ÿWPCŽ  
      5     Í;ü¦¹Œù×Èo~m>@U6½Ì¥ãö{ðì¨‹€ 5ÉCoð×Ñ«2_q§l=ŒÃ²Õe ñø–Ì´Zóu &æ{Äy<S[ÎgÒæÄ•Þ<¿²g„´-Ãˆ˜â îŽ2@~6uŠ¬
SõM‡¤:“À'ö
0(¥CÛg°?í},€Ý¡W9ÍûÐ8öIImlÇ{ªÛZñ…+©XL–È¼dµš¿1…^ÛE½a¥›dQXfUœ©Ý'&´ŠxN:#MŒÂxç’2x®2Øàä.\ª6€¥²²nó
?Añ¹³h{ÖLXß³9Õe·UÞ*X“ì"æÇÎZD"ã@ž"&Âm/žœÚàaÀµ=MØ“Þ^BI¹!É_>•à4ÿ†>®½9ÜUã‘#Ï–!”¡‰m×•ˆÉI F22·.íŠÝÐ +µ5ÂH™ ãéM6ú¶’`@­]$Rx¯„hò…¹ê€Íjd”!ìO5`;äÒ¨¨K7ÈV.È”hµ>?CtÿM&³êÜx5#rOÎÓÖûLúX¢)  ©=7¸oÏÂaóæÃŠ‚¿¯F…(3Ÿ°ú”v:m÷þ^Q}Ì\FÁyh)4o·¨` º`d$òR¥ZúDŠ×Äü $            U  >   ø     v  6  0   h   ¬  0   `     0   >   t  0   t   ²   U   (   &   U   J   N     "   ˜            ˜            ˜            ˜            ˜            ˜            ˜  	B      º  	B   +   ×  	D   /   	  	D   +   1	            1	            1	        \	  0   š   l	  #   É  
   U   N   Ï  	%        M      #     (   '  N      O            O  ^      Q  w      ]  4      a        u  	m      w   ô\	  	   `  ‹& T i m e s   N e w   R o m a n         
 '           Ø0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
            K J C    0    K J C   
 .      
       
       
           h                    ÿÿ: D e f a u l t   P a r a   D e f a u l t   P a r a g r a p h   F o n t       `                    ÿÿ: F o o t n o t e   R e f   F o o t n o t e   R e f e r e n c e       (                  ¿Š$       Ú    Ú0Ú
   
 Ú    \                 ÿÿ: B o d y   T e x t   I n   B o d y   T e x t   I n d e n t   Ó   X ÓÓ   X Ó                 $ ‹ L Y N N         ³ ˜kI  A   `  ‹2 W P   T y p o g r a p h i c S y m b o l s          
      Ñ   £ ÑÑ    „ Ñ                   d    '     S i n g l e 1         ÿÿÿd    )     1                        d x    d  '                              d x    d#| x            (   r               6$ ¡   ¡   Ô   .  .  ÔÔ    ÔÔ     ÔÓ      ÓÔ €  ô¸¨ ò  X X   ÔÔ €  ô¸¨ ò ò ô¸¨ Ô ˜\ \ K J C D C 0 1 \ S A V I N   9 0 6 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              È È È È È È È È 0                                                                                                                                                                 ( @øÐ  	   Z  ‹6 T i m e s   N e w   R o m a n   R e g u l a r           X   ;                                        ³ŽÞ<Z         Ë{/;    ê:i¢× +00             ÿU‹ÿ  ÀÀÀÝ
 ƒ  6! ÝÔ   .  .  ÔÔ    ÔÔ     ÔÓ      ÓÔ €  ô*» ò  X X   ÔÔ €  ô*» ò ò ô*» ÔÝ    ÝÔ_        ÔÑ   ° ÑÑ    X° ÑÑ     ÑÓ   
 ÓÓ    
