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WAGE EXECUTION PROCEEDINGS STATE OF CONNECTICUT
APPLICATION, ORDER, EXECUTION “SUPERIOR COURT EER
www,jud.ct.
gov WAGEEX
SD-CV-3 Rav. 2-15
G.G.S. $4 31-586), 52-450a, 52-082, 52-3889,
28 USS, 208(2)(7} Empl oy
See Page er
2 for :ions.
Instruct
Instructions
ORE
Proper Officer
Judgment Creditor ar Attomey clark
4. Loave one signed copy wih employer.
1. Unies fing electronically, prepare original and four coples, 4e-fssue executlon by signing original 2. Make refum an signed original.
r ordared limitation at the bottom of
2 Attach form JD-CV-2a to this form, or Include with executfon 2 Ente any court
3, Leave ane copy of Modification and Exeription
‘as one POF electronic form.
k
of court.
seilonIi on pape 2.
3. Return orginal and 2 coptes it on paper.
Claim form (40-CV-32) wih employer and fil}in
3. Prasent original and 3 coples to clar 4.Retainlscan copy foreaurt fla, “Date of Service“ on form.
4, Keap ona copy for your ile.
Name and maling address of Judgment Creditor or Attomey ADA NOTICE
(Ta be completed by Judgment Gredifér
or Atomey) 4
r the Slate
‘The Judicial Sranch.of
‘of Connecticut complies with the Americans
SCHREIBER LAW; LLC with Disablitles Act (ADA), Ifyou need.a
reasonable accommodation Ia accordance
53 Stiles Road, Suite A102 wih the ADA, confact a court clerk or ar ADA
contact person listed at wwwjud.ct.gowADA.
Salem, NH 03079
L
4
eT]
‘Address of court (Number, street, and foun) GA. wD, Housing Sesston
05/09/18 WHO cv186089090S
‘Hartford Judicial District, 85 Washington St, Hartford CT 06106
(eats)
oe Name(s) aid address(as) ol Judgment Credier(s) 4503895" Flame(sy and address(es) ofdudgment Debtors)
FUNDADOR MANGUAL
Midland Funding, LLC 62 FLORENCEST
1350 Camino De La Retna Suite'100
MANCHESTER, CT 06040
iSarv Diego, CA 92208
2 “Telephone dumber of employer (ifknown)
Waits and address of employ erof Judgment ‘Dablor ifanowny
2 JOASI5 OUTSOU RCING, ING~ 2054 VISTA PK! WY STE 300 WEST PALM BEACH, FL33432
and atomay’s fees) @ Amount ofcosts and fees
T Amountof judgment (indude whore applicable, ‘Prajadginont interest $417.00
$6127.28 :
4. Toralamount pald (iFany) xe S Tolalameun unpad (Subiract4 trom 3)
3 Tote amounlot judgment , costs and fees (Add 7 anda)”
$0.00 $6544.28
$6544.28
on ive judgment Sf
by dthe coun) | 7. Application fees pi aL for prior executions
E-Applcation tes for wage execution (ifnor wave Check appieablo
$105,00
7and 6
5,6,es Posyuagment interest was
F. Giker Court odered posludgmant costs and fees ‘8. To) ormn
ordered by the Court,
$0.00 $6649.28
The Judgment Det ‘btor(s) has/have
nt against the above-named Judgment Debtor(s).
‘The above-named Judgment’: reditor(s} recovered a judgme
falted to pay the total amount due on that, Judgment. by the ‘above-named
above entered an order that the Judgment be pald
Pursuant lo the Connecticut General Statutes, the Coprt listed
Juxigment Debtor(s) In the following Installment payments: *See Note below
$35.00 was ordered (o be pald In Weekly weekly, monthly, or other) instalment payments,
The amount of
of execution ealeulated on pa ge 2 of this form.
