Preview
APPWEX
WAGE EXECUTION PROCEEDINGS STATE OF CONNECTICUT
APPLICATION, ORDER, EXECUTION SUPERIOR COURT IAEA)
JD-CV-3. Rev. 2-15 www. jud.ct.gov
C.GS. §§ 31-58(), 52-350a, 52-361a, 52-356d, WAGEEX
29US.C 206(a)(1) Employer: See Page 2 for instructions
instructions ACE
Judgment Creditor or Attorney Clerk Proper Officer
1, Unless filing electronically, prepare original and four copies. _1, Issue execution by signing original. 1, Leave gne signed copy with employer.
2. Altach form JD-CV-3a to this form, or include with execution 2. Enter any court ordered limitation at the bottom of 2. Make return on signed original,
as one PDF electronic form. section Il on page 2. 3. Leave one copy of Modification and Exemption
3. Present original and 3 copies to clerk of court. 3, Return original and 2 copies if on paper. Claim form (JD-CV-3a) with employer and fil in
4. Keep one copy for your file. 4, Retain/scan copy for court file. "Date df Service” on form.
Name and mailing address of Judgment Creditor or Attorney
(To be completed by Judgment Creditor or Altomey)
ADANOTICE
r 7 Branch of the Stat
MIDLAND CREDIT MANAGEMENT, INC i complies vith the Americans
C/O London & London
48 Christian Lane .
Newington, CT 06111 21-11342
Sf Aides of court (Wumber, sweet, andiown) | Jaa. [X]JD. Housing Session | Date of judgment joket number =
(Fete) 50 FIELD STREET TORRINGTON CT 06790 23-Sep-21 - LI-CV-21-6028430-S
fame(s) and address(es) of Judgment Creditor(s) Name(s) and address(es) of Judgment Debtor(s)
MIDLAND CREDIT MANAGEMENT, INC Kayla Beyus .
C/O London & London . ~
48 Christian Lane 179 Pearl St Apt 1
§ Newington, CT 06111 Torrington CT 06790-5232
| Name and address of employer of Judgment Debtor fi nawn) "566 Roberts St “7 "jelephone number of employer “(i known
= Litchfield Woods be0/489-5801
= Amount of judgment ; Amount of costs hind fees —
1,117.04
‘3 Total amount of judgment, costs and fees (AGT and 3) 4. Total amount paid if anyy
1,219.44 - 0.00 1,21
- Tolal dmount unpaid (Subtract 4 from 3)
44»
%. Application fee for wage execution (if not waived by the court) | 7. Application fees paid for prior executions on this judgment “1
Check irappicable
‘ostjudgment interest was
ordered by the Court
failed to pay the total amount due on that judgment.
Judgment Debtor(s) in the following installment payments:
The amount of 35.00" _wasorderedto be paid in_ Weekly (weekly, monthly, or other) instal
(Note: This is not the amount the employer must pay. Employer must pay the amount of execution calculated o
| The court ordered that installment payments begin on 22-Oct-21 (commencement date)
The Judgment Debtor(s) failed to comply with the Installment Payment Order
due on the judgment shown in line 9 above —_—_|
‘Signed (Judgment Greditor or Attorney) On (Datey Telephone Number
The above-named Judgment Creditar(s) recovered a judgment against the above-named Judgment Debtor(s). The Judgment Debtor(s) has/have
Pursuant to the Connecticut General Statutes, the Court listed above entered an order that the judgment be paid by the above-named
lIment payments. *See Note below
page 2 of this form.
Therefore, the Judgment Creditor(s) applies/apply for this execution upon the wages of the Judgment Debtor(s) for the remaining amount
For Court Use Only
File date
400805 Russell L. London | 06/07/2022 860-666-4500
To: Any Proper Officer
By the authority of the State of Connecticut, you are ordered to cause any wages due to the Judgment
Debtor(s), not exceeding the Amount of Execution calculated on page 2, to be paid to the Judgment
Creditor(s) until the judgment is satisfied, including postjudgment interest as ordered by the court, if
applicable, plus the application fee(s) and other Court ordered postjudgment costs and fees, and your own
fees or until the execution is modified or set aside.
Serve this execution within one year of this date, and make return of service to this courtwithin thirty days
from satisfaction of the execution.
