I01 - Application: Interception of Federal Moneys under Part II of the Family Orders and Agreements Enforcement Assistance Act

Protected when received by the Department of Justice

Part 1: Applicant Identification

Part 2: Debtor/Creditor Information

Debtor

09 Sex:
Line# 12 Language of choice:

Creditor

Part 3: Garnishee Summons Financial Terms

23 Payment period code:
Line# 24 Are periodic payments cumulative?
Line# 25 Default holdbacks Amount or percentage you wish to be exempt from garnishment.

Garnishment Options

Line# 26 Specific holdbacks per source of funds

Fill in A or B if you wish exemptions from garnishment to differ from default above, or C if you wish to have a set amount garnished per transaction.

For A, indicate the percentage you want exempted from garnishment.

For B, indicate the amount you want exempted from garnishment.

For C, indicate the specific amount to be garnished.

Or

Or

Part 4 Documents

This application must be accompanied by a garnishee summons.

Part 5 Declaration

I declare that the information given in this application is true and is for the purpose of applying for the interception of federal moneys in accordance with the Family Orders and Agreements Enforcement Assistance Act.


Signature of declarant

JUS 578 (2013/06)

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