 ÓÓ     ÓÔ €  X`ª  X ò ô*» ÔÔ €  XÑ X  X X`ª ÔÔ   ÿ      ÔÑ €	  ¸I  Ñ(Adopted€7/10)Ô €  &ë  % X XÑ ÔÔ €  &Ìj % % &ë  ÔÔ      ÿ   ÔÐ   	 X      ÐÓ    ÓòòTo€be€used€on€and€after€July€1,€2010.óóÐ   	  È    ÐòòóóÌÔ_        ÔÔ_        ÔÌà@    ââ ì àòòWRITTEN€EXPLANATION€OFˆÐ   	 Eí   Ðà@    Ú	Ú	 ì à€GARNISHEEððS€COMPUTATION€OF€EARNINGS€WITHHELDóóˆÐ   	 ü¤   Ðà@    $ ì à(Chapter€60)ˆÐ   	 ³[   ÐÌÌJudgment€Creditor:à0    ¸ àà     àJudgment€CreditorÐ    Ø€	 ¸(#¸(#  ÐÌJudgment€Debtor:à0    ¸ àà     àJudgment€DebtorÐ    F
î ¸(#¸(#  ÐÌGarnishee:à0    `	 àà    ¸ àà0    `	(#`	(# àGarnisheeÐ    ´\	 (#(#  Ðà     àà0    `	 àà0    ¸`	(#`	(# àà0    ¸(#¸(# àGarnisheeÔ €  &€Š % % &Ìj Ô=Ô €  &Ìj % % &€Š Ôs€addressÐ    k
 (#(#  Ðà     àà0    `	 àà0    ¸`	(#`	(# àà0    ¸(#¸(# àGarnisheeÔ €  &€Š % % &Ìj Ô=Ô €  &Ìj % % &€Š Ôs€countyÐ    ,Ô
 (#(#  Ðà     àà0    `	 àà0    ¸`	(#`	(# àà0    ¸(#¸(# à{GarnisheeÔ €  &€Š % % &Ìj Ô=Ô €  &Ìj % % &€Š Ôs€fax€phone€number€(if€known)}Ð    í• (#(#  Ðà     àà0    `	 àà0    ¸`	(#`	(# àà0    ¸(#¸(# à{GarnisheeÔ €  &€Š % % &Ìj Ô=Ô €  &Ìj % % &€Š Ôs€e„mail€address€(if€known)}Ð    ®V (#(#  ÐÌCourt€Case€No:à0    `	 àà0    ¸`	(#`	(# àà0    ¸(#¸(# àCase€No.Ð    &Î (#(#  ÐÌÌ1.€€If€the€judgment€debtor€(employee)€terminated€employment€before€the€first€day€of€the€payroll€period€forÐ   	 Kó   Ðwhich€this€form€is€made,€complete€the€following€section€and€sign€and€date€the€form€at€the€bottom.Ð   	 ª   ÐÌThe€Judgment€debtor€(employee)€terminated€employment€on€_________________________Ð   	 p   Ð€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€(date)Ð   	 'Ï   ÐÌ2.€€If€the€above€paragraph€does€not€apply€you€must€complete€the€rest€of€this€form.Ð   	 •=   ÐÌ3.€€Read€carefully€the€attached€Instructions€to€Garnishee.Ð   	 «   ÐÌ4.€€You€must€complete€this€form€for€each€payroll€period€for€the€judgment€debtor,€that€ends€while€theÐ   	 q    Ðgarnishment€order€remains€in€effect.€€Only€one€form€needs€to€be€completed€for€each€payroll€period€for€theÐ   	 (Ð!   Ðjudgment€debtor.Ð   	 ß‡"   ÐÌ5.€€This€Written€Explanation€form€covers€the€following€pay€period:Ð   	 Mõ$   ÐÌà     àstart€date:à    ¸ à_____________________Ð   	 »c&   Ðà     àend€date:à0    ¸ à_____________________Ð    r' ¸(#¸(#  ÐÌ6.€€The€normal€pay€period€for€employee€is€(designate€one):Ð   	 àˆ)   Ðweekly€_____€€€€€€every€two€weeks€_____€€€€€€semi-monthly€_____€€€€€€€monthly€_____.€€€€€€€€€€€€€€€€Ð   	 — ?*   ÐÓ'   ° 0  x Ð (#°   œX' ÓÌ7.€€Total€gross€earnings€due€for€the€pay€period€covered€by€this€form€are:Ð   	 "­,   Ð€à     àà      ƒ .    à$_____________.Ð   	 ¼"d -   ÐÌ8.€€Amounts€required€by€law€to€be€withheld€for€the€pay€period€or€periods€covered€are:Ð   	 *$Ò!/   ÐÌÓ   X   Ó(1)€€Federal€social€security€taxà      ƒ .  ¸¸/  à$_____________.