Preview
WAGE EXECUTION PROCEEDINGS STATE OF CONNECTICUT “— eH
APPLICATION, ORDER, EXECUTION “SUPERIOR COURT EEE he
SD-CV-3. Rav. 2-15 www.,jud.ct. gov
8.3005: Sabie, 2506 vacex Sag
SG, 2082) Employer.See Pave 2 forinsieuclons tt
Instructions TRE
Judgment Creditor cr Attomey Clerk Proper Officer —
1. Uniess filing electronically, prepare: original and four copies. 4.1ssuo oxacutlon by signing original. 4. Loave one signod copy with omplayer.
2 Attach form JD-CV-3a fo thls form, or Include: with execution 2. Enter any'courl ordared imitation at the bottom of 2, Maka-relum on-signed original.
as one PDF clectranic form. ‘seciian Ii on page 2. ‘3, Leave.one copy of Mouification and Exemption
9, Present original and 3'cdples to clark of cour, 3. Relum original and 2 coples it on paper. Clalm form (JD-CV-3s) with employer and fil in
4, Keep ona copy for your fle, 4.Retaln/scati copy forcourt fila. “Dale of Servics* on-farm,
Nama and:malling address of Judgment Creditor or Attorney
{Ta be completed by Judgment Gredifor ot Altomay) ADA NOTICE
‘ , ° aE et
SCHREIBER LAW, LLC sa Aa ADA. Uyauneesa
53 Stiles Road, Suite A102 . reasonabls accammodatfon In accardence
with the ADA, confact a court cleck or an ADA’
Salem, NH 03079 contact parson {sted al wavwJud.ct. goWADA.
L _
==—=T Address of court (Nt x mate ofjuugmemt | Dot ber
« tea, | Hartford Judicat Distrlet, 5 Washington St, Hartford CT 06108 05/09/18 HHD-cvig6089080S
Name(s} and wddress(es) of Judgment Crediior(s) 4003895 " Flamagy and address(es) of dudgment Debtor(s)
IMidtand Funding, LLC FUNDADOR MANGUAL
1350 Camino De.ta Retna Sulte'£00 62 FLORENCE ST
Sar Diego, CA92208 MANCHESTER, CT 06040
c
2
‘| Nameand address ‘Of employer of Judgment Deblor Titknoyeny “Telephone slumber of emplayat Uifknawny
& fpasis oursouncine, INC- 2054 VISTA PKWY STESOO WEST PALM BEACH, FL 33414
& brcamountorjepmant (adudo whore spplcable, projadgmontInforost and etiomey’s 7085) BAmount of costs and feos
= (6127.28 : $447.00
3, Pola amount of judgment, costs and fees: Add Tend2) 4. Tora amount pale (ir any) Re G, Total amount Unpald (Subtract 4 trom ‘a
$6544.28 $0.00 $6544.28.
G, Application fee for wage execution {if not Talved by ta.caur) | 7 Application Tees pald for por executions on this Judgment ey
$105,00 $0.00 Check Fappiceblo
FE Ciher Goon andered posyuugment costs and fees WF” |B. Tolal of Tres 5,6, 7ande a Posyudgment interest was
$0.00 $6649.28. ordered by the Court
‘The above-named Judgment Creditor(s) racovered a Judgment ‘against the, ‘above-named. Jtudgment Debtor(s). “The.Judgment Debtor(s) has/have
fallad to pay the total amount due on that Judgment.
Pursuantto the Connecticut General Statutes, the Conrt listed abave.entered an order that the Judgment be pald by the‘aboye-named
Judgment Beblor(s) Inthe following installment payments:
The amountor $35.00 wasordered to bepaidin Weekly — (weekly, monthly, or olher) fnstaliment payments, "See Note below
(Note: This Is. nog the amount the employer must pay. Employer must pay the amountof execution calculated on page 2 of this fom.