(Note: ‘This Is noéthe amount the emplayer must pay. Employer must pay the amount
en 06/01/18 (commencement date)
The court omiered thal installment payments begin
instaliment. Payment Order
The Judgment Debtor(s) falled to comply wilt the s) forthe remaining amount
this execution upon the-wages of the Judgment Debtor{
& Therefore, the Judgment Creditor(s) applies/apply for For Caurt Use Only
Bl Q labnd
dua on the judgment shown in line 9 above Telephone Number
(Daioy
(unin Piel far
File date
4-800-423-8142
+
To: Any Proper Officer any wages dus tothe Judgment
to cause
By tha authority of the State ofC onnecticut, you are, ordered ted on page 2, to be pald to the Judgment
Debtor(s), net © xceeding the Am: cunt of Execut ion cajcula
d, fricludi ng posljud gment t interest as ordered by tha court, if
'Sreditor(s) unttl the judg ment is satisfie ordered po: sstjui gmant costs and fees, and your own)
applicable, plus the appl ication fea(s} and other Court
fees or until the execullon is modified orselastda. thin thiny days
and make rel tum of service fo this courtwi
Serve this execution wililn one-year of tls date,
from satisfaction of the execution, “on (are)
‘Signed (Assistant Clerk of sald court)
Page 1 of2 WAGE EXECUTION PROCEEDINGS
aR est orm: i
Important Notice To Employer
‘You are being served with a-wage execulion, a courl order requiring you to withhold non-exempt wages from a parson employed by you. This execution is being served on you
because your ampioyes, the Judgment Debior (on page 1), has had a judgment enlered against him/her by the Superior Court requiring himvher lo pay judgment, costs end 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 ihe law regarding wage-executions. Please read each section carefully.
1. You must notify the employee— Your employee has certain legal righls which executions are fo be salisfied in the order in which you are served with them. (income
may allow hinvher fo request the court to change or slop this execution upon his/her withholdings and voluntary wage deductions for support of a family, if there are any,
wages. A notice of his/her rights and how to get a hearing in court fs atlached to the must be paid betora this execution: Femily support income withholdings and voluntary
secand copy of the wage execution given fo you by the officer. You must complete wage deductions are issued on Form JO-FiM-1,)
your portion of the wage execution and your portion of the exemplion and modification V. Maximum amount deducted — The maximum amount which can be legally
claim form and deliver or mail, postage prepaid, a copy of these papers to your
employee immediately so that your employee can make any claims allowed by law.
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
ean never be more. The computations you compicis below will allow you to calculate
|. Execution not effective for 20 days— This execution fs not effective until afler the exact amount which should be withheld from this employee's wagas.
10 days fram the day the officer served these papers on you. No money should bo
doductad from your employee's wages unlil the firsl wages you pay fo your employee ‘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
afler the 20-day period ends. if your employee elects within the 20-day period to
make @ claim to the court that his/her wages are partially or totally exempt from computations below. Your employee has a right to request the court to reduce the
‘execution to pay this judgment or he/she seeks to have the amount of this execulion amount withheld, but until you receive nolice that the courl has agreed to allow the
amount to be reduced, you must withhold the maximum amount,
changed, wages are not fo be withheld from the employee until the coyrt decides the
aims or dotermines tha rights of your employee in this casa. If you are not notified VI. Your duty to comply with this execution — You have a lega! duly lo make
that your employee has filed papers with the court, the execution is to be enforced deductions from your employee's wages and pay any amounts deducted as required
afler 20 days from the date of service
on you. by this execution. If you do nol, legal action may be taken against you. If you are.
found fo be in contempt of a court order, you may be held lable to the ducgment
Ml, Stay of execution — No eamings claimed to be exempl or subject to a claim for ‘Creditor for the amounts of wages which you did nol withhold from your employee.
modification may be withheld from any employee until determination of the claim by Vil. Discipline against your employes — You may not discipline, suspend or
the court. discharge your employee because this wage execution has been served upon you. If
you do unlawfully take action against your employee, you may be Hable to pay him all
IV. Onty one execution issued under section 52.361a of the General Statutes is of his lost eamings and employment benefils from the time of your action to the tme
to be satisfied ata time — You mus! make deductions from your employee's wages thal the employee is reinstated.
and pay over the withheld money against only ona execution Issued under General ‘The law allows you to take disciplinary measures against the employee if you are
Slatules section 52-3614 at a time. if you are served with more than one execution
issued under General Statutes section 52-361a agains! this employee's weges, the served with more than-7 wage executions against his/her wages.in any calendar year.
