Preview
APPWEX
WAGE EXECUTION PROCEEDINGS STATE OF CONNECTICUT
APPLICATION, ORDER, EXECUTION SUPERIOR COURT CCMA
JD-CV-3. Rev. 2-16 www,jud.ct.gov
C.G.S, §§ 31-58(), 52-3502, 52-36 1a, 52-356d, WAGEEX
29 U.S.C. 206(a)(1) ‘Employer: See Pade 2 for instructions TAREE
Instructions
Judgment Creditor or Attorney Clerk Proper Officer
1, Uniess filing electronically, prepare original and four copies. 1, Issue execution by signing original, 1, Leave one signed copy with employer.
2. Attach 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 fill In
4, Keep one copy for your file. 4. Retain/scan copy for court file. “Date of Service" on form.
Name and mailing address of Judgment Greditor or Attorney
(To be completed by Judgment Creditor-or Attomey) ‘Sesiezonns ADA NOTICE
‘The Judicial Branch of the State
Tobin Melien & Marohn of Comectcu comple wth he Americans
itt lities Act . need a
45 Court Street teatonsble accommodation ft accoreance
with the ADA, contact a court clerk or an ADA
New Haven, cT 0651 1 contact person listed at www.jud.ct.gov/ADA_
L a!
‘Address of court (Number, street, and tov) GA. [x] uD. Housing Session | Daleof judgment | Docket number
(ros) |_P.O. Box 247, Litchfield, CT . 5/26/15 LLI-CV-14-6009926-S
Name(s) and address(¢s) of Judgment Creditor(s)- Name(s).and adi lress(es) of Judgment Debiarisy
ASSET ACCEPTANCE, LLC BRENDAN M MCDONALD
clo Tobin Melien & Marohn 43 Julla Ln
45 Court Street
5 New Haven, CT 06511 Thomaston, Connecticut 06787-1272
8 Name-and address of employer of Judgment Debtor {if known) Telephone number of-employer fi known)
& 4, Amount of judgment: {include where applicable, prejudgmentinierest and attomey’s fees): ‘2. Amount of costs and fees:
$9,915.56 $399.50
3. Total amount of judgment, costs and feos (Add. Tanda 4. Total amount paid (if any) 5, Tolal amount unpaid (Subiracl 4 froma) r
$10,315.06 $.00 ‘$10,315.06
Application faa Tor wage execullan -(if not waived by the court) | 7. Application fees pald for prior executions on this judgment
$100.00 Check i applicable
Execution
8. Other Court ardared:posijudgment costs and fees 8. Foetal oflines 6, 6, 7 and 6 Fy Pos{udgment interest was
$10,415.06 ordered -by the Court
The above-named Judgment Creditor(s) recovered a judgment against the above-named Judgment Debtor(s). The Judgment Debtor(s) has/have
failed to pay the total amount due on that judgment.
Pursuant to the Connecticut General Statutes, the Court listed above entered an order that the judgment be paid by the above-named
Judgment Debtor(s) in the following installment payments:
The amount of was ordered to be paid in weekly (weekly, monthly, or other) installment payments. *See Note below
(Note: This is not the amount the employer must pay. Employer must pay the amount of execution calculated on page 2 of this form.
‘The court ordered that installment payments begin 7 6/22/41 5 (commencement date)
The Judgment Debtor(s) failed to comply with the |/stallivent. Payment Order
Therefore, the Judgment Creditor(s) appliesi; if ply for this execution upon the wages of the Judgment Debtor(s) for the remaining amount
due on the judgment shown in line 9 ahve, For Gourt Use Only
Signed (Judgment Greditor or Att Haley Telepiione Number ‘basa
pwilliam L, Marohn Vit. “221/205 203-777-6660 He date
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 OFFICE OF THE CLERK
Creditor(s) until the judgment is satisfied, including postjudgment interest as ordered by the court, if SUPERIOR COURT
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 retum of service to this courtwithin thirty days JAN 15 2016
from satisfaction of the execution.