- Or
(TAP) | UfJe22—
Execution
Page 1 of 2
IAGE EXECUTION PROCEEDINGS
pos”Important Notice To Employer
You are being served witha wage execution, a court order requi
1g you to withhold non-exempt wages from a person employed by yt
because your employee, the Judgment Debtor (on page 1), has had a judgment entered against him/her by the Superior Court requiring
the Judgment Creditor (on page 1) and has not made payment of the total amount of the judgment plus any costs and fees as shown on|
actions you must take in order to comply with the law regai
| You must notify the employee — Your employee has certain legal rights which
may allow him/her to request the court to change or stop this execution upon his/her
wages, A.notice of hisiher rights and how to get a hearing in court is attached to the
second copy of the wage execution given to you by the officer. You must complete
your portion of the wage execution and your portion of the exemption and modification
dlaim form and defiver or mail, postage prepaid, a copy of these papers fo your
‘employee immediately so that your employee can make any claims allowed by law.
Il. Execution not effective for 20 days — This execution is not effective until after
20 days from the day the officer served these papers on you. No money should be
deducted from your employee's wages until the first wages you pay to your employee
after the 20-day period ends. If your employee elects within the 20-day period to
make a claim to the court that hisher wages are partially or totally exempt from
execution to pay this judgment or he/she seeks to have the amount of this execution
changed, wages are not to be withheld fram the employee until the court decides the
claims or determines the rights of your employee in this case. If you are not notified
that your employee has filed papers with the court, the executi to be enforced
after 20 days from the date of service on you.
{ll. Stay of execution — No eamings claimed to be exempt or subject to a claim for
modification may be withheld from any employee unt! determination of the claim by
the court.
\V. Only one execution issued under section 52-26ta of the General Statutes is
to he satisfied at a time — You must make deductions from your employee's wages
and pay over the withheld money against only one execution issued under General
Statutes section §2-361a at a time. If you are served with more than one execution
issued under General Statutes section §2-361a against this employee's wages, the
Section I. Calculation Of Employee's Disposable Earnings
\g wage executions. Please read each section carefully.
executions are to be satisfied in the order
withholdings. and voluntary wage deducti
must be paid before this execution. Family
wage deductions are issued on Form JD-Fi
V. Maximum amount deducted — The
21-11342
. This execution is being served on you
inher to pay judgment, costs and fees to
page 1. This notice is to inform you of the
which you are served with them. (Income
for support of a family, if there are any,
support income withholdings and voluntary
4)
maximum amount which can be legally
withheld from your employee's wages is 25% of hishher disposable earnings for each
week. The amount to be withheld to pay th}
can never be more. The computations you
the exact amount which should be withheld
withhold and pay over the maximum
js execution may be less than 25%, but it
-omplete below will allow you to calculate
rom this employee's wages.
jount which -you figure out using the
Unless the court orders that this crm to be for a smaller amount, you must
computations below. Your employee has
amount withheld, but until you receive not
Fight to request the court ta reduce the
e that the court has agreed to allow the
amount to be reduced, you must withhold the maximum amount.
Vi. Your duty to comply with this exec!
deductions fram your employee's wages a
by this execution. if you do not, legal acti
ition — You have a legal duty to make
id pay any amounts deducted as required
n may be taken against you. If you are
found to be in contempt of a court order,
Creditor for the amounts of wages which y
lyou may be held liable to the Judgment
did not withhold from your employee.
Vil. Discipline against your emplayee |— You may not discipline, suspend or
discharge your employee because this wage execution has been served upon you. If
you do unlawfully take action against your dmployee, you may be liable to pay him all
of his lost earnings and employment benefts from the time of your action to the time
that the employeeis reinstated.
The law allows you to take disciplinary m
served with more than 7 wage executions a
asures against the employee if you are
jainst his/her wages in any calendar year.
“Disposable Earnings" means that part of the earnings of an individual remaining after the deduction from|those earnings of amounts to be
withheld for payment of federal income and employment taxes, normal retirement contributions, union di
insurance premiums, health insurance premiums, and federal tax levies,
1. Employee's gross compensation per week...
2. Federal income tax withheld ...
3. Federal employment tax. .
4, Normal retirement contribution ....