“The court ordered that Installment payments begin on 06/01/18 (commencement date)
‘The Judgmertt Debtor(s) falled to comply wilt the lnstalimenl.Payment Order
§ Therefore, the Judgment Creditor(s) applies/apply for this execution upon the- wages: ofthe Judgment Debtor(s) forthe remaining amount
| duo on the judgment shown in line 9 above >
3 Signpy (Jud Phil aed Orr Tint Telephone Number asta For Gout Uso Only
5 [> .\\n Ln [dilln\aho- | s-s00-25-s1e
To: Any Proper Officer
By the authority of the Slate of Connecticut, you are, ordered to cquse any Wages dus to the Judgment
Deblor(s), not exceeding {he Amount of Execution cajculated on page 2, {o be pald fo the Judgment
-Craditor(s} until thé Judgments ‘satisfied, Including pastfudgment Interests ordered by tha court, if
applicable, plus the ‘application fea(s) and other Couit ordered postjudgment costs and fess, and your own!
fees opyntil the execulion Is modified. orselaside. L
‘Serv this execulion within. one-year ‘Of this date, and make retum of sarvice fo this courtwithin thinty days
sallbtactlon/of the executfon. 5 A 1
orl sald il mm (oaie) |
MdLA ZO
Page 1 of Z WAGE EXECUTION PROCEEDINGS|
Important Notice To Employer
‘You ara being served with awage execution, a court order requiring you to withhold non-exempt wages from a person empfoyed by you. This execution is being served on you
because your amployee, the Judgment Debior (on page 1), has had a judgment entered against hini/her by the Superior Court requiring hinvner lo pay judgment, costs and fees to
the Judgment Creditor (on-page 1) and has not made payment of the tolal amount of the judgment plus any costs and fees as shown on page 1. This notice is to inform you of the
actions you must take in order to comply with the law regarding wage:executions. Please read each section carefully.
1. You must notify the employee — Youremployce has certain legal tights which
may allow him/her fo request the court to change or slop this execution upon hishher
wages. A notice of hisher rights and how to get a’hearing In court is atlached to the
‘second copy of the wage execution givan fo you by the officer. Yau must complete
your portion of the wage execution and your portion of the exemplion:and modificalion
claim form and deliver or mail, postage prepaid, a copy of these papers to your
employee immediately so that your eniployee can make any claims allowed by law,
il. Execution not affective for 20 days — This execution Is not effective until afler
20 days from the day ihe officer served these papers on you. No monsy should be
deducled from your employee's wages until the.first wages you pay to your employee
afier the 20-day period ends. If your employee elects within the 20-day period to
make a Gaim to the court that hisMher wages ere 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 lo be wilhheld from the employee until the court decides the
aims 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 execulion Is to be enforced
after 20 days from the date of service on you.
Il; Stay of execution — No earings claimed to be exampl or subject to a claim for
inodification may be wilhheld from any employee uniil determination of the claim by
the court.
1V. Only one execution issued under section 52-361a of tha Genoral Statutes is
to bo satisfied at a time —- You must inake deductions from your employee's wages
‘and pay over the withheld itioney against only one éxocution Issued under General
Statutes section 52-3614 at a time. If-you are served with more than one.execulion
Issued under General Statutes section 52-3612 against this employee's wages, the
executions are fo be satisfied In the ordar in which you are served with them, (income
withholdings and voluntary wage deductions for support of a family, if there are any,
must be paid belore this execution: Family support income withholdings and voluntary
wage deductions are issued'on Form JO-FM-1.)
V. Maximum amount deducted — The maximum amount which can be legally
withheld from your employee's wages Ts 25% of his/her disposable-eamings for each
week, The-amount to be-withheld fo pay this execution may be less than 25%, but It
can never be more, The computations you complete below will allow you to calculate
the exact amount which should be withheld from this employee's wages.
Unless the court orders that this execution is to be for a smaller amount, you must.
withhold and pay over the maximum amount which you figure out using the
computations below. Your employee has a right to request the: court to reduce the
amount withheld, but until you receive nolice:that-the court has agreed lo allow the
‘amount fo be reduced, you must withhold the maximum amount.
VI. Your duty to comply with. this execution — You have a legat-duly fo make
deductions from your employee's wages and pay any amounts deducted as required
by this execution. If you do not, legal aclon may be ‘taken against you. If you are
found to be: in contempt of a court order, you may be held liable to the Judgment
Greditor for the amiounts.of wages which you did nol withhold from your employee.
Vil. Discipline against your employse — You may not discipline, suspend or
discharge your employee: because this wage execution has been served upon you. It
you do unlawtully take action against your employee, you may be liable to. pay him all
of his fost eamings and.employrient benefits from the time of your action to the time
thal the employee is reinsiated.
‘The law allows you ‘to lake disciplinary measures agains! the employes if you are
served with more than-7 wage executions against his/her wages.in any calendar year.
- Séction I. Calculation Of Employee's Disposable Earnings
“Disposable Eamings" means that part‘of the earings 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 ‘dues and initiation fees, group life
insurance premiums, health Insurance premiums, and federal tax levies.
