __ ___ ___________ _______________ ____________ ____ ________________ ___________ AF FIR M ATIO N I, N am e ( p ers o n s ig n in g A ffir m atio n), a m th e th ir d p arty o r I a m a u th oriz ed b y th e th ir d p arty to c o m pete th is e arn in gs d is c lo su re w ork sh eet, a n d h av e d one s o t r u th fu lly a n d t o t h e b est o f m y k now le d ge. D ate d : _ _____ _______ _____________________________ S ig natu re_ ____________________________T itle_ ____________________________T ele p hone N um ber