Section |. Calculation Of Employee's Disposable Earnings
"Disposable Eamings" means that part of the earnings of an individual remaining after the deduction from these earnings of amounts to be
withheld for payment of federal income and employment taxes, normal retirement contributions, union dues and initiation fees, group Ife
insurance. premiums, health insurance premiums, and federal tax levies.
1. Employee's gross compensation per week....
2. Federal income tax withheld oe
3. Federal employment tax..... a a
4, Normal retirement contribution ..
5. Union dues and initiation fees «2.0...
6. Group life insurance premium .
7. Health insurance premium........
8. Other federal tax levies ......-.1000 wee wae
9. Total allowable deductions (Add lines 2-8)...
40. Weekly Disposable Earnings (Subtract line 9 from line 4)........05 ae
Section Il. Calculation Of Employee's Disposable Earnings
To-be calculated by employer Column 1 Column 2
A-1, Weekly disposable eamings (from line 10 above) $
A-2, 25% of disposable earnings for week
B-1. Weekly disposable eamings (from line 10 above) $
B-2, Fo ity times the higher of the current federal minimum $
ly wage or slate full minimum fair wage.
Amount by which line B-1 exceeds B-2
‘Amount of Execution (Employer must pay the lesser of the two amounts in column 2 unless the court $
‘ordered limitatian set forth below (s @ lesser amount, in which case the emptoyer must pay that lesser amount)
Court ordered limitation (ff any, to be enlored by clerk)
JD-CV-3 Rev. 2-15 Page 2 of 2
EXEMPTION AND MODIFICATION
CLAIM FORM, WAGE EXECUTION STATE OF CONNECTICUT
JD-C¥-3a Rev. 11-75
C.GS. § 31-58()), 52-212, 52-3504, 52-352b, 52-361a,
SUPERIOR COURT
www jud.ct.gov
52-351b, 29.5.0, 208(a}(1)
Name and mailing address of judgment debtor (person who must pay monay).or
attomey of judgment debtor
HELENA
MXMPEX
(To be completed by jidgmant
creditor (parson who money
Is paid to}) Instructions
To proper officer: Complete Section I! below and
To make service on employer in accordance with the
FUNDADOR MANGUAL
instructions on form JD-CV-3.
62 FLORENCE ST
MANCHESTER, CT 06040 To employer: Compiste Section il! befow and
immediately deliver to employes.
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).
Geographical Name and address of court
Judicial Housing
ba District
Nameof case
Session umber ae
‘Hartford Judicial District, 95 Washington St., Hartford CT 06106
Decket number
Midland Funding, LLC v. FUNDADOR MANGUAL HHD-CV186089090S
‘Name of judgment
destor (person who must pay money)
FUNDADOR MANGUAL
Section ll - Proper Officer must complete this section
Tame
at properofcer Dale of service of wage execudon on employer
Employer must fill out this section and IMMEDIATELY send one copy of this form and the Wage
Section Ill - Execution form (JD-CV-3) fo the judgment debtor (General Statutes section 52-361a(d)).
Wanie and address of employer ‘Telephone number of payroll deparment
Date of delivery
or maiing to judgment deator Total amaunt
of wage execinion ‘Amount to be taken out from weekly earnings:
$ $
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%)-cf 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 tell your employer.
Your earnings may be exempt from execution (do not have to be taken) — Any wages eared by a person who gets public
assistance under an incentive earings 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 earings are exempt by law from execution you: must fill
out and sign the Claim of Exemption on.page 2 of thls form and return 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 withhoiding (removing) your earings 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 tobe
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 cut 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
eamings 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. A fee will be charged to you fora motion to set aside judgment.