1. Employee's gross compensation per week......
2. Federal Income tax Withheld .....ccssecsrenseeserssrsnccnrsenetteneesersserereane
3, Federal employment tax.....
4. Normal retirement contribution .........-++
5. Union dues and initiation f6€S .....sscsseceverenrse canes
6. Group life insurance premium .....
7. Health insurance premium.....
8. Other federal tax leVieS......eeeeees
9. Total allowable deductions:(Add lines 2-8)........ss1+
40. Weekly Disposable Earnings (Subtract line 9 from line 4).
Section Il. Calculation Of Employee's Disposable Earnings
Tobe calculated by employer Column 4 Column 2
A-1, Weekly disposable eamings (from line 10 above) $
A-2. 25% of disposable earnings for week $
B+1. Weekly disposable earnings (from line 10 above) $
Forty times the higher of the current federal minimum
B2 houly wage orstate full minimum falr wage. s
Amount by which line B-1 exceeds B-2 $
f Executl ‘must pay the fesser.of the two amounts in column 2 unless the court
‘Sned ttt set fouh Selon a fessor amount, in which caso the. employer must pay thet lesser amount) $
Court ordered limitation (if any, to be entered by clerk)
“ID-CV-3 Rev, 2-15
Page 2 of 2EXEMPTION AND MODIFICATION
CLAIM FORM, WAGE EXECUTION STATE OF CONNECTICUT
JO-CV-3a_ Rev, 11-18 ¢ ee
.05.§31-5%, 52-212, $2-350, 52-352b, 52-3614, SU PERIOR COURT . 2
§2381h, 29 U.S.C, 206{a)(1) www jud.ct.gov
i 4
Name and mailing adres hudgent debtor pees who must pay money).or TO
(To be completed by judgment creditor (parséi who money ts pakt Lo)) MXMPEX
= Instructions
To: To propet officer: Complete Section I! below and
FUNDADOR MANGUAL make servicé on employer in accordance with the
62 FLORENCE ST instructions on.form JD-CV-3.
MANCHESTER, CT 06040 Toemployer: Complete Section iif befow and
immediately deliver to employee.
. a
Judgment Creditor (person who. money is paid to) must fill out this section and attach to one copy of the
Section | « \ya¢e execution application (JD-CV-3).
‘Geographical ‘Name and address of court
dudical Housin; 4; i
District, si cain oO Area er Hartford Judicial District, 95 Washington St., Hartford CT 06106
Name of case Docket number
Midland Funding, LLC v. FUNDADOR MANGUAL HHD-CV186089090S
‘Name of judgment debtar (person who must pay money)
FUNDADOR MANGUAL
Section ll - Proper Officer must complete this section
Namectproperofice SSS SN i of ens ag eT OT TOG foyer
Section ill - Employer mustfill out this’section and IMMEDIATELY send one copy of this formand the Wage
“ Execution form (JD-CV-3) fo thejudgment debtor (General Statutes section 52-361a(d)).
‘Name and address of employer "Telephone number of payroll department
“Date of delivery or mailing to judgment debtor “Total amount of wage execution ‘Amount to be taken out from weekly earnings
$ $
Section lV - Notice:to judgment debtor (person who must pay money)
Because a judgment entered against you, the attached execution has.been issued against wages eamed by you from the employer
named above. Beginning twenty (20)days from the Date of Service of Wage, Execution on Employer indicated above, the employer will
remove from your weekly earnings an amount of money which leaves you with (a) seventy-five:percent (75%) of your disposable eamings
OR (b) forty (40) times the higher of the minimum hourly wage sat by federal law or‘state law; whichever Is the larger amount, On page 2 of
this form are the:sections of the Connecticut General Statutes:which your-employer must follow to figure out (calculate) the weekly amount
that may be taken’ out of yourwages.to agree with the wage execution. If you think that your employer has not calculated the weekly
amount correctly, you.should tell your employer. .
Your earnings may be exempt from execution (do not:have'to be taken) — Any-wages eamed by a person who gets public
assistance.under an Incentive earnings or'similar program are.exempt from (may not be taken from you) execution, (Section '52-352b(d) of
the Connecticut General Statutes).
How to claim:an exemption allowed by law — If you-wantto claim that your earnings are’exempt by law from execution you must fil
out-and sign the Claim of Exemption on.page 2 of this form and retum this exemption and modification claim form to the Superior Court at
the-above-address.
