WAGE EXECUTION PROCEEDINGS
`APPLICATION, ORDER, EXECUTION
`
`STATE OF CONNECTICUT
`
`SUPERIOR COURT
`Employer: See Page 2 for instructions
`
`www.jud.ct.gov
`
`JD-CV-3 Rev. 2-15
`C.G.S. §§ 31-580), 52-350a, 52-361a, 52-356d,
`29 U.S.C. 206(a)(1)
`1. Unless filing electronically, prepare original and four copies.
`1. Issue execution by signing original.
`2. Attach form JD-CV-3a to this form, or include with execution
`2. Enter any court ordered limitation at the bottom of
`as one PDF electronic form.
`section 11 on page 2.
`3. Present original and 3 copies to clerk of court.
`3.Return original and 2 copies if on paper.
`4. Keep one copy for your file.
`4. Retain/scan copy for court file.
`Name and mailing address of Judgment Creditor or Attorney
`(To be completed by Judgment Creditor or Attorney)
`
`Judgment Creditor or Attorney
`
`Instructions
`
`Clerk
`
`Proper Officer
`
`APPWEX
`1111111111111111111111111111111111111111
`WAGE EX
`1111111111111111111111111111111111111111
`1. Leave one signed copy with employer.
`2. Make return on signed original.
`3. Leave one copy of Modification and Exemption
`Claim form (JD-CV-3a) with employer and fill in
`"Date of Service" on form.
`ADA NOTICE
`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 a court clerk or an ADA
`contact person listed at www.jud.ct.gov/ADA.
`
`---,
`
`_J
`
`D G.A. IX] J.D.
`
`I Docket number
`D Housing Session I Date of judgment
`Name(s) and address(es) of Judgment Debtor(s)
`
`C/0 London & London
`48 Christian Lane
`Newington, CT 06111
`Address of court (Number, street, and town)
`Name(s) and address(es) of Judgment Creditor(s)
`
`L
`
`C/0 London & London
`48 Christian Lane
`Newington, CT 06111
`
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`Telephone number of employer (if known)
`Name and address of employer of Judgment Debtor (If known) Ill
`I
`1. Amount of judgment (Include where applicable, prejudgment interest and attorney's fees)
`2. Amount of costs and fees
`15. Total amount unpaid (Subtract 4 from 3)
`3. Total amount of judgment, costs and fees (Add 1 and 2)
`14. Total amount paid (If any) i.7.
`6. Application fee for wage execution (If not waived by the court)
`17. Application fees paid for prior executions on this judgment llJ
`Check if applicable
`8. Other Court ordered postjudgment costs and fees ..i 19. Total of lines 5, 6, 7 and 8 LZi
`::J Postjudgment interest was
`I
`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, 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 on
`(commencement date)
`The Judgment Debtor(s) failed to comply with the Installment Payment Order
`Therefore, the Judgment Creditor(s) applies/apply for this execution upon the wages of the Judgment Debtor(s) for the remaining amount
`due on the judgment shown in line 9 above
`For Court Use Only
`On (Date)
`Telephone Number
`;;ned (Judg���c;�;r or Attorney)
`File date
`860-666-4500
`Russell L. London
`I
`I
`I
`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
`Creditor(s) until the judgment is satisfied, including postjudgment interest as ordered by the court, if
`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 return of service to this courtwithin thirty days
`from satisfaction of the execution.
`On (Date)
`Signed (Assistant Clerk of said court)
`
`~
`
`I
`
`�
`
`I
`Page 1 of 2
`
`WAGE EXECUTION PROCEEDINGS
`
`17-66531
`
`146 WHITE STREET
`
`CAPITAL ONE BANK (USA), N.A.
`
`CAPITAL ONE BANK (USA), N.A.
`
`DANBURY CT 06810
`
`05/15/2018
`
`DBD-CV-18-6025906-S
`
`Brian Guyton
`
`9 Westview Dr
`
`Danbury CT 06810-7020
`
`109 Legion Avenue
`
`CONTINUUM OF CARE
`
`New Haven CT 06519
`
`203/562-2264
`
`1,516.49
`
`101.55
`
`1,618.04
`
`0.00
`
`1,618.04
`
`105.00
`
`210.00
`
`0.00
`
`1,933.04
`
`35.00
`
`weekly
`
`06/15/2018
`
`03/14/2022
`
`