toms seen om Ta JUDICIAL DISTRICT
REP tice AC. ILS AOb OF LITCHFIELD
Page 1 of 2 WAGE EXECUTION PROCEEDINGS.Important Notice To Employer
You are being served with a wage execution, a court order requiring you to withhold non-exempt wages from a person employed by you. This execution is being served on you
because your employee, the Judgment Debtor (on page 1), has had a judgment entered against hinvher by the Superior Court requiring hinvher to pay Judgment, costs and fees to
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 page 1. This notice Is 10 inform you of tha
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 — Your employee has certain legal rights which
may allow hinvher to request the court to change or stop this execution upon his/her
wages, A notice of his/her 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
claim form and deliver or mail, postage prepaid, a copy of these papers to your
employee Immediately so that your empioyee can make any claims allowed by law.
UI, 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
daducted 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 his/her wages are partially or totally exempt from
‘execution to pay this judgment or he/she seeks to have the amount of this execulfon
changed, wages are not to be withheld from 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 execution is to be enforced
_ after 20 days from the date of service on you,
III, Stay of execution — No eamings claimed to be exempt or subject to a claim for
modification may be withheld from any employee until determination of the claim by
the court,
IV. Only one execution Issued under section 52-361a of the General Statutes is
to be satisfied at a time — You must make deductions fram your employee's wages
and pay over the withhald money against only one execution Issued under General
Statutes section 52-361a at a time. If you are served with more than one execution
issued under General Statutes section 52-361a against this employee's wages, the
executions are to be satisfied in the order 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 before this execution. Family support income withholdings and voluntary
wage deductions are issued on Form JD-FM-1,)
V. Maximum amount deducted — The maximum amount which can be legally
withheld from your employee's wages is 25% of his/her disposable eamings for each
week. The amount to be withheld to 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 notice 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 execution — You'have a legal duly to make
deductions from your employee's wages and pay any amounts deducted as required
by this execution, If you do not, legal action 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
Creditor for the amounts of wages which you did not withhold from your employee,
Vil. Discipline against your employes — You may not discipline, suspend or
discharge your employee because this wage execution has been served upon you. if
you do unlawtully take action against your employes, you may be liable to pay him all
of his lost eamings and employment benefits from the time of your action to the time
that the employee is reinstated,
The {avi allows you to take disciplinary measures against the employee if you are
served with more than 7 wage executions against his/her wages in any calendar year.
Section I. Calculation Of Employee's Disposable Earnings
"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 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 ....
3. Federal employment tax...
4. Normal retirement contribution .....
5. Union dues and initiation fees ..
6. Group life insurance premium ...
7. Health insurance premium...
‘ 8, Other federal tax levies.
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
To be calculated by employer
A-1, Weekly disposable earnings (trom line 10 above)
A-2. 25% of disposable earnings for week
B-1. Weekly disposable earnings (from line 10 above)
2, Forly times the higher of the current federal minimum
“ hourly wage-or state full minimum fair wage:
Amount by which line B-1 exceeds B-2
Amount of Execution (Employer must pay thé lesser of the two amounts in column 2 unless the court
ordered limitation set forth below is a lesser amount, in which case the employer must pay that lesser amount)
Column 1 [Column 2
$
5
$
$
$
$
‘Coun ordered limitation (any, to be entered By clark
Page 2 of 2EXEMPTION AND MODIFICATION iP
CLAIM FORM, WAGE EXECUTION STATE OF CONNECTICUT
JD-CV-3a_Rev. 9
aa SUPERIOR COURT
C.GS, § 31-58(), 52-212, §2-360a, 52-352b, 52-3614, i
feats 29 age 206(a)(1) ° % www. jud.ct.gov
Name and mailing address of judgment debtor (person who must pay money) or ACNOTAATE 13-03192-0
altomey of judgment debtor . MX MPEX WE1.FRM
(To be completed by judgment creditor (person who money is paid to))
r 4 Instructions
To: BRENDAN M MCDONALD To proper officer: Complete Section {I below and
. 43 Julia Li make service on employer in accordance with the
ulla Ln instructions on form JD-CV-3,
. To employer: Complete Section ili below and
Thomaston, Connecticut 06787-1272 immediately deliver to employee.