Page1 of2 Exemption and modification claim
posRrints Ce
Section V -.Claim of exemption established by law
|, the Judgment Debtor (person who must pay money), claim and certify under the penalty cf false statement that my
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 my earnings
are exempt from execution, or
OC Other statutory exemption (state exemption and statutory citation)
‘Signed (dudgment Debory Date signed Name and address of judgment debtor Telephone number
Section Vi - Claim for modification
1, the Judgment Debtor (person whe must pay money), ask for a modification of the wage execution against me because:
‘New amount requested Dascribe why you think you should geta modification (nave less money taken from your wages)
/ Perweek
Signed (Judgment Dabor) Date signed Name and compiete mailing address of judgment debtor Telephone 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 claim ed
Signed (Judgment Creditor{s) or Attornsy)} Name of Judgment Greditor{s) or Attomey Date
Section Vill - Notice of hearing on exemption:/ modification claim
Date af hearing Time of hearing ‘Courtroom
By the Assistant Clesk
= M.
Section IX - Order of court
It is ordered that:
Signed (Judge, Magisirate, Assistant Clerk) Date signed
By order of the court
General Statutes
4. The following is the part of section 52-364a(f) of the Connecticut General Statutes which says whal part of your wages can be removed by the employer
and given tothe 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
for that
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
1938, 29 U.S.C.
week exceed forty (40) times the higher of (A) the minimum hourly wage prescribed by section 6{a)(1) of the Fair Labor Standards Actare ofpayable.”
Section 206(a)(1), or (B) the full minimum fair wage established by subsection ()) of seation 31-58, in effect at the time the eamings
parts of
2. The following is.the part of section 52-350a(4) of the Connecticut General Statutes which defines disposable earnings and which defines what
your wages which can not be included i in your total earings when figuring out (calculating) the weekly amount which is subject ta execution.
“Disposable earings’ means that pat 1 of fhe earnings of an individual remaining after the deduction from those eamings of amounts Tequired to be
withheld for payment of federal income an d employment taxes, normal retirement contributions, union dues and Initiation fees, group Ife 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 cr.an ADA
contact person listed at www.jud.ct.gow/ADA.
UD-CV-3a (back/page 2) Rev. 11-15 Page2 of2
aa Baad
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arr ee, WAGE EXECUTION PROCEEDINGS STATE OF CONNECTICUT APPLICATION, ORDER, EXECUTION “SUPERIOR COURT EER www,jud.ct. gov WAGEEX SD-CV-3 Rav. 2-15 G.G.S. $4 31-586), 52-450a, 52-082, 52-3889, 28 USS, 208(2)(7} Empl oy See Page er 2 for :ions. Instruct Instructions ORE Proper Officer Judgment Creditor ar Attomey clark 4. Loave one signed copy wih employer. 1. Unies fing electronically, prepare original and four coples, 4e-fssue executlon by signing original 2. Make refum an signed original. r ordared limitation at the bottom of 2 Attach form JD-CV-2a to this form, or Include with executfon 2 Ente any court 3, Leave ane copy of Modification and Exeription ‘as one POF electronic form. k of court. seilonIi on pape 2. 3. Return orginal and 2 coptes it on paper. Claim form (40-CV-32) wih employer and fil}in 3. Prasent original and 3 coples to clar 4.Retainlscan copy foreaurt fla, “Date of Service“ on form. 4, Keap ona copy for your ile. Name and maling address of Judgment Creditor or Attomey ADA NOTICE (Ta be completed by Judgment Gredifér or Atomey) 4 r the Slate ‘The Judicial Sranch.of ‘of Connecticut complies with the Americans SCHREIBER LAW; LLC with Disablitles Act (ADA), Ifyou need.a reasonable accommodation Ia accordance 53 Stiles Road, Suite A102 wih the ADA, confact a court clerk or ar ADA contact person listed at wwwjud.ct.gowADA. Salem, NH 03079 L 4 eT] ‘Address of court (Number, street, and foun) GA. wD, Housing Sesston 05/09/18 WHO cv186089090S ‘Hartford Judicial District, 85 Washington St, Hartford CT 06106 (eats) oe Name(s) aid address(as) ol Judgment Credier(s) 4503895" Flame(sy and address(es) ofdudgment Debtors) FUNDADOR MANGUAL Midland Funding, LLC 62 FLORENCEST 1350 Camino De La Retna Suite'100 MANCHESTER, CT 06040 iSarv Diego, CA 92208 