`

`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 him/her by the Superior Court requiring him/her 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 to inform you of the
`actions you must take in order to comply with the law regarding wage executions. Please read each section carefully.
`
`I. You must notify the employee - Your employee has certain legal rights which
`may allow him/her 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 employee can make any claims allowed by law.
`
`•
`II. 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
`deducted 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 execution
`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.
`
`Ill. Stay of execution - No earnings 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 from your employee's wages
`and pay over the withheld money against only one execution issued under General
`Statutes section 52-361 a at a time. If you are served with more than one execution
`issued under General Statutes section 52-361 a 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 executio n. 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 earnings 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 duty 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.
`
`VII. Discipline against your employee - You may not discipline, suspend or
`discharge your employee because this wage execution has been served upon you. If
`you do unlawfully take action against your employee, you may be liable to pay him all
`of his lost earnings and employment benefits from the time of your action to the time
`that the employee is reinstated.
`
`The law 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 II. Calculation Of Employee's Disposable Earnings
`
`To be calculated by employer
`
`Column 1
`
`A-1. Weekly disposable earnings (from line 10 above)
`
`A-2. 25% of disposable earnings for week
`
`B-1. Weekly disposable earnings (from line 10 above)
`
`8_2_ Forty times the higher of the cur rent f ederal minimum
`y
`g
`g
`houri wa e or s tate full minimum fair wa e.
`
`Amount of Execution (Employer must pay the 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)
`
`Amount by which line B-1 exceeds B-2
`
`Court ordered limitation (If any, to be e ntered by clerk)
`
`JD-CV-3 Rev. 2-15
`
`Page 2 of 2
`
`17-66531
`
`

`

`EXEMPTION AND MODIFICATION
`CLAIM FORM, WAGE EXECUTION
`JD-CV-3a Rev. 11-15
`C.G.S. § 31-58(i), 52-212, 52-350a, 52-352b, 52-361 a,
`52-361 b, 29 U.S.C. 206(a)(1)
`
`Name and mailing address of judgment debtor (person who must pay money) or
`attorney of judgment debtor
`(To be completed by judgment creditor (person who money is paid to))
`1
`
`1
`
`To:
`
`C/0 London & London
`48 Christian Lane
`Newington, CT 06111
`
`STATE OF CONNECTICUT
`SUPERIOR COURT
`www.jud.ct.gov
`
`1111111111111111111111111111111111111111
`MXMPEX
`Instructions
`To proper officer: Complete Section II below and
`make service on employer in accordance with the
`instructions on form JD-CV-3.
`
`To employer: Complete Section Ill below and
`immediately deliver to employee.
`
`L
`~
`Section 1 _ Judgment Creditor (person who money is paid to) must fill out this section and attach to one copy of the
`wage execution application (JD-CV-3).
`Name and address of court
`Geographical
`~ District D Housing
`lvl Judicial
`X
`Superior Court
`Name of case
`
`Session
`
`D Area
`
`number
`
`Name of judgment debtor (person who must pay money)
`
`v.
`
`Section II - Proper Officer must complete this section
`Name of proper officer
`
`Date of service of wage execution on employer
`
`Section 111 _ 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 52-361 a(d)).
`Name and address of employer
`Telephone number of payroll department
`
`Docket number
`
`Date of delivery or mailing to judgment debtor
`
`Amount to be taken out from weekly earnings
`$
`
`Total amount of wage execution
`$
`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 tell 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).
`If you want to claim that your earnings are exempt by law from execution you must fill
`How to claim an exemption allowed by law -
`out and sign the Claim of Exemption on page 2 of this 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 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.
`When the clerk of Superior Court gets this form the clerk will tell you and the judgment
`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. A fee will be charged to you for a motion to set aside judgment.
`Page 1 of2
`
`For Court Use Only
`
`File date
`
`Exemption and modification claim
`
`Brian Guyton
`
`9 Westview Dr
`
`Danbury CT 06810-7020
`
`17-66531
`
`146 WHITE STREET
`
`DANBURY CT 06810
`
`Brian Guyton
`
`CAPITAL ONE BANK (USA), N.A.
`
`Brian Guyton
`
`DBD-CV-18-6025906-S
`
`

`

`Section V - Claim of exemption established by law
`
`I, 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:
`
`D I get public assistance and earn wages under an incentive earnings or similar program and my earnings
`are exempt from execution, or
`D 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
`
`I, the Judgment Debtor (person who must pay money), ask for a modification of the wage execution against me because:
`New amount requested
`Describe why you think you should get a modification (have less money taken from your wages)
`
`I Per week
`
`Signed (Judgment Debtor)
`
`Date signed
`
`Name and complete 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 claimed
`Name of Judgment Creditor(s) or Attorney
`Signed (Judgment Credifor(s) or Attorney))
`Date
`
`Section VIII - Notice of hearing on exemption I modification claim
`
`Date of h earing
`
`Time of hearing
`
`Courtroom
`
`_.M.
`
`By the Assistant Clerk
`
`Section IX - Order of court
`
`It is ordered that:
`
`Signed (Judge, Magistrate, Assistant Clerk)
`
`General Statutes
`
`By order of the court
`
`Date signed
`
`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 ear nings 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 General 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.gov/ADA/.
`
`JD-CV-3a (backlpage2) Rev.11-15
`
`Page 2 of 2
`
`17-66531
`
`