5. Union dues and initiation fees..,;,.0..ccclosr
6. Group life insurance premium ..
7. Health insurance premium...
8. Other federal tax levies... ccccion
9. Total allowable deductions (Add lines 2-8)...
10. Weekly Disposable Earnings (Subtract line 9 from line 1)...
Section Il. Calculation Of Employee's Disposable Earnings
es and initiation fees, group life
. To be calculated by employer [ Column 4 ‘Colum
A-1. Weekly disposable earnings (fromiline 10 above) Ss
‘A2. 25% of disposable eamings for week s
8-1. Weekly disposable earnings (from line 10 above) Ss
B.2, Forty times the higher of the current federal minimum iS
hourly wage or state full minimum fair wage.
Amount by which line B-1 exceeds 8-2
‘Amount of Execution (Employer must pay the lesser of the two amounts in column 2 unless the court
‘ordered limitation set forth befowis a lesser amount, in which case the employer must pay that jesser amount)
Court ordered limitation (if any, to be entered by clerk)
JD-CV-5 Rev. 215
Page 2 of 2EXEMPTION AND MODIFICATION
CLAIM FORM, WAGE EXECUTION
JOCVSa Rov 11-15
CG § § 31-58), 52-212, 52.350a 52-3520, 523814,
52.381b, 29 USC. 208(a)(1)
SUP!
Name and mailing address of judgment debtor (persaa who must Pay money) or
attorney of udgment debtor
STATE GF CONNECTICUT
OR COURT
jud.ct.gov
EAE LRH)
(To be completed by judgment creditor (parsca who maney 16 Bald fo}) aM Pex
Ckayia Beyus 7a . Instructions
To: To proper officer:|Complele Section II below and
. make service on employer th accordance with the
479 Pearl St Apt 4 insiructians on form JD-CV-2
Tortington CT 06790-5232 To employer: Complete Section Il! below and
21-11342 immedately detiver lo empleyee,
L —!
Section | - Judgment Creditor (person who money is paid to) must fill out this section and attach to one copy of the
wage execution application (JD-CV-3).
me ee Geepapnica: Name and agwess oF oirt
we Senin OARS | Superior Court 50 FIELD STREET TORRINGTON CT 06790
Name of case Kayla Beyus Bechet number
MIDLAND CREDIT MANAGEMENT, INC _ v. | LLI-CV-21-6028430-S
Nama of{udgment dettar (peison who awisl pay money)
Kayla Beyus
Section Il - Proper Officer must complete thi
Name of preperetficer —~ -
Oste of Service of wage exqauton an embioyer
Section i. Employer must fil out this section and IMMEDIATELY send one copy of thi
Execution form (JD-CV-3} to the judgment debtor (General Statutes section
Name and address of empieyer Tel
” f Totat amount of wage execution:
$ $
Baz of daivery or meling to judgment dabior
form and the Wage
-36 $a}.
rane number of payroll dapastment
"| Amount te ee taken out from weakly eainings
Because a judgment entered against you, the attached execution has been issued against wages eared by you from the employer
named above Beginning twenty (20) days from the Date of Service of Wage Execution on Employer indic:
remove from your weekly eamings an amount of money which leaves you with (a) seventy-five percent (7:
OR (b) farty (40) times the higher of the minimum hourly wage set by federal iaw or state law; whichever is|
this fom are the sections of the Connecticut General Statutes which your employer must follow to figure ot
that may be taken out of your wages to agree with the wage execution. If you think that your employer has|
amount corectly, you should tell your employer.
Your earnings may be exempt from execution (do not have to be taken) — Any wages eamed by
assistance under an incentive earnings or similar program are exempt from (may not be taker from you) e:
the Connecticut Genera! Statutes).
