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Arizona Supreme Court Page 1 of 2 AOCCVGE13F-100518
(1) [ ] JUSTICE COURT , COUNTY OF
(2) [ ] MUNICIPAL COURT , COUNTY OF
(3) [ ] ARIZONA SUPERIOR COURT, COUNTY OF
(4) Petitioner/Plaintiff
[ ] Judgment Creditor
[ ] Judgment Debtor
Name:
Address:
City, State, Zip Code:
Email Address:
Phone(s):
(5) Respondent/Defendant
[ ] Judgment Debtor
[ ] Judgment Creditor
Name:
Address:
City, State, Zip Code:
Email Address:
Phone(s):
(6) Garnishee:
Name:
Address:
City, State, Zip Code:
Email Address:
Phone(s):
Attorney:
(7) Case Number:
GARNISHEE’S NONEXEMPT
EARNINGS STATEMENT
(Support Judgment)
(ARS § 12-1598.16(K))
1. This non-exempt earnings statement covers the following pay period:
(8) _____________________ to ____________________________.
2. Do you currently employ the judgment debtor? (9) [ ] Yes [ ] No
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Case Number: (7)
Arizona Supreme Court Page 2 of 1 AOCCVGE13F-100518
3. If no, what was the last date on which the judgment debtor worked for you?
(10) .
4. Do you owe the judgment debtor any earnings for this pay period? (11) [ ] Yes [ ] No
WITHHOLDING WORKSHEET
Judgment debtor’s gross earnings (pre-tax) for this pay period (12) $
Judgment debtor’s deductions required by law (13) $
Judgment debtor’s disposable income: line (12) minus line (13) (14) $
Enter 50% of line (14) (15) $
Enter amounts withheld pursuant to a garnishment or levy served
before this garnishment that was for support of a person
(16) $
Enter amounts withheld pursuant to a garnishment or levy served
before this garnishment that was not for support of a person
(17) $
Line (16) plus line (17) (18) $
Line (15) minus line (18) (19) $
Line (19) minus $5 (20) $
The amount shown on line (19) is the amount you should withhold for this pay period.
The amount shown on line (20) is the amount you deliver to the judgment creditor.
(21) (22)
Copy provided to judgment debtor on:
Date:
By: [ ] Mail [ ] Hand delivery
Copy provided to judgment creditor on:
Date:
By: [ ] Mail [ ] Hand delivery
(23)
Date Garnishee or Authorized Agent