2 “Telephone dumber of employer (ifknown) Waits and address of employ erof Judgment ‘Dablor ifanowny 2 JOASI5 OUTSOU RCING, ING~ 2054 VISTA PK! WY STE 300 WEST PALM BEACH, FL33432 and atomay’s fees) @ Amount ofcosts and fees T Amountof judgment (indude whore applicable, ‘Prajadginont interest $417.00 $6127.28 : 4. Toralamount pald (iFany) xe S Tolalameun unpad (Subiract4 trom 3) 3 Tote amounlot judgment , costs and fees (Add 7 anda)” $0.00 $6544.28 $6544.28 on ive judgment Sf by dthe coun) | 7. Application fees pi aL for prior executions E-Applcation tes for wage execution (ifnor wave Check appieablo $105,00 7and 6 5,6,es Posyuagment interest was F. Giker Court odered posludgmant costs and fees ‘8. To) ormn ordered by the Court, $0.00 $6649.28 The Judgment Det ‘btor(s) has/have nt against the above-named Judgment Debtor(s). ‘The above-named Judgment’: reditor(s} recovered a judgme falted to pay the total amount due on that, Judgment. by the ‘above-named above entered an order that the Judgment be pald Pursuant lo the Connecticut General Statutes, the Coprt listed Juxigment Debtor(s) In the following Installment payments: *See Note below $35.00 was ordered (o be pald In Weekly weekly, monthly, or other) instalment payments, The amount of of execution ealeulated on pa ge 2 of this form. (Note: ‘This Is noéthe amount the emplayer must pay. Employer must pay the amount en 06/01/18 (commencement date) The court omiered thal installment payments begin instaliment. Payment Order The Judgment Debtor(s) falled to comply wilt the s) forthe remaining amount this execution upon the-wages of the Judgment Debtor{ & Therefore, the Judgment Creditor(s) applies/apply for For Caurt Use Only Bl Q labnd dua on the judgment shown in line 9 above Telephone Number (Daioy (unin Piel far File date 4-800-423-8142 + To: Any Proper Officer any wages dus tothe Judgment to cause By tha authority of the State ofC onnecticut, you are, ordered ted on page 2, to be pald to the Judgment Debtor(s), net © xceeding the Am: cunt of Execut ion cajcula d, fricludi ng posljud gment t interest as ordered by tha court, if 'Sreditor(s) unttl the judg ment is satisfie ordered po: sstjui gmant costs and fees, and your own) applicable, plus the appl ication fea(s} and other Court fees or until the execullon is modified orselastda. thin thiny days and make rel tum of service fo this courtwi Serve this execution wililn one-year of tls date, from satisfaction of the execution, “on (are) ‘Signed (Assistant Clerk of sald court) Page 1 of2 WAGE EXECUTION PROCEEDINGS aR est orm: i Important Notice To Employer ‘You are being served with a-wage execulion, a courl order requiring you to withhold non-exempt wages from a parson employed by you. This execution is being served on you because your ampioyes, the Judgment Debior (on page 1), has had a judgment enlered against him/her by the Superior Court requiring himvher lo pay judgment, costs end 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 ihe law regarding wage-executions. Please read each section carefully. 1. You must notify the employee— Your employee has certain legal righls which executions are fo be salisfied in the order in which you are served with them. (income may allow hinvher fo request the court to change or slop this execution upon his/her withholdings and voluntary wage deductions for support of a family, if there are any, wages. A notice of his/her rights and how to get a hearing in court fs atlached to the must be paid betora this execution: Femily support income withholdings and voluntary secand copy of the wage execution given fo you by the officer. You must complete wage deductions are issued on Form JO-FiM-1,) your portion of the wage execution and your portion of the exemplion and modification V. Maximum amount deducted — The maximum amount which can be legally claim form and deliver or mail, postage prepaid, a copy of these papers to your employee immediately so that your employee can make any claims allowed by law. 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 ean never be more. The computations you compicis below will allow you to calculate |. Execution not effective for 20 days— This execution fs not effective until afler the exact amount which should be withheld from this employee's wagas. 