How to claim an exemption allowed by law — tf you want to claim that your earnings are exempt b}
out and sign the Claim of Exemption on page 2 of this form and return this exemption and modification clai}
.the above address. .
have a hearing to figure out the issues raised by your claim. If this form is received by the court no later th
ited above, the employer wilf
%) of your disposable earnings
the larger amount. On page 2 of
it (calculate) the weekly amount
not calculated the weekly
a person who gets public
ecution. (Section 52-352b{(d) of
law from execution you must fill
a form to the Superior Court at
In twenty (20) days from the Date
Wien the clerk of the Superior Court gets this form, the clerk will notify you and the judgment creditor the date on which the court will
of Service of Wage Execution on Empioyer indicated above, the employer will not begin withholding (rem:
wages until afier your claim is figured out by the court A claim may also be filed after the twenty (20) day 9
exempt may be withhe'd from any employee until the claim has been figured out.
ving) your eamings from your
jeriod. No earnings claimed to be
Modification of execution — If you have reasonable cause to believe that you have a right toa moprcation (change) of the wage
il
execution and you want to ask for a modification {to have [ess money taken from your wages), you must fi
page 2 of this form and return this exemption and modification claim form to the Superior Court
at the address listed above.
When the clerk of Superior Court gets this form the clerk will tell you and the judgment
creditor the date on which the court will have a hearing to figure out the issues raised by your |
Claim. If this form is received by the court no later than twenty (20) days from the Date of Service
of Wage Exacutlon on Employer indicated above, the empioyer will not begin withholding your
earnings until after your claim is figured out by the court A ciajm may a'so be filed af:er the twenty
(20) day period. No eamings subject to a claim for modification may be withheld from any
employee until the clam has been figured out,
Setting aside judgment — If the judgment was made against you because you did not
come to court, you may, within four (4) months of the date the court made its judgment and upon
hefiel that you have reasonab'e cause, ask the court to set aside the judgment entered against
you and the case will begin again. A fee will be charged to you for a motion to set aside judgment. |
Page 1 ef2
(Fleddre
‘out the Claim for Modification on
For Court Use Only
Exemption and modification claimSection V - Claim of exemption established by law
1, the Judgment Debtor (person who must pay money), claim and certify under the penalty of
earnings are exempt from execution (do not have to be taken) because:
| get public assistance and earn wages under an incentive earnings or similar program and!
are exempt from execution, or
Other statutory exemption (state exemption and statutory citation) _
21-41342
false statement that my
my earnings
Signed (Judgment Debtor) [Date signed Name and address of judgment debtor
:
k
Telephone number
“Section VI - Claim for modification
{, the Judgment Debtor (person who must pay money), ask for a modification of the wage e:
“ <« |." think you should get a modification (have less money taken from you
“few amount requested
/ Per week
Signed (Judgment Debtor) Date signed | Name and complete mailing address of judgment debtor
ecution against me becaus
Ir wages)
| Telephone number
sone
Section VIl - Agreement to a modification
The Judgment Creditor(s) (person who money is paid to) agrees to the modification of the
“Signed (Judgment Creditor(s) or Attorney)) for(s) or Aitomey “|
= seen
lage Execution claimed
Section Vill - Notice of hearing on exemption / modi
7 Courtroom
|
L
Date ofhearing Time of hearing
By the Assistant Clerk
M.
“Section IX- Orderof court
It is ordered that:
‘Signed (Judge, Magistrate, Assistant Clerk)
ate signed
By order of the court
General Statutes
1. The following is the part of section 52-361a(f) of the Connecticut General Statutes which says what part of your wages
and given to the judgment creditor.
“The maximum part of the aggregate weekly earnings of an individual which may be subject under this section to |
a judgment is the lesser of (1) twenty-five (25) percent of his disposable earings for that week, or (2) the amount by
week exceed forty (40) times the higher of (A) the minimum hourly wage prescribed by section 6(a)(1) of the Fair Labor|
Section 206(a)(1), or (B) the full minimum fair wage established by subsection (j) of section 31-58, in effect at the time t
2. The following is the part of section 52-350a(4) of the Connecticut General Statutes which defines disposable earning:
your wages which can not be included in your total earnings when figuring out (calculating) the weekly amount which is’
“Disposable eamings' means that part of the earnings of an individual remaining after the deduction from those earnt
withheld for payment of federal income and employment taxes, normal retirement contributions, union dues and initiatioy
premiums, health insurance premiums and federal tax levies."
| The Judicial Branch of the State of Connecticut complies with the Americans with Disabilities
| reasonable accommodation in accordance with the ADA, contact the clerk at the court named
contact person listed at www.jud.ct.gow/ADA/.
