STATE OF MINNESOTA |
DISTRICT COURT |
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COUNTY OF
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JUDICIAL DISTRICT |
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(Creditor) |
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(Debtor) |
GARNISHMENT |
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(Garnishee) |
EARNINGS DISCLOSURE |
Yes
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No
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Yes
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No
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3. |
COLUMN A. |
Enter the date of debtor's payday. |
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4. |
COLUMN B. |
Enter debtor's gross earnings for each payday. |
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5. |
COLUMN C. |
Enter debtor's disposable earnings for each payday. |
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6. |
COLUMN D. |
Enter 25 percent of disposable earnings. (Multiply Column C by .25.) |
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7. |
COLUMN E. |
Enter here 40 times the hourly federal minimum wage ($..........) times the number of work weeks included in each payday. (Note: If a pay period includes days in excess of whole work weeks, the additional days should be counted as a fraction of a work week equal to the number of work days in excess of a whole work week divided by the number of work days in a normal work week.) |
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8. |
COLUMN F. |
Subtract the amount in Column E from the amount in Column C, and enter here. |
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9. |
COLUMN G. |
Enter here the lesser of the amount in Column D and the amount in Column F. |
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10. |
COLUMN H. |
Enter here any amount claimed by you as a setoff, defense, lien, or claim, or any amount claimed by any other person as an exemption or adverse interest which would reduce the amount of earnings owing to the debtor. (Note: Any indebtedness to you incurred by the debtor within the ten days before the receipt of the first garnishment on a debt may not be set off against amounts otherwise subject to the garnishment. Any assignment of earnings made by the debtor to any party within ten days before the receipt of the first garnishment on a debt is void.) |
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You must also describe your claim(s) and the claims of others, if known, in the space provided below the worksheet and state the name(s) and address(es) of these persons. |
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Enter zero in Column H if there are no claims by you or others which would reduce the amount of earnings owing to the debtor. |
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11. |
COLUMN I. |
Subtract the amount in Column H from the amount in Column G and enter here. This is the amount of earnings that you must retain for the payday for which the calculations were made. |
Dated:
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Signature |
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Title |
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Telephone Number |
A |
B |
C |
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Payday |
Gross |
Disposable |
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Date |
Earnings |
Earnings |
1. |
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2. |
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3. |
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4. |
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5. |
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6. |
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7. |
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8. |
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9. |
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10. |
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D |
E |
F |
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25% of Column C |
40 X Min. Wage |
Column C minus Column E |
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2. |
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3. |
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4. |
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5. |
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6. |
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7. |
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8. |
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9. |
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10. |
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G |
H |
I |
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Lesser of Column D and Column F |
Setoff, Lien, Adverse Interest, or Other Claims |
Column G minus Column H |
1. |
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2. |
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3. |
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4. |
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5. |
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6. |
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7. |
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8. |
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9. |
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10. |
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TOTAL OF COLUMN I |
$
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STATE OF MINNESOTA |
DISTRICT COURT |
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COUNTY OF
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JUDICIAL DISTRICT |
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(Creditor) |
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(Debtor) |
GARNISHMENT |
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(Garnishee) |
EARNINGS DISCLOSURE |
Yes
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No
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Dated:
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Signature |
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Title |
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Telephone Number |
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EARNINGS DISCLOSURE WORKSHEET |
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Debtor's Name |
A |
B |
C |
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Payday |
Gross |
Disposable |
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Date |
Earnings |
Earnings |
1. |
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$
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$
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2. |
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3. |
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4. |
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5. |
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6. |
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7. |
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8. |
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9. |
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10. |
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D |
E |
F |
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Either 50, 55, 60, or 65% of Column C |
Setoff, Lien, Adverse Interest, or Other Claims |
Column D minus Column E |
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2. |
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3. |
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4. |
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5. |
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6. |
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7. |
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8. |
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9. |
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10. |
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TOTAL OF COLUMN F |
$
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Signature |
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Dated: |
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(...)
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Title |
Phone Number |
STATE OF MINNESOTA |
DISTRICT COURT |
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COUNTY OF
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JUDICIAL DISTRICT |
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(Creditor) |
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against |
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(Debtor) |
NONEARNINGS DISCLOSURE |
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and |
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(Garnishee) |
Dated:
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Signature |
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Title |
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Telephone Number |
Official Publication of the State of Minnesota
Revisor of Statutes