(Revised 7/05)
File Stamp Date Case Number ________
Prepared by: Filer's name, SC# Filer's address Filer's phone number {Filer's fax phone number} {Filer's e-mail address} Attorney for Judgment Creditor
In The District Court of ______ County, Kansas
Judgment Creditor name vs. Judgment Debtor name Judgment Debtor address
Judgment Creditor Case No. ______ Judgment Debtor
Garnishee name Garnishee Garnishee's address Garnishee's county {Garnishee's fax phone number (if known)} {Garnishee's e-mail address (if known)} Pursuant to Chapter 60 of Kansas Statutes Annotated Type of Service Requested: ___________________ by ____________________ ORDER TO PAY MONEY TO COURT With regard to the Order of Garnishment dated _____________, _______, the Garnishee, ______________________, is hereby ordered to pay to the clerk of this court the sum of $ ___________. Said Garnishee shall be discharged from liability to said defendant for money so paid. If the amount to be paid is less than the amount the Garnishee is holding pursuant to the garnishment, the Garnishee shall promptly release the balance to the defendant. The garnishee shall make its check payable to and mail to: Clerk of the District Court ______________ County Courthouse ______________________________ ______________________________ Dated: ________________________. ______________________________ Signature, Judge
Approved: _________________________________ Judgment Creditor or Attorney Signature SC#
{If applicable, include the following: This is a communication from a debt collector. This is an attempt to collect a debt and any information obtained will be used for that purpose.}