10 days fram the day the officer served these papers on you. No money should bo doductad from your employee's wages unlil the firsl wages you pay fo your employee ‘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 afler the 20-day period ends. if your employee elects within the 20-day period to make @ claim to the court that his/her wages are partially or totally exempt from computations below. Your employee has a right to request the court to reduce the ‘execution to pay this judgment or he/she seeks to have the amount of this execulion amount withheld, but until you receive nolice that the courl has agreed to allow the amount to be reduced, you must withhold the maximum amount, changed, wages are not fo be withheld from the employee until the coyrt decides the aims or dotermines tha rights of your employee in this casa. If you are not notified VI. Your duty to comply with this execution — You have a lega! duly lo make that your employee has filed papers with the court, the execution is to be enforced deductions from your employee's wages and pay any amounts deducted as required afler 20 days from the date of service on you. by this execution. If you do nol, legal action may be taken against you. If you are. found fo be in contempt of a court order, you may be held lable to the ducgment Ml, Stay of execution — No eamings claimed to be exempl or subject to a claim for ‘Creditor for the amounts of wages which you did nol withhold from your employee. modification may be withheld from any employee until determination of the claim by Vil. Discipline against your employes — You may not discipline, suspend or the court. discharge your employee because this wage execution has been served upon you. If you do unlawfully take action against your employee, you may be Hable to pay him all IV. Onty one execution issued under section 52.361a of the General Statutes is of his lost eamings and employment benefils from the time of your action to the tme to be satisfied ata time — You mus! make deductions from your employee's wages thal the employee is reinstated. and pay over the withheld money against only ona execution Issued under General ‘The law allows you to take disciplinary measures against the employee if you are Slatules section 52-3614 at a time. if you are served with more than one execution issued under General Statutes section 52-361a agains! this employee's weges, the served with more than-7 wage executions against his/her wages.in any calendar year. Section |. Calculation Of Employee's Disposable Earnings "Disposable Eamings" means that part of the earnings of an individual remaining after the deduction from these earnings of amounts to be withheld for payment of federal income and employment taxes, normal retirement contributions, union dues and initiation fees, group Ife insurance. premiums, health insurance premiums, and federal tax levies. 1. Employee's gross compensation per week.... 2. Federal income tax withheld oe 3. Federal employment tax..... a a 4, Normal retirement contribution .. 5. Union dues and initiation fees «2.0... 6. Group life insurance premium . 7. Health insurance premium........ 8. Other federal tax levies ......-.1000 wee wae 9. Total allowable deductions (Add lines 2-8)... 40. Weekly Disposable Earnings (Subtract line 9 from line 4)........05 ae Section Il. Calculation Of Employee's Disposable Earnings To-be calculated by employer Column 1 Column 2 A-1, Weekly disposable eamings (from line 10 above) $ A-2, 25% of disposable earnings for week B-1. Weekly disposable eamings (from line 10 above) $ B-2, Fo ity times the higher of the current federal minimum $ ly wage or slate full minimum fair wage. Amount by which line B-1 exceeds B-2 ‘Amount of Execution (Employer must pay the lesser of the two amounts in column 2 unless the court $ ‘ordered limitatian set forth below (s @ lesser amount, in which case the emptoyer must pay that lesser amount) Court ordered limitation (ff any, to be enlored by clerk) JD-CV-3 Rev. 2-15 Page 2 of 2 EXEMPTION AND MODIFICATION CLAIM FORM, WAGE EXECUTION STATE OF CONNECTICUT JD-C¥-3a Rev. 11-75 C.GS. § 31-58()), 52-212, 52-3504, 52-352b, 52-361a, SUPERIOR COURT www jud.ct.gov 52-351b, 29.5.0, 208(a}(1) Name and mailing address of judgment debtor (person who must pay monay).or attomey of judgment debtor HELENA MXMPEX (To be completed by jidgmant creditor (parson who money Is paid to}) Instructions To proper officer: Complete Section I! below and To make service on employer in accordance with the FUNDADOR MANGUAL instructions on form JD-CV-3. 