JD-CV-3a (back/page 2) Rev. 11-15 Page 2 of 2
can be removed by the employer
or other withholding for payment of
lich his disposable earings for that
tandards Act of 1938, 29 U.S:C.
\e earnings are payable.”
and which defines what parts of
bject to execution.
9s of amounts requiredto be
fees, group life insurance
Act (ADA). If you need a
on page 1 or an ADA
Preview
APPWEX WAGE EXECUTION PROCEEDINGS STATE OF CONNECTICUT APPLICATION, ORDER, EXECUTION SUPERIOR COURT IAEA) JD-CV-3. Rev. 2-15 www. jud.ct.gov C.GS. §§ 31-58(), 52-350a, 52-361a, 52-356d, WAGEEX 29US.C 206(a)(1) Employer: See Page 2 for instructions instructions ACE Judgment Creditor or Attorney Clerk Proper Officer 1, Unless filing electronically, prepare original and four copies. _1, Issue execution by signing original. 1, Leave gne signed copy with employer. 2. Altach form JD-CV-3a to this form, or include with execution 2. Enter any court ordered limitation at the bottom of 2. Make return on signed original, as one PDF electronic form. section Il on page 2. 3. Leave one copy of Modification and Exemption 3. Present original and 3 copies to clerk of court. 3, Return original and 2 copies if on paper. Claim form (JD-CV-3a) with employer and fil in 4. Keep one copy for your file. 4, Retain/scan copy for court file. "Date df Service” on form. Name and mailing address of Judgment Creditor or Attorney (To be completed by Judgment Creditor or Altomey) ADANOTICE r 7 Branch of the Stat MIDLAND CREDIT MANAGEMENT, INC i complies vith the Americans C/O London & London 48 Christian Lane . Newington, CT 06111 21-11342 Sf Aides of court (Wumber, sweet, andiown) | Jaa. [X]JD. Housing Session | Date of judgment joket number = (Fete) 50 FIELD STREET TORRINGTON CT 06790 23-Sep-21 - LI-CV-21-6028430-S fame(s) and address(es) of Judgment Creditor(s) Name(s) and address(es) of Judgment Debtor(s) MIDLAND CREDIT MANAGEMENT, INC Kayla Beyus . C/O London & London . ~ 48 Christian Lane 179 Pearl St Apt 1 § Newington, CT 06111 Torrington CT 06790-5232 | Name and address of employer of Judgment Debtor fi nawn) "566 Roberts St “7 "jelephone number of employer “(i known = Litchfield Woods be0/489-5801 = Amount of judgment ; Amount of costs hind fees — 1,117.04 ‘3 Total amount of judgment, costs and fees (AGT and 3) 4. Total amount paid if anyy 1,219.44 - 0.00 1,21 - Tolal dmount unpaid (Subtract 4 from 3) 44» %. Application fee for wage execution (if not waived by the court) | 7. Application fees paid for prior executions on this judgment “1 Check irappicable ‘ostjudgment interest was ordered by the Court failed to pay the total amount due on that judgment. Judgment Debtor(s) in the following installment payments: The amount of 35.00" _wasorderedto be paid in_ Weekly (weekly, monthly, or other) instal (Note: This is not the amount the employer must pay. Employer must pay the amount of execution calculated o | The court ordered that installment payments begin on 22-Oct-21 (commencement date) The Judgment Debtor(s) failed to comply with the Installment Payment Order due on the judgment shown in line 9 above —_—_| ‘Signed (Judgment Greditor or Attorney) On (Datey Telephone Number The above-named Judgment Creditar(s) recovered a judgment against the above-named Judgment Debtor(s). The Judgment Debtor(s) has/have Pursuant to the Connecticut General Statutes, the Court listed above entered an order that the judgment be paid by the above-named lIment payments. *See Note below page 2 of this form. Therefore, the Judgment Creditor(s) applies/apply for this execution upon the wages of the Judgment Debtor(s) for the remaining amount For Court Use Only File date 400805 Russell L. London | 06/07/2022 860-666-4500 To: Any Proper Officer By the authority of the State of Connecticut, you are ordered to cause any wages due to the Judgment Debtor(s), not exceeding the Amount of Execution calculated on page 2, to be paid to the Judgment Creditor(s) until the judgment is satisfied, including postjudgment interest as ordered by the court, if applicable, plus the application fee(s) and other Court ordered postjudgment costs and fees, and your own fees or until the execution is modified or set aside. Serve this execution within one year of this date, and make return of service to this courtwithin thirty days from satisfaction of the execution. - Or (TAP) | UfJe22— Execution Page 1 of 2 IAGE EXECUTION PROCEEDINGS pos”Important Notice To Employer You are being served witha wage execution, a court order requi 1g you to withhold non-exempt wages from a person employed by yt because your employee, the Judgment Debtor (on page 1), has had a judgment entered against him/her by the Superior Court requiring the Judgment Creditor (on page 1) and has not made payment of the total amount of the judgment plus any costs and fees as shown on| actions you must take in order to comply with the law regai | You must notify the employee — Your employee has certain legal rights which may allow him/her to request the court to change or stop this execution upon his/her wages, A.notice of hisiher rights and how to get a hearing in court is attached to the second copy of the wage execution given to you by the officer. You must complete your portion of the wage execution and your portion of the exemption and modification dlaim form and defiver or mail, postage prepaid, a copy of these papers fo your ‘employee immediately so that your employee can make any claims allowed by law. Il. Execution not effective for 20 days — This execution is not effective until after 20 days from the day the officer served these papers on you. No money should be deducted from your employee's wages until the first wages you pay to your employee after the 20-day period ends. If your employee elects within the 20-day period to make a claim to the court that hisher wages are partially or totally exempt from execution to pay this judgment or he/she seeks to have the amount of this execution changed, wages are not to be withheld fram the employee until the court decides the claims or determines the rights of your employee in this case. If you are not notified that your employee has filed papers with the court, the executi to be enforced after 20 days from the date of service on you. {ll. Stay of execution — No eamings claimed to be exempt or subject to a claim for modification may be withheld from any employee unt! determination of the claim by the court. \V. Only one execution issued under section 52-26ta of the General Statutes is to he satisfied at a time — You must make deductions from your employee's wages and pay over the withheld money against only one execution issued under General Statutes section §2-361a at a time. If you are served with more than one execution issued under General Statutes section §2-361a against this employee's wages, the Section I. Calculation Of Employee's Disposable Earnings \g wage executions. Please read each section carefully. executions are to be satisfied in the order withholdings. and voluntary wage deducti must be paid before this execution. Family wage deductions are issued on Form JD-Fi V. Maximum amount deducted — The 21-11342 . This execution is being served on you inher to pay judgment, costs and fees to page 1. This notice is to inform you of the which you are served with them. (Income for support of a family, if there are any, support income withholdings and voluntary 4) maximum amount which can be legally withheld from your employee's wages is 25% of hishher disposable earnings for each week. The amount to be withheld to pay th} can never be more. The computations you the exact amount which should be withheld withhold and pay over the maximum js execution may be less than 25%, but it -omplete below will allow you to calculate rom this employee's wages. jount which -you figure out using the Unless the court orders that this crm to be for a smaller amount, you must computations below. Your employee has amount withheld, but until you receive not Fight to request the court ta reduce the e that the court has agreed to allow the amount to be reduced, you must withhold the maximum amount. Vi. Your duty to comply with this exec! deductions fram your employee's wages a by this execution. if you do not, legal acti ition — You have a legal duty to make id pay any amounts deducted as required n may be taken against you. If you are found to be in contempt of a court order, Creditor for the amounts of wages which y lyou may be held liable to the Judgment did not withhold from your employee. Vil. Discipline against your emplayee |— You may not discipline, suspend or discharge your employee because this wage execution has been served upon you. If you do unlawfully take action against your dmployee, you may be liable to pay him all of his lost earnings and employment benefts from the time of your action to the time that the employeeis reinstated. The law allows you to take disciplinary m served with more than 7 wage executions a asures against the employee if you are jainst his/her wages in any calendar year. “Disposable Earnings" means that part of the earnings of an individual remaining after the deduction from|those earnings of amounts to be withheld for payment of federal income and employment taxes, normal retirement contributions, union di insurance premiums, health insurance premiums, and federal tax levies, 1. Employee's gross compensation per week... 2. Federal income tax withheld ... 