L J
i, _ Judgment Creditor (person who money is paid to) must fill out this section and attach to one copy of the
Section | wage execution application (JD-CV-3).
Judidal Housi ‘Geographical Wame and addrass-of court
arene gousing, Area P.O, Box 247 Litchfield, CT 06759
Name of ease Docket number
ASSET ACCEPTANCE, LLC VS. BRENDAN M MCDONALD LLI-CV-14-6009926-S
Name of judgment debtor (person who must pay maney)
RENDAN M MCDONALD
Section Il - Proper Officer must complete this section
‘Name of proper officer Dato of Service of wage execullon on employer
Section Ill - Employer must fill out this section and IMMEDIATELY send one copy of this form and the Wage
Execution form (JD-CV-3) to the judgment debtor (General Statutes section 52-361a(d)).
Name and address of employer Telephone numberof payroll department
Bate of delivery of maliing to judgment deblor “Total amount of wage execution “Amount to-be taken oul from weekly earings
{$s $
Section IV - Notice to judgment debtor (person who must pay money)
Because a judgment entered against you, the attached execution has been issued against wages earned 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 earnings
‘OR (b) forty (40) times the higher of the minimum hourly wage set 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 your wages to agree with the wage execution. If you think that your employer has not calculated the weekly
amount correctly, you should tel! your employer. .
Your earnings may be exempt from execution (do not have to be taken) — Any wages earned 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 want to claim that your earnings are exempt by law from execution you must fill
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 clerk of the Superior Court gets this form, the clerk will notify you and the judgment creditor of 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 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 a modification (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 on
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 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 Execution on Employer indicated above, the employer will not begin withholding your
earnings until after your claim is figured out by the court. A claim may also be filed after the twenty
(20) day period. No earnings subject to a claim 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 reasonable cause, ask the court to set aside the judgment entered against
you and the case will begin again.
Page.1 of 2 Exemption and modification claimSection V - Claim of exemption established by law
|, the Judgment Debtor (person who must pay money), claim and certify under the penalty of false statement that my
earnings are exempt from execution (do not have to be taken) because:
(1 | get public assistance and earn wages under an incentive earnings or similar program and my earnings
are exempt from execution, or
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
|, the Judgment Debtor (person who must pay money), ask for a modification of the wage execution against me because:
New amoiint requested Describe why you think you should get a modification (hive less money taken from your wages)
{Per week
‘Signed (dudgment Debtor) 7 Dale signed Name and complete mailing addréss of judgment debtor ee number
Section VII - Agreement to a modification
The Judgment Creditor(s) (person who money is paid to) agrees to the modification of the Wage Execution claimed
Signed (Judgment Creditor(s) or Altomey)) ‘Name of Judgment Creditor(s) or Aitorney | Date
Section VIII - Notice of hearing on exemption / ification claim
Date of hearing Time of hearing ‘Courtroom =
.M. By the Assistant Clerk
Section IX - Order of court
It is ordered that:
Signed: (Judge, Magistrate, Assistanl Clerk) Date 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 can be removed by the employer
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 levy or other withholding for payment of
a judgment is 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 higher of (A) the minimum hourly wage prescribed by section 6(a)(1) of the Fair Labor Standards Act of 1938, 29 U.S.C.
Section 206(a)(1), or (B) the full minimum fair wage established by subsection (i) of section 31-58, in effect at the time the earnings are payable.”
2. The following is the part of section 52-350a(4) of the Connecticut Generat Statutes which defines disposable earnings and which defines what parts of
your wages which can not be included in your total earnings when figuring out (calculating) the weekly amount which is subject to execution.