When the clerkoftthe Superior Court gets this form, the clerk will notify you and the judgment creditor of the-date on which the court wil
have a heaiing to figure out the.issues raised by your'claim. If this form Is-recelved by the:court no later than twenty (20) days.from the Date
of Service of Wage Execution on Employer indicated ‘above; the employer will not begin'withholding (removing) your earnings from your
‘wages until after your claim is figured out by the court. A claim may also be filed after the twenty (20) day period. No-earnings claimed to be
exempt may be withheld from any employee until the-claim has been figured out.
Modification of execution — If you have reasonable’ cause to believe that you have a right to amodification (change) of the wage .
execution and you want to ask for a modification (to have less. money taken from your wages), you must fill out the.Claim for Modification or
page 2 of this form and return this:exemption and modification claim form to the Superior Court
at the address listed above. For Court Use Only
When the clerk of Superior Court gets this-form the clerk will tell you and the judgment File:date
creditor the'date on Which the court will have a hearing to‘figure out the issues ralséd’by your
claim. If this form Is received by the court-no later thah twenty (20) days from the Date of Service
of Wage. Execution on Employer indicated above, the:employer will not begin withholding your
eamings until after:your claim Is figured out by the court. Avclaim may, also be filed.after the twenty
(20) day period. No earnings subject to a.clainy for modification may be withheld from any
employee until the claim 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
belief that you have reasonablé-cause, ask the court'to set aside'the judgment ‘entered against
you and the case will begin again. Afee will be charged to you for a motion to-set aside judgment. -
Page 1 of2 emption and modification clair
KSennhoome) [ERGsehrormadSection V -.Claim of exemption established by law
4 the Judgment Debtor (person who must pay money), claim and certify under‘the penalty of false statement that my
earnings.are exempt.from execution (donot have.to be taken) because:
(C1 | get public assistance and earn wages under'an incentive earnings or similar program and my earnings
are exempt from execution, or
(1 Other statutory exemption (state exemption and statutory: citation)
‘Signed (Judgment Debtor} Date signed: Name 'and-address of judgment debtor Telephone number
Section VI - Claim for modification
1, the Judgment Debtor (person who must pay money), ask for a modification of the wage execution against me because:
‘Newamount requested Describe why you think you should geta modification (haveless money taken from your wages)
1 Perweek
“Signed {Judgment Dablor). Date signed ‘Name and complete mailing address of judgment debtor ‘Telephone number
Section Vil - Agreement:to a modificatiori
The Judgment Creditor(s) (person who money is paid to) agrees tothe modification of the Wage: Execution claimed
‘Signed (Judgment Gredior{s) or Attorney) Name of Judgment Graditor(s) or ARomey Date
Section Vill - Notice of hearing on exemption;/ modification claim
‘Date ofhearing Time of hearing ‘Courtroom
.M.
By the Assistant. Clerk
Section IX - Order of court
Itis.ordered that:
‘Signed (Judge, Magistrate, Assistant Clerk) ‘Date.signed
By order.of the court
General Statutes
4. The following is the part.of section 52-361a({) of thi Connecticut General ‘Statutes which says what part of your wages can be removed by the-employer
and given tothe Judgment creditor. .
"The maximum. part of thé aggregate weekly earnings of an individual which may be.subject under this section to levy.or othér withholding for payment of
a Judgments the lesser of (1) twenty-five (25) ‘percent of his disposable earnings for that week, or (2) the amount by which his. disposable earnings for that
week exceed forty (40) times the higtier of (A) the minimum hourly wage prescribed by section 6(a)(1) of the Fatr Labor Standards Act of 1938, 29 U.S.C.
Section 206(a\(1), or (B) the full minimum fair wage established By subsection () of section 31-58, in effect at thelime the eamings-are payable.”
2. The following is.the part of section.52-350a(4) of the Contiecticut ‘General Statutes,which defines disposable earnings and which.defines what parts of
your wages which ean not be ‘included in your jotal eamings when figuring out (calculating) the weekly amount which is subject to execution.
“Disposable edmings' means that part of the eamings ‘of'anindividual remaining after the deduction from, ttiose edmings of amounts required to be
withheld for payment of federal income and employment taxes, normal retirement contributions, union dues-and initiation fees, group life insurance
premiums, health insurance premiums.and federal tax levies.”
