Fill and Sign the Garnishee Form

STATE OF INDIANA IN THE ___________ SUPERIOR COURT NO. _________ ) SS: COUNTY OF _____________ ) CAUSE NO. ____________ ______________________________, Plaintiff(s), vs. ______________________________, ______________________________, Defendant, and Garnishee Defendant (Employer). ______________________________ Defendant’s Social Security Number NOTICE: Indiana Code § 34-1-11-21 provides that the Garnishee Defendant (Employer) is accountable for monies in his hands and/or payable to Defendant from the date of the service of these interrogatories. INTERROGATORIES PROPOUNDED TO GARNISHEE DEFENDANT (EMPLOYER) Plaintiff submits the following interrogatories to be answered by the Garnishee Defendant: (All questions must be answered) 1. Is Defendant in your employ? Yes No 2. If Defendant is no longer in your employ, do you retain any monies payable to him? Yes No If yes, how much? $_____________________________. 3. If the Defendant is no longer employed by you, what is the name and address of Defendant’s current employer?_______________________________________________________________________________. 4. What is Defendant’s residence address? _____________________________________________________. 5. What is Defendant’s Social Security number? ___________________ Date of Birth?_________________. 6. If defendant is on an hourly pay rate, what is that rate? _________________________________________. 7. What is Defendant’s pay period? (Weekly/bi-weekly/monthly) ___________________________________. 8. If Defendant is on a salary, what is his gross salary? ___________________________________________. 9. State the amount of any other wages, salary, commissions, rebates, profits, or income the defendant draws for receives from you other than those above. $_______________________________. 10. Are there, at present, any garnishments or wage attachments on Defendant’s earnings? Yes No If yes, list the cause numbers:_________________________________________________________. I swear or affirm, under the penalty of perjury, that the foregoing representations are true. Date signed:__________________ _________________________________________ Signature Please return to: _________________________________________ __________________________________ _____________________________________ County Clerk Printed Name __________________________________ __________________________________ _________________________________________ Position with Garnishee Defendant (Employer)