Fill and Sign the Plaintiffs Name Address Zip Code and Phone Form

POST JUDGMENTPAYMENT AGREEMENT Docket No. Trial Court of Massachussetts District Court Department Judgment has entered for the plaintiff in the amount of $ ___________. Defendant agrees to pay plaintiff $ ___________ on or before ____/____/_______ Defendant agrees to pay plaintiff $ ___________ each week/month. The first payment is to be made to the plaintiff on or before _____/_____/_______ Other _______________________________________________________________________________________________ It is agreed that interest will will not continue to accrue on the unpaid balance until the total amount has been received by the plaintiff. Signatures: Payments shall be mailed to ____________________________________________________________________________ This form must be used to provide the terms of any small claim, supplementary process, or summary process payment agreement made by the parties. Under the law, the defendant cannot be ordered to pay a civil judgment with any income received from certain public assistance and benefit programs. In addition, a certain amount of a defendant's earnings is exempt from inclusion in a court payment order, see page 2. The parties should consider these exemptions when entering into a payment agreement. Plaintiff's Name, Address, Zip Code and Phone ____________________________________________ ____________________________________________ ____________________________________________ TERMS OF THE PARTIES' AGREEMENT Plaintiff or Plaintiff's Attorney Defendant or Defendant's Attorney The parties must bring this completed Agreement before a Clerk so that the Court may consider entry of the Agreement as a Court Order. Each party should keep a completed copy of this Agreement. C O U R T O R D E R The agreement set forth above is hereby entered as an order of this court, and will be enforceable as such. Next court date (if applicable): The parties are hereby ordered to appear in this Court on / / at __________ If the defendant does not comply with this agreement and/or fails to appear on the scheduled date he or she may be subject to contempt and a capias may issue for his or her arrest. SIGNATURE OF JUDGE OR MAGISTRATE : Date: Defendant's Name, Address, Zip Code and Phone _____________________________________________ _____________________________________________ _____________________________________________ Court • Veterans' Benefit Veterans Benefits pursuant to G.L. c. 115, § 5 Veteran's Benefits pursuant to 38 USC § 5301 (a) Special Benefits for certain WWII Veterans, 42 USC § 1001 Veterans' Medal of Honor Benefits, 38 USC § 1562 • • Unemployment Benefits, G.L. c. 151A, § 36 • Workers' Compensation, G.L. c. 152 • Social Security Benefits, 42 USC § 401 • Federal Old-Age, Survivors & Disablity Insurance Benefits , 42 USC § 407 • Maternal Child Health Services Block Grant, 42 USC § 701 • SSI for Aged, Blind and Disabled, 42 USC § 1381 (a)2. In addition, the following amount of earnings is exempt and cannot be ordered to satisfy any judgment and payment order of the court. The exempt amount is whichever of the following is greater: (A) the first $125 of weekly wages per week (G.L. c. 246, § 28) OR (B) 25% of weekly disposable earnings* or $154.50** (30 x federal minimum wage) of weekly disposable income , whichever is less (15 U.S.C. 1671 - 1677). * "Disposable earnings" means that part of the earnings of any individual remaining after the deduction from those earnings of any amounts required by law to be withheld. ** This assumes the federal minimum wage is $5.15 per hour. • Veterans' Benefit Veterans Benefits pursuant to G.L. c. 115, § 5 Veteran's Benefits pursuant to 38 USC § 5301 (a) Special Benefits for certain WWII Veterans, 42 USC § 1001 Veterans' Medal of Honor Benefits, 38 USC § 1562 • • Unemployment Benefits, G.L. c. 151A, § 36 • Workers' Compensation, G.L. c. 152 • Social Security Benefits, 42 USC § 401 • Federal Old-Age, Survivors & Disablity Insurance Benefits , 42 USC § 407 • Maternal Child Health Services Block Grant, 42 USC § 701 • SSI for Aged, Blind and Disabled, 42 USC § 1381 (a)2. In addition, the following amount of earnings is exempt and cannot be ordered to satisfy any judgment and payment order of the court. The exempt amount is whichever of the following is greater: (A) the first $125 of weekly wages per week (G.L. c. 246, § 28) OR (B) 25% of weekly disposable earnings* or $154.50** (30 x federal minimum wage) of weekly disposable income , whichever is less (15 U.S.C. 1671 - 1677). * "Disposable earnings" means that part of the earnings of any individual remaining after the deduction from those earnings of any amounts required by law to be withheld. ** This assumes the federal minimum wage is $5.15 per hour. • Veterans' Benefit Veterans Benefits pursuant to G.L. c. 115, § 5 Veteran's Benefits pursuant to 38 USC § 5301 (a) Special Benefits for certain WWII Veterans, 42 USC § 1001 Veterans' Medal of Honor Benefits, 38 USC § 1562 • • Unemployment Benefits, G.L. c. 151A, § 36 • Workers' Compensation, G.L. c. 152 • Social Security Benefits, 42 USC § 401 • Federal Old-Age, Survivors & Disablity Insurance Benefits , 42 USC § 407 • Maternal Child Health Services Block Grant, 42 USC § 701 • SSI for Aged, Blind and Disabled, 42 USC § 1381 (a)2. In addition, the following amount of earnings is exempt and cannot be ordered to satisfy any judgment and payment order of the court. The exempt amount is whichever of the following is greater: (A) the first $125 of weekly wages per week (G.L. c. 246, § 28) OR (B) 25% of weekly disposable earnings* or $154.50** (30 x federal minimum wage) of weekly disposable income , whichever is less (15 U.S.C. 1671 - 1677). * "Disposable earnings" means that part of the earnings of any individual remaining after the deduction from those earnings of any amounts required by law to be withheld. ** This assumes the federal minimum wage is $5.15 per hour. • Veterans' Benefit Veterans Benefits pursuant to G.L. c. 115, § 5 Veteran's Benefits pursuant to 38 USC § 5301 (a) Special Benefits for certain WWII Veterans, 42 USC § 1001 Veterans' Medal of Honor Benefits, 38 USC § 1562 • • Unemployment Benefits, G.L. c. 151A, § 36 • Workers' Compensation, G.L. c. 152 • Social Security Benefits, 42 USC § 401 • Federal Old-Age, Survivors & Disablity Insurance Benefits , 42 USC § 407 • Maternal Child Health Services Block Grant, 42 USC § 701 • SSI for Aged, Blind and Disabled, 42 USC § 1381 (a)2. In addition, the following amount of earnings is exempt and cannot be ordered to satisfy any judgment and payment order of the court. The exempt amount is whichever of the following is greater: (A) the first $125 of weekly wages per week (G.L. c. 246, § 28) OR (B) 25% of weekly disposable earnings* or $154.50** (30 x federal minimum wage) of weekly disposable income , whichever is less (15 U.S.C. 1671 - 1677). * "Disposable earnings" means that part of the earnings of any individual remaining after the deduction from those earnings of any amounts required by law to be withheld. ** This assumes the federal minimum wage is $5.15 per hour.