The Judicial Branch-of the State of Corinecticut: complies with the Americans with Disabilities Act (ADA). If you need a
reasonable accommodation in accordance.with the ADA, contact the. clerk at the court named on page 1 or.an ADA
contact person listed at www.jud.ct.gov/ADAY.
ID-CV-3a (backpage 2) Rev. 11-18 Page 2 of 2
Preview
WAGE EXECUTION PROCEEDINGS STATE OF CONNECTICUT “— eH APPLICATION, ORDER, EXECUTION “SUPERIOR COURT EEE he SD-CV-3. Rav. 2-15 www.,jud.ct. gov 8.3005: Sabie, 2506 vacex Sag SG, 2082) Employer.See Pave 2 forinsieuclons tt Instructions TRE Judgment Creditor cr Attomey Clerk Proper Officer — 1. Uniess filing electronically, prepare: original and four copies. 4.1ssuo oxacutlon by signing original. 4. Loave one signod copy with omplayer. 2 Attach form JD-CV-3a fo thls form, or Include: with execution 2. Enter any'courl ordared imitation at the bottom of 2, Maka-relum on-signed original. as one PDF clectranic form. ‘seciian Ii on page 2. ‘3, Leave.one copy of Mouification and Exemption 9, Present original and 3'cdples to clark of cour, 3. Relum original and 2 coples it on paper. Clalm form (JD-CV-3s) with employer and fil in 4, Keep ona copy for your fle, 4.Retaln/scati copy forcourt fila. “Dale of Servics* on-farm, Nama and:malling address of Judgment Creditor or Attorney {Ta be completed by Judgment Gredifor ot Altomay) ADA NOTICE ‘ , ° aE et SCHREIBER LAW, LLC sa Aa ADA. Uyauneesa 53 Stiles Road, Suite A102 . reasonabls accammodatfon In accardence with the ADA, confact a court cleck or an ADA’ Salem, NH 03079 contact parson {sted al wavwJud.ct. goWADA. L _ ==—=T Address of court (Nt x mate ofjuugmemt | Dot ber « tea, | Hartford Judicat Distrlet, 5 Washington St, Hartford CT 06108 05/09/18 HHD-cvig6089080S Name(s} and wddress(es) of Judgment Crediior(s) 4003895 " Flamagy and address(es) of dudgment Debtor(s) IMidtand Funding, LLC FUNDADOR MANGUAL 1350 Camino De.ta Retna Sulte'£00 62 FLORENCE ST Sar Diego, CA92208 MANCHESTER, CT 06040 c 2 ‘| Nameand address ‘Of employer of Judgment Deblor Titknoyeny “Telephone slumber of emplayat Uifknawny & fpasis oursouncine, INC- 2054 VISTA PKWY STESOO WEST PALM BEACH, FL 33414 & brcamountorjepmant (adudo whore spplcable, projadgmontInforost and etiomey’s 7085) BAmount of costs and feos = (6127.28 : $447.00 3, Pola amount of judgment, costs and fees: Add Tend2) 4. Tora amount pale (ir any) Re G, Total amount Unpald (Subtract 4 trom ‘a $6544.28 $0.00 $6544.28. G, Application fee for wage execution {if not Talved by ta.caur) | 7 Application Tees pald for por executions on this Judgment ey $105,00 $0.00 Check Fappiceblo FE Ciher Goon andered posyuugment costs and fees WF” |B. Tolal of Tres 5,6, 7ande a Posyudgment interest was $0.00 $6649.28. ordered by the Court ‘The above-named Judgment Creditor(s) racovered a Judgment ‘against the, ‘above-named. Jtudgment Debtor(s). “The.Judgment Debtor(s) has/have fallad to pay the total amount due on that Judgment. Pursuantto the Connecticut General Statutes, the Conrt listed abave.entered an order that the Judgment be pald by the‘aboye-named Judgment Beblor(s) Inthe following installment payments: The amountor $35.00 wasordered to bepaidin Weekly — (weekly, monthly, or olher) fnstaliment payments, "See Note below (Note: This Is. nog the amount the employer must pay. Employer must pay the amountof execution calculated on page 2 of this fom. “The court ordered that Installment payments begin on 06/01/18 (commencement date) ‘The Judgmertt Debtor(s) falled to comply wilt the lnstalimenl.Payment Order § Therefore, the Judgment Creditor(s) applies/apply for this execution upon the- wages: ofthe Judgment Debtor(s) forthe remaining amount | duo on the judgment shown in line 9 above > 3 Signpy (Jud Phil aed Orr Tint Telephone Number asta For Gout Uso Only 5 [> .\\n Ln [dilln\aho- | s-s00-25-s1e To: Any Proper Officer By the authority of the Slate of Connecticut, you are, ordered to cquse any Wages dus to the Judgment Deblor(s), not exceeding {he Amount of Execution cajculated on page 2, {o be pald fo the Judgment -Craditor(s} until thé Judgments ‘satisfied, Including pastfudgment Interests ordered by tha court, if applicable, plus the ‘application fea(s) and other Couit ordered postjudgment costs and fess, and your own! fees opyntil the execulion Is modified. orselaside. L ‘Serv this execulion within. one-year ‘Of this date, and make retum of sarvice fo this courtwithin thinty days sallbtactlon/of the executfon. 