“Disposable earnings’ means that part of the earnings of an individual remaining after the deduction from those earnings 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 Connecticut 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.gow/ADA/.
JD-CV-3a (back/page 2) Rev. 4-14 Page 2 of 2
Preview
APPWEX WAGE EXECUTION PROCEEDINGS STATE OF CONNECTICUT APPLICATION, ORDER, EXECUTION SUPERIOR COURT CCMA JD-CV-3. Rev. 2-16 www,jud.ct.gov C.G.S, §§ 31-58(), 52-3502, 52-36 1a, 52-356d, WAGEEX 29 U.S.C. 206(a)(1) ‘Employer: See Pade 2 for instructions TAREE Instructions Judgment Creditor or Attorney Clerk Proper Officer 1, Uniess filing electronically, prepare original and four copies. 1, Issue execution by signing original, 1, Leave one signed copy with employer. 2. Attach 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 fill In 4, Keep one copy for your file. 4. Retain/scan copy for court file. “Date of Service" on form. Name and mailing address of Judgment Greditor or Attorney (To be completed by Judgment Creditor-or Attomey) ‘Sesiezonns ADA NOTICE ‘The Judicial Branch of the State Tobin Melien & Marohn of Comectcu comple wth he Americans itt lities Act . need a 45 Court Street teatonsble accommodation ft accoreance with the ADA, contact a court clerk or an ADA New Haven, cT 0651 1 contact person listed at www.jud.ct.gov/ADA_ L a! ‘Address of court (Number, street, and tov) GA. [x] uD. Housing Session | Daleof judgment | Docket number (ros) |_P.O. Box 247, Litchfield, CT . 5/26/15 LLI-CV-14-6009926-S Name(s) and address(¢s) of Judgment Creditor(s)- Name(s).and adi lress(es) of Judgment Debiarisy ASSET ACCEPTANCE, LLC BRENDAN M MCDONALD clo Tobin Melien & Marohn 43 Julla Ln 45 Court Street 5 New Haven, CT 06511 Thomaston, Connecticut 06787-1272 8 Name-and address of employer of Judgment Debtor {if known) Telephone number of-employer fi known) & 4, Amount of judgment: {include where applicable, prejudgmentinierest and attomey’s fees): ‘2. Amount of costs and fees: $9,915.56 $399.50 3. Total amount of judgment, costs and feos (Add. Tanda 4. Total amount paid (if any) 5, Tolal amount unpaid (Subiracl 4 froma) r $10,315.06 $.00 ‘$10,315.06 Application faa Tor wage execullan -(if not waived by the court) | 7. Application fees pald for prior executions on this judgment $100.00 Check i applicable Execution 8. Other Court ardared:posijudgment costs and fees 8. Foetal oflines 6, 6, 7 and 6 Fy Pos{udgment interest was $10,415.06 ordered -by the Court The above-named Judgment Creditor(s) recovered a judgment against the above-named Judgment Debtor(s). The Judgment Debtor(s) has/have failed to pay the total amount due on that judgment. Pursuant to the Connecticut General Statutes, the Court listed above entered an order that the judgment be paid by the above-named Judgment Debtor(s) in the following installment payments: The amount of was ordered to be paid in weekly (weekly, monthly, or other) installment payments. *See Note below (Note: This is not the amount the employer must pay. Employer must pay the amount of execution calculated on page 2 of this form. ‘The court ordered that installment payments begin 7 6/22/41 5 (commencement date) The Judgment Debtor(s) failed to comply with the |/stallivent. Payment Order Therefore, the Judgment Creditor(s) appliesi; if ply for this execution upon the wages of the Judgment Debtor(s) for the remaining amount due on the judgment shown in line 9 ahve, For Gourt Use Only Signed (Judgment Greditor or Att Haley Telepiione Number ‘basa pwilliam L, Marohn Vit. “221/205 203-777-6660 He date 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 OFFICE OF THE CLERK Creditor(s) until the judgment is satisfied, including postjudgment interest as ordered by the court, if SUPERIOR COURT 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 retum of service to this courtwithin thirty days JAN 15 2016 from satisfaction of the execution. toms seen om Ta JUDICIAL DISTRICT REP tice AC. ILS AOb OF LITCHFIELD Page 1 of 2 WAGE EXECUTION PROCEEDINGS.Important Notice To Employer You are being served with a wage execution, a court order requiring you to withhold non-exempt wages from a person employed by you. This execution is being served on you because your employee, the Judgment Debtor (on page 1), has had a judgment entered against hinvher by the Superior Court requiring hinvher to pay Judgment, costs and fees to 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 page 1. This notice Is 10 inform you of tha 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 — Your employee has certain legal rights which may allow hinvher to request the court to change