62 FLORENCE ST MANCHESTER, CT 06040 To employer: Compiste Section il! befow and immediately deliver to employes. 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). Geographical Name and address of court Judicial Housing ba District Nameof case Session umber ae ‘Hartford Judicial District, 95 Washington St., Hartford CT 06106 Decket number Midland Funding, LLC v. FUNDADOR MANGUAL HHD-CV186089090S ‘Name of judgment destor (person who must pay money) FUNDADOR MANGUAL Section ll - Proper Officer must complete this section Tame at properofcer Dale of service of wage execudon on employer Employer must fill out this section and IMMEDIATELY send one copy of this form and the Wage Section Ill - Execution form (JD-CV-3) fo the judgment debtor (General Statutes section 52-361a(d)). Wanie and address of employer ‘Telephone number of payroll deparment Date of delivery or maiing to judgment deator Total amaunt of wage execinion ‘Amount to be taken out from weekly earnings: $ $ 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%)-cf 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 tell your employer. Your earnings may be exempt from execution (do not have to be taken) — Any wages eared by a person who gets public assistance under an incentive earings 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 earings are exempt by law from execution you: must fill out and sign the Claim of Exemption on.page 2 of thls form and return 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 withhoiding (removing) your earings 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 tobe 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 cut 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 eamings 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. A fee will be charged to you fora motion to set aside judgment. Page1 of2 Exemption and modification claim posRrints Ce Section V -.Claim of exemption established by law |, the Judgment Debtor (person who must pay money), claim and certify under the penalty cf false statement that my 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 my earnings are exempt from execution, or OC Other statutory exemption (state exemption and statutory citation) ‘Signed (dudgment Debory Date signed Name and address of judgment debtor Telephone number Section Vi - Claim for modification 1, the Judgment Debtor (person whe must pay money), ask for a modification of the wage execution against me because: ‘New amount requested Dascribe why you think you should geta modification (nave less money taken from your wages) / Perweek Signed (Judgment Dabor) Date signed Name and compiete mailing address of judgment debtor Telephone 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 claim ed Signed (Judgment Creditor{s) or Attornsy)} Name of Judgment Greditor{s) or Attomey Date Section Vill - Notice of hearing on exemption:/ modification claim Date af hearing Time of hearing ‘Courtroom By the Assistant Clesk = M. Section IX - Order of court It is ordered that: Signed (Judge, Magisirate, Assistant Clerk) Date signed By order of the court General Statutes 4. The following is the part of section 52-364a(f) of the Connecticut General Statutes which says whal part of your wages can be removed by the employer and given tothe 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 for that 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 1938, 29 U.S.C. week exceed forty (40) times the higher of (A) the minimum hourly wage prescribed by section 6{a)(1) of the Fair Labor Standards Actare ofpayable.” Section 206(a)(1), or (B) the full minimum fair wage established by subsection ()) of seation 31-58, in effect at the time the eamings parts of 2. The following is.the part of section 52-350a(4) of the Connecticut General Statutes which defines disposable earnings and which defines what your wages which can not be included i in your total earings when figuring out (calculating) the weekly amount which is subject ta execution. “Disposable earings’ means that pat 1 of fhe earnings of an individual remaining after the deduction from those eamings of amounts Tequired to be withheld for payment of federal income an d employment taxes, normal retirement contributions, union dues and Initiation fees, group Ife 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 cr.an ADA contact person listed at www.jud.ct.gow/ADA. UD-CV-3a (back/page 2) Rev. 11-15 Page2 of2 aa Baad