5 A 1 orl sald il mm (oaie) | MdLA ZO Page 1 of Z WAGE EXECUTION PROCEEDINGS| Important Notice To Employer ‘You ara being served with awage execution, a court order requiring you to withhold non-exempt wages from a person empfoyed by you. This execution is being served on you because your amployee, the Judgment Debior (on page 1), has had a judgment entered against hini/her by the Superior Court requiring hinvner lo pay judgment, costs and fees to the Judgment Creditor (on-page 1) and has not made payment of the tolal amount of the judgment plus any costs and fees as shown on page 1. This notice is to inform you of the actions you must take in order to comply with the law regarding wage:executions. Please read each section carefully. 1. You must notify the employee — Youremployce has certain legal tights which may allow him/her fo request the court to change or slop this execution upon hishher wages. A notice of hisher rights and how to get a’hearing In court is atlached to the ‘second copy of the wage execution givan fo you by the officer. Yau must complete your portion of the wage execution and your portion of the exemplion:and modificalion claim form and deliver or mail, postage prepaid, a copy of these papers to your employee immediately so that your eniployee can make any claims allowed by law, il. Execution not affective for 20 days — This execution Is not effective until afler 20 days from the day ihe officer served these papers on you. No monsy should be deducled from your employee's wages until the.first wages you pay to your employee afier the 20-day period ends. If your employee elects within the 20-day period to make a Gaim to the court that hisMher wages ere 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 lo be wilhheld from the employee until the court decides the aims 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 execulion Is to be enforced after 20 days from the date of service on you. Il; Stay of execution — No earings claimed to be exampl or subject to a claim for inodification may be wilhheld from any employee uniil determination of the claim by the court. 1V. Only one execution issued under section 52-361a of tha Genoral Statutes is to bo satisfied at a time —- You must inake deductions from your employee's wages ‘and pay over the withheld itioney against only one éxocution Issued under General Statutes section 52-3614 at a time. If-you are served with more than one.execulion Issued under General Statutes section 52-3612 against this employee's wages, the executions are fo be satisfied In the ordar in which you are served with them, (income withholdings and voluntary wage deductions for support of a family, if there are any, must be paid belore this execution: Family support income withholdings and voluntary wage deductions are issued'on Form JO-FM-1.) V. Maximum amount deducted — The maximum amount which can be legally withheld from your employee's wages Ts 25% of his/her disposable-eamings for each week, The-amount to be-withheld fo pay this execution may be less than 25%, but It can never be more, The computations you complete below will allow you to calculate the exact amount which should be withheld from this employee's wages. Unless the court orders that this execution is to be for a smaller amount, you must. withhold and pay over the maximum amount which you figure out using the computations below. Your employee has a right to request the: court to reduce the amount withheld, but until you receive nolice:that-the court has agreed lo allow the ‘amount fo be reduced, you must withhold the maximum amount. VI. Your duty to comply with. this execution — You have a legat-duly fo make deductions from your employee's wages and pay any amounts deducted as required by this execution. If you do not, legal aclon may be ‘taken against you. If you are found to be: in contempt of a court order, you may be held liable to the Judgment Greditor for the amiounts.of wages which you did nol withhold from your employee. Vil. Discipline against your employse — You may not discipline, suspend or discharge your employee: because this wage execution has been served upon you. It you do unlawtully take action against your employee, you may be liable to. pay him all of his fost eamings and.employrient benefits from the time of your action to the time thal the employee is reinsiated. ‘The law allows you ‘to lake disciplinary measures agains! the employes if you are served with more than-7 wage executions against his/her wages.in any calendar year. - Séction I. Calculation Of Employee's Disposable Earnings “Disposable Eamings" means that part‘of the earings 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 ‘dues and initiation fees, group life insurance premiums, health Insurance premiums, and federal tax levies. 