or stop this execution upon his/her wages, A notice of his/her 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 claim form and deliver or mail, postage prepaid, a copy of these papers to your employee Immediately so that your empioyee can make any claims allowed by law. UI, 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 daducted 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 his/her wages are partially or totally exempt from ‘execution to pay this judgment or he/she seeks to have the amount of this execulfon changed, wages are not to be withheld from 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 execution is to be enforced _ after 20 days from the date of service on you, III, Stay of execution — No eamings claimed to be exempt or subject to a claim for modification may be withheld from any employee until determination of the claim by the court, IV. Only one execution Issued under section 52-361a of the General Statutes is to be satisfied at a time — You must make deductions fram your employee's wages and pay over the withhald money against only one execution Issued under General Statutes section 52-361a at a time. If you are served with more than one execution issued under General Statutes section 52-361a against this employee's wages, the executions are to be satisfied in the order 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 before this execution. Family support income withholdings and voluntary wage deductions are issued on Form JD-FM-1,) V. Maximum amount deducted — The maximum amount which can be legally withheld from your employee's wages is 25% of his/her disposable eamings for each week. The amount to be withheld to 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 notice 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 execution — You'have a legal duly to make deductions from your employee's wages and pay any amounts deducted as required by this execution, If you do not, legal action 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 Creditor for the amounts of wages which you did not withhold from your employee, Vil. Discipline against your employes — You may not discipline, suspend or discharge your employee because this wage execution has been served upon you. if you do unlawtully take action against your employes, you may be liable to pay him all of his lost eamings and employment benefits from the time of your action to the time that the employee is reinstated, The {avi allows you to take disciplinary measures against the employee if you are served with more than 7 wage executions against his/her wages in any calendar year. Section I. Calculation Of Employee's Disposable Earnings "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 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 .... 3. Federal employment tax... 4. Normal retirement contribution ..... 5. Union dues and initiation fees .. 6. Group life insurance premium ... 7. Health insurance premium... ‘ 8, Other federal tax levies. 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 To be calculated by employer A-1, Weekly disposable earnings (trom line 10 above) A-2. 25% of disposable earnings for week B-1. Weekly disposable earnings (from line 10 above) 2, Forly times the higher of the current federal minimum “ hourly wage-or state full minimum fair wage: Amount by which line B-1 exceeds B-2 Amount of Execution (Employer must pay thé lesser of the two amounts in column 2 unless the court ordered limitation set forth below is a lesser amount, in which case the employer must pay that lesser amount) Column 1 [Column 2 $ 5 $ $ $ $ ‘Coun ordered limitation (any, to be entered By clark Page 2 of 2EXEMPTION AND MODIFICATION iP CLAIM FORM, WAGE EXECUTION STATE OF CONNECTICUT JD-CV-3a_Rev. 9 aa SUPERIOR COURT C.GS, § 31-58(), 52-212, §2-360a, 52-352b, 52-3614, i feats 29 age 206(a)(1) ° % www. jud.ct.gov Name and mailing address of judgment debtor (person who must pay money) or ACNOTAATE 13-03192-0 altomey of judgment debtor . MX MPEX WE1.FRM (To be completed by judgment creditor (person who money is paid to)) r 4 Instructions To: BRENDAN M MCDONALD To proper officer: Complete Section {I below and . 