3. Federal employment tax. . 4, Normal retirement contribution .... 5. Union dues and initiation fees..,;,.0..ccclosr 6. Group life insurance premium .. 7. Health insurance premium... 8. Other federal tax levies... ccccion 9. Total allowable deductions (Add lines 2-8)... 10. Weekly Disposable Earnings (Subtract line 9 from line 1)... Section Il. Calculation Of Employee's Disposable Earnings es and initiation fees, group life . To be calculated by employer [ Column 4 ‘Colum A-1. Weekly disposable earnings (fromiline 10 above) Ss ‘A2. 25% of disposable eamings for week s 8-1. Weekly disposable earnings (from line 10 above) Ss B.2, Forty times the higher of the current federal minimum iS hourly wage or state full minimum fair wage. Amount by which line B-1 exceeds 8-2 ‘Amount of Execution (Employer must pay the lesser of the two amounts in column 2 unless the court ‘ordered limitation set forth befowis a lesser amount, in which case the employer must pay that jesser amount) Court ordered limitation (if any, to be entered by clerk) JD-CV-5 Rev. 215 Page 2 of 2EXEMPTION AND MODIFICATION CLAIM FORM, WAGE EXECUTION JOCVSa Rov 11-15 CG § § 31-58), 52-212, 52.350a 52-3520, 523814, 52.381b, 29 USC. 208(a)(1) SUP! Name and mailing address of judgment debtor (persaa who must Pay money) or attorney of udgment debtor STATE GF CONNECTICUT OR COURT jud.ct.gov EAE LRH) (To be completed by judgment creditor (parsca who maney 16 Bald fo}) aM Pex Ckayia Beyus 7a . Instructions To: To proper officer:|Complele Section II below and . make service on employer th accordance with the 479 Pearl St Apt 4 insiructians on form JD-CV-2 Tortington CT 06790-5232 To employer: Complete Section Il! below and 21-11342 immedately detiver lo empleyee, L —! Section | - Judgment Creditor (person who money is paid to) must fill out this section and attach to one copy of the wage execution application (JD-CV-3). me ee Geepapnica: Name and agwess oF oirt we Senin OARS | Superior Court 50 FIELD STREET TORRINGTON CT 06790 Name of case Kayla Beyus Bechet number MIDLAND CREDIT MANAGEMENT, INC _ v. | LLI-CV-21-6028430-S Nama of{udgment dettar (peison who awisl pay money) Kayla Beyus Section Il - Proper Officer must complete thi Name of preperetficer —~ - Oste of Service of wage exqauton an embioyer Section i. Employer must fil out this section and IMMEDIATELY send one copy of thi Execution form (JD-CV-3} to the judgment debtor (General Statutes section Name and address of empieyer Tel ” f Totat amount of wage execution: $ $ Baz of daivery or meling to judgment dabior form and the Wage -36 $a}. rane number of payroll dapastment "| Amount te ee taken out from weakly eainings Because a judgment entered against you, the attached execution has been issued against wages eared by you from the employer named above Beginning twenty (20) days from the Date of Service of Wage Execution on Employer indic: remove from your weekly eamings an amount of money which leaves you with (a) seventy-five percent (7: OR (b) farty (40) times the higher of the minimum hourly wage set by federal iaw or state law; whichever is| this fom are the sections of the Connecticut General Statutes which your employer must follow to figure ot that may be taken out of your wages to agree with the wage execution. If you think that your employer has| amount corectly, you should tell your employer. Your earnings may be exempt from execution (do not have to be taken) — Any wages eamed by assistance under an incentive earnings or similar program are exempt from (may not be taker from you) e: the Connecticut Genera! Statutes). How to claim an exemption allowed by law — tf you want to claim that your earnings are exempt b} out and sign the Claim of Exemption on page 2 of this form and return this exemption and modification clai} .the above address. . have a hearing to figure out the issues raised by your claim. If this form is received by the court no later th ited above, the employer wilf %) of your disposable earnings the larger amount. On page 2 of it (calculate) the weekly amount not calculated the weekly a person who gets public ecution. (Section 52-352b{(d) of law from execution you must fill a form to the Superior Court at In twenty (20) days from the Date Wien the clerk of the Superior Court gets this form, the clerk will notify you and the judgment creditor the date on which the court will of Service of Wage Execution on Empioyer indicated above, the employer will not begin withholding (rem: wages until afier your claim is figured out by the court A claim may also be filed after the twenty (20) day 9 exempt may be withhe'd from any employee until the claim has been figured