State of North Dakota | ) | In ___________ Court | ||
) | ss. | |||
County of __________ | ) | ____________________ | ||
____________________________________________________________ | ||||
Plaintiff | ||||
vs. | ||||
____________________________________________________________ | ||||
Defendant | ||||
and | Garnishment Disclosure | |||
____________________________________________________________ | ||||
Garnishee |
I am the __________________ of the garnishee and duly authorized to disclose for the garnishee.
On ______________, ______, the time of service of garnishee summons on the garnishee, there was due and owing the defendant from the garnishee the following:
a. Total earnings in pay period | ________ |
b. Federal tax | ________ |
c. State tax | ________ |
d. FICA (social security/Medicare) | ________ |
e. Total deductions (lines b+c+d) | ________ |
f. Disposable earnings (line a less line e) | ________ |
g. Twenty-five percent of line f | ________ |
h. Minimum wage exemption (minimum wage times forty hours times number of weeks in pay period) | ________ |
i. Line f less line h | ________ |
j. Line g or line i (whichever is less) | ________ |
k. Dependent exemption (twenty dollars per dependent per week, if claimed) | ________ |
l. Adverse interest or setoff | ________ |
m. Total of lines k and l | ________ |
n. Line j less line m (the amount of earnings subject to garnishment) | ________ |
Signature ___________________________
Garnishee or Authorized Representative of Garnishee
____________________
Title
Subscribed and sworn to before me on ______________, _____.
____________________
Notary Public
N.D.C.C. § 32-09.1-09