1. Employee's gross compensation per week...... 2. Federal Income tax Withheld .....ccssecsrenseeserssrsnccnrsenetteneesersserereane 3, Federal employment tax..... 4. Normal retirement contribution .........-++ 5. Union dues and initiation f6€S .....sscsseceverenrse canes 6. Group life insurance premium ..... 7. Health insurance premium..... 8. Other federal tax leVieS......eeeeees 9. Total allowable deductions:(Add lines 2-8)........ss1+ 40. Weekly Disposable Earnings (Subtract line 9 from line 4). Section Il. Calculation Of Employee's Disposable Earnings Tobe calculated by employer Column 4 Column 2 A-1, Weekly disposable eamings (from line 10 above) $ A-2. 25% of disposable earnings for week $ B+1. Weekly disposable earnings (from line 10 above) $ Forty times the higher of the current federal minimum B2 houly wage orstate full minimum falr wage. s Amount by which line B-1 exceeds B-2 $ f Executl ‘must pay the fesser.of the two amounts in column 2 unless the court ‘Sned ttt set fouh Selon a fessor amount, in which caso the. employer must pay thet lesser amount) $ Court ordered limitation (if any, to be entered by clerk) “ID-CV-3 Rev, 2-15 Page 2 of 2EXEMPTION AND MODIFICATION CLAIM FORM, WAGE EXECUTION STATE OF CONNECTICUT JO-CV-3a_ Rev, 11-18 ¢ ee .05.§31-5%, 52-212, $2-350, 52-352b, 52-3614, SU PERIOR COURT . 2 §2381h, 29 U.S.C, 206{a)(1) www jud.ct.gov i 4 Name and mailing adres hudgent debtor pees who must pay money).or TO (To be completed by judgment creditor (parséi who money ts pakt Lo)) MXMPEX = Instructions To: To propet officer: Complete Section I! below and FUNDADOR MANGUAL make servicé on employer in accordance with the 62 FLORENCE ST instructions on.form JD-CV-3. MANCHESTER, CT 06040 Toemployer: Complete Section iif befow and immediately deliver to employee. . a Judgment Creditor (person who. money is paid to) must fill out this section and attach to one copy of the Section | « \ya¢e execution application (JD-CV-3). ‘Geographical ‘Name and address of court dudical Housin; 4; i District, si cain oO Area er Hartford Judicial District, 95 Washington St., Hartford CT 06106 Name of case Docket number Midland Funding, LLC v. FUNDADOR MANGUAL HHD-CV186089090S ‘Name of judgment debtar (person who must pay money) FUNDADOR MANGUAL Section ll - Proper Officer must complete this section Namectproperofice SSS SN i of ens ag eT OT TOG foyer Section ill - Employer mustfill out this’section and IMMEDIATELY send one copy of this formand the Wage “ Execution form (JD-CV-3) fo thejudgment debtor (General Statutes section 52-361a(d)). ‘Name and address of employer "Telephone number of payroll department “Date of delivery or mailing to judgment debtor “Total amount of wage execution ‘Amount to be taken out from weekly earnings $ $ Section lV - Notice:to judgment debtor (person who must pay money) Because a judgment entered against you, the attached execution has.been issued against wages eamed by you from the employer named above. Beginning twenty (20)days from the Date of Service of Wage, Execution on Employer indicated above, the employer will remove from your weekly earnings an amount of money which leaves you with (a) seventy-five:percent (75%) of your disposable eamings OR (b) forty (40) times the higher of the minimum hourly wage sat by federal law or‘state law; whichever Is the larger amount, On page 2 of this form are the:sections of the Connecticut General Statutes:which your-employer must follow to figure out (calculate) the weekly amount that may be taken’ out of yourwages.to agree with the wage execution. If you think that your employer has not calculated the weekly amount correctly, you.should tell your employer. . Your earnings may be exempt from execution (do not:have'to be taken) — Any-wages eamed by a person who gets public assistance.under an Incentive earnings or'similar program are.exempt from (may not be taken from you) execution, (Section '52-352b(d) of the Connecticut General Statutes). How to claim:an exemption allowed by law — If you-wantto claim that your earnings are’exempt by law from execution you must fil out-and sign the Claim of Exemption on.page 2 of this form and retum this exemption and modification claim form to the Superior Court at the-above-address. When the clerkoftthe Superior Court gets this form, the clerk will notify you and the judgment creditor of the-date on which the court wil have a heaiing to figure out the.issues raised by your'claim. If this form Is-recelved by the:court no later than twenty (20) days.from the Date of Service of Wage Execution on Employer indicated ‘above; the employer will not begin'withholding (removing) your earnings from your ‘wages until after your claim is figured out by the court. A claim may