out. ving) your eamings from your jeriod. No earnings claimed to be Modification of execution — If you have reasonable cause to believe that you have a right toa moprcation (change) of the wage il execution and you want to ask for a modification {to have [ess money taken from your wages), you must fi page 2 of this form and return this exemption and modification claim form to the Superior Court at the address listed above. When the clerk of Superior Court gets this form the clerk will tell you and the judgment creditor the date on which the court will have a hearing to figure out the issues raised by your | Claim. If this form is received by the court no later than twenty (20) days from the Date of Service of Wage Exacutlon on Employer indicated above, the empioyer will not begin withholding your earnings until after your claim is figured out by the court A ciajm may a'so be filed af:er the twenty (20) day period. No eamings subject to a claim for modification may be withheld from any employee until the clam has been figured out, Setting aside judgment — If the judgment was made against you because you did not come to court, you may, within four (4) months of the date the court made its judgment and upon hefiel that you have reasonab'e cause, ask the court to set aside the judgment entered against you and the case will begin again. A fee will be charged to you for a motion to set aside judgment. | Page 1 ef2 (Fleddre ‘out the Claim for Modification on For Court Use Only Exemption and modification claimSection V - Claim of exemption established by law 1, the Judgment Debtor (person who must pay money), claim and certify under the penalty of earnings are exempt from execution (do not have to be taken) because: | get public assistance and earn wages under an incentive earnings or similar program and! are exempt from execution, or Other statutory exemption (state exemption and statutory citation) _ 21-41342 false statement that my my earnings Signed (Judgment Debtor) [Date signed Name and address of judgment debtor : k Telephone number “Section VI - Claim for modification {, the Judgment Debtor (person who must pay money), ask for a modification of the wage e: “ <« |." think you should get a modification (have less money taken from you “few amount requested / Per week Signed (Judgment Debtor) Date signed | Name and complete mailing address of judgment debtor ecution against me becaus Ir wages) | Telephone number sone Section VIl - Agreement to a modification The Judgment Creditor(s) (person who money is paid to) agrees to the modification of the “Signed (Judgment Creditor(s) or Attorney)) for(s) or Aitomey “| = seen lage Execution claimed Section Vill - Notice of hearing on exemption / modi 7 Courtroom | L Date ofhearing Time of hearing By the Assistant Clerk M. “Section IX- Orderof court It is ordered that: ‘Signed (Judge, Magistrate, Assistant Clerk) ate signed By order of the court General Statutes 1. The following is the part of section 52-361a(f) of the Connecticut General Statutes which says what part of your wages and given to the judgment creditor. “The maximum part of the aggregate weekly earnings of an individual which may be subject under this section to | a judgment is the lesser of (1) twenty-five (25) percent of his disposable earings for that week, or (2) the amount by week exceed forty (40) times the higher of (A) the minimum hourly wage prescribed by section 6(a)(1) of the Fair Labor| Section 206(a)(1), or (B) the full minimum fair wage established by subsection (j) of section 31-58, in effect at the time t 2. The following is the part of section 52-350a(4) of the Connecticut General Statutes which defines disposable earning: your wages which can not be included in your total earnings when figuring out (calculating) the weekly amount which is’ “Disposable eamings' means that part of the earnings of an individual remaining after the deduction from those earnt withheld for payment of federal income and employment taxes, normal retirement contributions, union dues and initiatioy premiums, health insurance premiums and federal tax levies." | The Judicial Branch of the State of Connecticut complies with the Americans with Disabilities | reasonable accommodation in accordance with the ADA, contact the clerk at the court named contact person listed at www.jud.ct.gow/ADA/. JD-CV-3a (back/page 2) Rev. 11-15 Page 2 of 2 can be removed by the employer or other withholding for payment of lich his disposable earings for that tandards Act of 1938, 29 U.S:C. \e earnings are payable.” and which defines what parts of bject to execution. 9s of amounts requiredto be fees, group life insurance Act (ADA). If you need a on page 1 or an ADA