Fill and Sign the Ohio Interim Form

______________ COUNTY MUNICIPAL COURT INTERIM / FINAL REPORT AND ANSWER OF GARNISHEE (2716.07, 08 ORC) ____________________________________________________________ Judgment Creditor VS. CASE NO. _______________________________________________ ____________________________________________________________ Please note: make multiple copies of this form, as a newly completed copy Judgment Debtor must be sent with each payment at least once every 30 days. The Garnishee __________________________________________________________________________________ _, in the above case states as follows: INTERIM REPORT 1. The date that the garnishee received the garnishment order of the judgment debtor’s personal earnings was _____________________________________ 2. The total probable amount due on the judgment, including court costs, judgment interest and, if applicable, pre-judgment interest, as stated in either section A of the garnishment order of the judgment debtor’s personal earnings or in the Affidavit of Current Balance Due of the Garnishment Order if that affidavit has been received subsequent to the garnishment order, is $______________________________________________________________________ 3. The pay period of the judgment debtor is (enter weekly, biweekly, semimonthly, or monthly. Do not enter a pay period of more than one month) _________________________ 4. The disposable earnings of the judgment debtor earned during the judgment debtor’s present pay period is (“Disposable Earnings” means earnings after deductions required by law. “Present Pay Period” means the pay period for which you are completing this Interim/Final Report & Answer of Garnishee). $______________________________ 5. The amount equal to 25% of the judgment debtor’s disposable earnings set forth in section 4 of this form is $____________________________________ 6. ________________times the current federal minimum hourly wage is (if the judgment debtor is paid weekly, enter 30, if paid biweekly, enter 60, if paid semimonthly, enter 65, if paid monthly, enter 130, then calculate the amount). $______________________________________ 7. The amount by which the amount in section 4 of this form exceeds the amount in section 6 of this form is $______________________________________ 8. The smallest of either the amount entered in section 5 of this form, the amount entered in section 7, or the amount entered in section 2 is, $___________________________ 9. The amount entered in section 8 of this form, plus or minus, as appropriate, the garnishee’s processing fee is $______________ (if the amount entered in section 8 equals the amount entered in section 2, then add up to $3.00; otherwise subtract up to $3.00) 10. Other deductions $_________________________ 11. The calculated amount that has been withheld from the judgment debtor’s personal earnings during the judgment debtor’s present pay period and that is submitted with this Interim/Final report and Answer of Garnishee is $________________________________ FINAL REPORT (in addition to questions 1 & 2, answer the following questions when filing a Final Report) 3. The total probable amount that has been withheld from the judgment debtor’s disposable earnings and paid to the court while the garnishment order of the judgment debtor’s personal earnings remained in effect is $____________________________________ 4. (When applicable) the total probable amount due on the judgment (stated in 2 above) is not equal to the total amount that has been withheld (stated in 3 above), and the reason for that difference is that the garnishment order of the judgment debtor’s personal earnings ceased to be in effect for the following statutorily prescribed reason(s) (check whichever apply): (A)_____ A municipal or county court appointed a trustee for the judgment debtor and issued an order that stays the garnishment order of the debtor’s personal earnings. (B)_____ A federal bankruptcy court issued an order that stays the garnishment order of the judgment debtor’s personal earnings. (C)_____ A municipal, county, or common pleas court issued another garnishment order of personal earnings that related to the debtor and a different creditor, and Ohio or federal law provides the other order a higher priority. Set forth the name of the court that issued the higher priority order, the associated case number, the date that the higher priority order was received, and the balance due to the relevant judgment creditor under that order: ________________ ______________________________________________________________________________________________________________________________ (D)_____ A municipal, county, or common pleas court issued another garnishment order of personal earnings that relates to the debtor and a different creditor and that is not described in 4(C) above. Set forth the name of the court that issued the subsequently received order, the associated case number, the date that the subsequent order was received, and the balance due to the relevant judgment creditor under that order: _________________________________ ______________________________________________________________________________________________________________________________ (E)_____ The creditor or creditor’s attorney has issued a request that the garnishment order be terminated and the garnishee released from mandates of the garnishment order. (F)_____ Judgment debtor’s employment terminated on: ________________________________________________________________________________ (G)_____ Other: ________________________________________________________________________________________________________________ I CERTIFY THAT THE STATEMENTS ABOVE ARE TRUE. _________________________________________________________ATTY. I.D _______________ JUDGMENT CREDITOR/ATTORNEY __________________________________________________________________________________ ADDRESS __________________________________________________________________________________ CITY, STATE, ZIP CO DE PHONE NUMBER __________________________________________________________________________________ FOR CLERK OF COURT USE ONLY REVISED 09/00 Holding (For Clerk Use Only) $ Cash Check EMPLOYER NAME AND TITLE OF PERSON COMPLETING FORM SIGNATURE OF PERSON COMPLETING FORM PHONE NUMBER DATE THIS FORM IS INTENDED FOR USE AS EITHER AN INTERIM OR A FINAL REPORT AS NEEDED COPYRIGHT 2000 ALL RIGHTS RESERVED