43 Julia Li make service on employer in accordance with the ulla Ln instructions on form JD-CV-3, . To employer: Complete Section ili below and Thomaston, Connecticut 06787-1272 immediately deliver to employee. L J i, _ Judgment Creditor (person who money is paid to) must fill out this section and attach to one copy of the Section | wage execution application (JD-CV-3). Judidal Housi ‘Geographical Wame and addrass-of court arene gousing, Area P.O, Box 247 Litchfield, CT 06759 Name of ease Docket number ASSET ACCEPTANCE, LLC VS. BRENDAN M MCDONALD LLI-CV-14-6009926-S Name of judgment debtor (person who must pay maney) RENDAN M MCDONALD Section Il - Proper Officer must complete this section ‘Name of proper officer Dato of Service of wage execullon on employer Section Ill - Employer must fill out this section and IMMEDIATELY send one copy of this form and the Wage Execution form (JD-CV-3) to the judgment debtor (General Statutes section 52-361a(d)). Name and address of employer Telephone numberof payroll department Bate of delivery of maliing to judgment deblor “Total amount of wage execution “Amount to-be taken oul from weekly earings {$s $ Section IV - Notice to judgment debtor (person who must pay money) Because a judgment entered against you, the attached execution has been issued against wages earned 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 earnings ‘OR (b) forty (40) times the higher of the minimum hourly wage set 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 your wages to agree with the wage execution. If you think that your employer has not calculated the weekly amount correctly, you should tel! your employer. . Your earnings may be exempt from execution (do not have to be taken) — Any wages earned 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 want to claim that your earnings are exempt by law from execution you must fill 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 clerk of the Superior Court gets this form, the clerk will notify you and the judgment creditor of 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 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 a modification (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 on 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 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 Execution on Employer indicated above, the employer will not begin withholding your earnings until after your claim is figured out by the court. A claim may also be filed after the twenty (20) day period. No earnings subject to a claim 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 reasonable cause, ask the court to set aside the judgment entered against you and the case will begin again. Page.1 of 2 Exemption and modification claimSection V - Claim of exemption established by law |, the Judgment Debtor (person who must pay money), claim and certify under the penalty of false statement that my earnings are exempt from execution (do not have to be taken) because: (1 | get public assistance and earn wages under an incentive earnings or similar program and my earnings are exempt from execution, or 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 |, the Judgment Debtor (person who must pay money), ask for a modification of the wage execution against me because: New amoiint requested Describe why you think you should get a modification (hive less money taken from your wages) {Per week ‘Signed (dudgment Debtor) 7 Dale signed Name and complete mailing addréss of judgment debtor ee number Section VII - Agreement to a modification The Judgment Creditor(s) (person who money is paid to) agrees to the modification of the Wage Execution claimed Signed (Judgment Creditor(s) or Altomey)) ‘Name of Judgment Creditor(s) or Aitorney | Date Section VIII - Notice of hearing on exemption / ification claim Date of hearing Time of hearing ‘Courtroom = .M. By the Assistant Clerk Section IX - Order of court It is ordered that: Signed: (Judge, Magistrate, Assistanl Clerk) Date 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 can be removed by the employer 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 levy or other withholding for payment of a judgment is 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 higher of (A) the minimum hourly wage prescribed by section 6(a)(1) of the Fair Labor Standards Act of 1938, 29 U.S.C. Section 206(a)(1), or (B) the full minimum fair wage established by subsection (i) of section 31-58, in effect at the time the earnings are payable.” 2. The following is the part of section 52-350a(4) of the Connecticut Generat Statutes which defines disposable earnings and which defines what parts of your wages which can not be included in your total earnings when figuring out (calculating) the weekly amount which is subject to execution. “Disposable earnings’ means that part of the earnings of an individual remaining after the deduction from those earnings 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 Connecticut 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.gow/ADA/. JD-CV-3a (back/page 2) Rev. 4-14 Page 2 of 2