Ð   	 ˜%@#1   Ð(2)€€Federal€income€taxà      ƒ .  ¶¶&  à$_____________.Ð   	 O&÷#2   Ð(3)€€State€income€taxà      ƒ .  ÿÿ$  à$_____________.Ð   	 '®$3   Ð(4)€€Railroad€Retirement€Taxà      ƒ .  WW+  à$_____________.Ð   	 ½'e%4   ÐÓ     X ÓÌTOTAL€DEDUCTIONSà      ƒ .  ÇÇ  à$_____________.Ð   	 +)Ó&6   ÐÓ   X   Ó€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€(Deduct€only€those€items€listed€above)Ð   	 â)Š'7   ÐÓ     X ÓÌ9.€€Disposable€earnings€for€the€pay€period€covered€are:€à      ƒ .  ‹‹B  à$_____________.Ð   	 P+ø(9   Ð€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€(7€minus€8)Ð   	 ,¯):   ÐÌSee€the€attached€Instructions€to€Garnishee€to€determine€amount€of€disposable€earnings€to€be€withheld.Ð   	 u-+<   ÐÌ10.€€I€am€subtracting€from€the€disposable€earnings€in€9€pursuant€to€an€income€withholding€order€forÐ   	 ã.‹,>   Ðsupport€the€amount€of€à      ƒ .  ..   à$_____________.Ð   	 š/B-?   ÐÐ   	 Q0ù-@   ÐÑ  	 ¸I  Ñâ
   	    âÑ   £ ÑÑ    „X Ñâ
     	  âÑ
   
 Ñ11.€€I€am€subtracting€from€the€disposable€earnings€in€9€pursuant€to€a€lien€which€has€priority€overÐ   	 „      Ðgarnishments€under€the€law€the€following€amount:€€type€of€lien€______________à      ƒ .  øøW  àÐ   	 ;·    Ðà     àà      ƒ .    à$_____________.Ð   	 òn   ÐÌ12.€€In€accordance€with€the€instructions€accompanying€this€form,€I€have€determined€that€the€amountÐ   	 `Ü   Ðwhich€may€be€paid€to€employee€is€à      ƒ .  §§+  à$_____________.Ð   	 “   ÐÌ13.€€I€am€holding€from€the€amount€in€12€an€administrative€fee€in€the€amount€of€à      ƒ .  uuY  à$_____________.Ð   	 …   ÐÌSee€attached€Instructions€to€Garnishee€for€amount€of€the€administrative€fee€that€can€be€retained.Ð   	 ó	o	   ÐÌ14.€€After€paying€to€the€employee€the€amount€stated€in€12€less€the€administrative€fee€in€13,€and€deductingÐ   	 aÝ   Ðany€amount€shown€in€10€and€11,€I€am€holding€the€remainder€of€the€employee's€disposable€earnings€in€theÐ   	 ”   Ðamount€of€à      ƒ .  ËË  à$_____________.Ð   	 ÏK	   ÐÌ15.€€I€will€pay€the€amount€held€in€14€to€the€following€judgment€creditors:Ð   	 =¹
   ÐÌÓ*   ° Ü X° 0  x Ð (#* Óà    Ü àCase€No.à    `	 àà    ¸ àNameà     àà0    h àà0    Àh(#h(# àAddressà0    pÀ(#À(# àà0    Èp(#p(# àà0     È(#È(# àAmountÐ    «'  (# (#  ÐÌA.___________€à    ¸ à_______________à    À à_____________________à0      à$____________Ð    •  (# (#  Ðà    Ü àà0     àà0    `	(#(# àà0    ¸`	(#`	(# àà0    ¸(#¸(# àà0    h(#(# àà0    Àh(#h(# à_____________________Ð    ÐL À(#À(#  Ðà    Ü àà0     àà0    `	(#(# àà0    ¸`	(#`	(# àà0    ¸(#¸(# àà0    h(#(# àà0    Àh(#h(# à_____________________Ð    ‡ À(#À(#  ÐÌB.