also be filed after the twenty (20) day period. No-earnings claimed to be exempt may be withheld from any employee until the-claim has been figured out. Modification of execution — If you have reasonable’ cause to believe that you have a right to amodification (change) of the wage . execution and you want to ask for a modification (to have less. money taken from your wages), you must fill out the.Claim for Modification or page 2 of this form and return this:exemption and modification claim form to the Superior Court at the address listed above. For Court Use Only When the clerk of Superior Court gets this-form the clerk will tell you and the judgment File:date creditor the'date on Which the court will have a hearing to‘figure out the issues ralséd’by your claim. If this form Is received by the court-no later thah twenty (20) days from the Date of Service of Wage. Execution on Employer indicated above, the:employer will not begin withholding your eamings until after:your claim Is figured out by the court. Avclaim may, also be filed.after the twenty (20) day period. No earnings subject to a.clainy for modification may be withheld from any employee until the claim 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 belief that you have reasonablé-cause, ask the court'to set aside'the judgment ‘entered against you and the case will begin again. Afee will be charged to you for a motion to-set aside judgment. - Page 1 of2 emption and modification clair KSennhoome) [ERGsehrormadSection V -.Claim of exemption established by law 4 the Judgment Debtor (person who must pay money), claim and certify under‘the penalty of false statement that my earnings.are exempt.from execution (donot have.to be taken) because: (C1 | get public assistance and earn wages under'an incentive earnings or similar program and my earnings are exempt from execution, or (1 Other statutory exemption (state exemption and statutory: citation) ‘Signed (Judgment Debtor} Date signed: Name 'and-address of judgment debtor Telephone number Section VI - Claim for modification 1, the Judgment Debtor (person who must pay money), ask for a modification of the wage execution against me because: ‘Newamount requested Describe why you think you should geta modification (haveless money taken from your wages) 1 Perweek “Signed {Judgment Dablor). Date signed ‘Name and complete mailing address of judgment debtor ‘Telephone number Section Vil - Agreement:to a modificatiori The Judgment Creditor(s) (person who money is paid to) agrees tothe modification of the Wage: Execution claimed ‘Signed (Judgment Gredior{s) or Attorney) Name of Judgment Graditor(s) or ARomey Date Section Vill - Notice of hearing on exemption;/ modification claim ‘Date ofhearing Time of hearing ‘Courtroom .M. By the Assistant. Clerk Section IX - Order of court Itis.ordered that: ‘Signed (Judge, Magistrate, Assistant Clerk) ‘Date.signed By order.of the court General Statutes 4. The following is the part.of section 52-361a({) of thi Connecticut General ‘Statutes which says what part of your wages can be removed by the-employer and given tothe Judgment creditor. . "The maximum. part of thé aggregate weekly earnings of an individual which may be.subject under this section to levy.or othér withholding for payment of a Judgments the lesser of (1) twenty-five (25) ‘percent of his disposable earnings for that week, or (2) the amount by which his. disposable earnings for that week exceed forty (40) times the higtier of (A) the minimum hourly wage prescribed by section 6(a)(1) of the Fatr Labor Standards Act of 1938, 29 U.S.C. Section 206(a\(1), or (B) the full minimum fair wage established By subsection () of section 31-58, in effect at thelime the eamings-are payable.” 2. The following is.the part of section.52-350a(4) of the Contiecticut ‘General Statutes,which defines disposable earnings and which.defines what parts of your wages which ean not be ‘included in your jotal eamings when figuring out (calculating) the weekly amount which is subject to execution. “Disposable edmings' means that part of the eamings ‘of'anindividual remaining after the deduction from, ttiose edmings of amounts required to be withheld for payment of federal income and employment taxes, normal retirement contributions, union dues-and initiation fees, group life insurance premiums, health insurance premiums.and federal tax levies.” The Judicial Branch-of the State of Corinecticut: complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation in accordance.with the ADA, contact the. clerk at the court named on page 1 or.an ADA contact person listed at www.jud.ct.gov/ADAY. ID-CV-3a (backpage 2) Rev. 11-18 Page 2 of 2