___________€à    ¸ à_______________à    À à_____________________à0      à$____________Ð    õq  (# (#  Ðà    Ü àà0     àà0    `	(#(# àà0    ¸`	(#`	(# àà0    ¸(#¸(# àà0    h(#(# àà0    Àh(#h(# à_____________________Ð    ¬( À(#À(#  Ðà    Ü àà0     àà0    `	(#(# àà0    ¸`	(#`	(# àà0    ¸(#¸(# àà0    h(#(# àà0    Àh(#h(# à_____________________Ð    cß À(#À(#  ÐÌC.___________€à    ¸ à_______________à    À à_____________________à0      à$____________Ð    ÑM  (# (#  Ðà    Ü àà0     àà0    `	(#(# àà0    ¸`	(#`	(# àà0    ¸(#¸(# àà0    h(#(# àà0    Àh(#h(# à_____________________Ð    ˆ À(#À(#  Ðà    Ü àà0     àà0    `	(#(# àà0    ¸`	(#`	(# àà0    ¸(#¸(# àà0    h(#(# àà0    Àh(#h(# à_____________________Ð    ?» À(#À(#  ÐÌD.___________€à    ¸ à_______________à    À à_____________________à0      à$____________Ð    ­)  (# (#  Ðà    Ü àà0     àà0    `	(#(# àà0    ¸`	(#`	(# àà0    ¸(#¸(# àà0    h(#(# àà0    Àh(#h(# à_____________________Ð    dà  À(#À(#  Ðà    Ü àà0     àà0    `	(#(# àà0    ¸`	(#`	(# àà0    ¸(#¸(# àà0    h(#(# àà0    Àh(#h(# à_____________________Ð    —! À(#À(#  ÐÌI€will€continue€to€withhold€earnings€as€long€as€the€garnishment€order€remains€in€effect.€€As€the€earningsÐ   	 ‰#   Ðare€withheld,€I€will€promptly€pay€thereafter€the€earnings€as€they€are€withheld€to€the€judgment€creditorsÐ   	 @¼$   Ðentitled€thereto,€unless€I€receive€prior€to€such€payment€an€order€of€the€court€to€the€contrary.Ð   	 ÷s%   ÐÌÌJudgment€Debtor€Name€&€Address:à    h à___________________Ð   	  ˜(   Ðà    Ü àà0     àà0    `	(#(# àà0    ¸`	(#`	(# àà0    ¸(#¸(# àà0    h(#(# à___________________Ð    Ó O) h(#h(#  Ðà    Ü àà0     àà0    `	(#(# àà0    ¸`	(#`	(# àà0    ¸(#¸(# àà0    h(#(# à___________________Ð    Š!* h(#h(#  Ðà    Ü àà0     àà0    `	(#(# àà0    ¸`	(#`	(# àà0    ¸(#¸(# àà0    h(#(# à___________________Ð    A"½+ h(#h(#  ÐÌIf€more€space€is€needed,€attach€separate€sheet.Ð   	 ¯#+ -   ÐÌÌPursuant€to€K.S.A.€53-601,€as€amended,€I€declare€under€the€penalty€of€perjury€that€the€foregoing€is€trueÐ   	 Ô%P"0   Ðand€correct.Ð   	 ‹&#1   ÐÌEXECUTED€on€___________________,€_________.Ð   	 ù'u$3   ÐÌÌÓ   ¸   Ó_______________________________Ð   	 *š&6   ÐGarnisheeÐ   	 Õ*Q'7   ÐÓ     ¸ Óà    Ü àÌÌòòRETAIN€THE€ORIGINAL€OF€THIS€FORM€WITH€YOUR€NORMAL€PAYROLL€RECORDS.€Ð   	 ú,v):   ÐYOU€DO€NOT€NEED€TO€FURNISH€A€COPY€OF€THIS€FORM€TO€ANY€PARTY€UNLESSÐ   	 ±--*;   ÐÔ_         ÔREQUESTED€TO€DO€SO.€€IF€REQUESTED€TO€FURNISH€A€COPY€OF€THIS€FORM,€MAKE€AÐ   	 h.ä*<   ÐCOPY€OF€THE€ORIGINAL€AND€SEND€THE€COPY,€ALONG€WITH€THE€AFFIDAVIT,€INÐ   	 /›+=   ÐRESPONSE€TO€THE€REQUEST.óó
