Minn. Stat. § 551.06 — MN Code / Part 540_552 / Chapter 551 / Section 551.06
§ 551.06 ATTORNEY'S SUMMARY EXECUTION UPON EARNINGS.
Status: in_force

§ Subdivision 1. Procedure. When earnings are levied upon, this section must be complied with, in addition to the general provisions specified in section 551.04 .

§ Subd. 2. Definitions. For purposes of this section, the following terms have the meanings given them: (1) "earnings" means: (i) compensation paid or payable to an employee for personal service whether denominated as wages, salary, commissions, bonus, or otherwise, and includes periodic payments pursuant to a pension or retirement program; or (ii) compensation paid or payable to the producer for the sale of agricultural products; livestock or livestock products; milk or milk products; or fruit or other horticultural products produced when the producer is operating a family farm, a family farm corporation, or an authorized farm corporation, as defined in section 500.24, subdivision 2 ; (2) "disposable earnings" means that part of the earnings of an individual remaining after the deduction from those earnings of amounts required by law to be withheld; (3) "employee" means an individual who performs services subject to the right of the employer to control both what is done and how it is done; and (4) "employer" means a person for whom an individual performs services as an employee.

§ Subd. 3. Limitation on levy on earnings. (a) Unless the judgment is for child support, the maximum part of the aggregate disposable earnings of an individual for any pay period subjected to an execution levy may not exceed the lesser of: (1) 25 percent of the judgment debtor's disposable earnings; or (2) the amount by which the judgment debtor's disposable earnings exceed the greater of: (i) 40 times the hourly wage described in section 177.24, subdivision 1 , paragraph (a), clause (4); or (ii) 40 times the federal minimum hourly wages prescribed by section 6(a)(1) of the Fair Labor Standards Act of 1938, United States Code, title 29, section 206(a)(1), in effect at the time the earnings are payable, times the number of work weeks in the pay period. When a pay period consists of other than a whole number of work weeks, each day of that pay period in excess of the number of completed work weeks shall be counted as a fraction of a work week equal to the number of excess workdays divided by the number of days in the normal work week. (b) If the judgment is for child support, the levy may not exceed: (1) 50 percent of the judgment debtor's disposable income, if the judgment debtor is supporting a spouse or dependent child and the judgment is 12 weeks old or less (12 weeks to be calculated to the beginning of the work week in which the execution levy is received); (2) 55 percent of the judgment debtor's disposable income, if the judgment debtor is supporting a spouse or dependent child, and the judgment is over 12 weeks old (12 weeks to be calculated to the beginning of the work week in which the execution levy is received); (3) 60 percent of the judgment debtor's disposable income, if the judgment debtor is not supporting a spouse or dependent child and the judgment is 12 weeks old or less (12 weeks to be calculated to the beginning of the work week in which the execution levy is received); or (4) 65 percent of the judgment debtor's disposable income, if the judgment debtor is not supporting a spouse or dependent child, and the judgment is over 12 weeks old (12 weeks to be calculated to the beginning of the work week in which the execution levy is received). Execution levies under this section on judgments for child support are effective until the judgments are satisfied if the judgment creditor is a county and the employer is notified by the county when the judgment is satisfied. (c) No court may make, execute, or enforce an order or any process in violation of this section.

§ Subd. 4. Multiple levies on earnings. Except as otherwise provided in this chapter or section 518A.53 , the priority of multiple earnings execution levies is determined by the order in which the execution levies were served on the employer. If the employer is served with two or more writs of execution at the same time on the same day, the writ of execution issued pursuant to the first judgment entered has priority. If two or more execution levies are served on the same day and are based on judgments entered on the same day, then the employer shall select the priority of the earnings levies. However, in all cases except earnings execution levies on judgments for child support if the judgment creditor is a county and the employer is notified by the county when the judgment is satisfied, the execution levies shall be effective no longer than 90 days from the date of the service of the writ of execution.

§ Subd. 5. Earnings attachable. (a) Subject to the exemptions provided by subdivision 3 and section 550.37 , and any other applicable statute, and except as otherwise provided in paragraph (b), the service of a writ of execution under this chapter attaches all unpaid nonexempt disposable earnings owing or to be owed by the third party and earned or to be earned by the judgment debtor before and within the pay period in which the writ of execution is served and within all subsequent pay periods whose paydays occur within the 90 days after the date of service of the writ of execution. "Paydays" means the days upon which the third party pays earnings to the judgment debtor in the ordinary course of business. If the judgment debtor has no regular paydays, paydays means the 15th day and the last day of each month. If the levy attaches less than $10, the third party shall not retain and remit the sum. (b) The service of a writ of execution on a judgment for child support attaches to all unpaid nonexempt disposable earnings owing or to be owed by the third party and earned or to be earned by the judgment debtor before and within the pay period in which the writ of execution is served and within all subsequent pay periods until the judgment is satisfied if the judgment creditor is a county and the third party is notified by the county when the judgment is satisfied.

§ Subd. 6. Earnings exemption notice. Before the first levy on earnings, the attorney for the judgment creditor shall serve upon the judgment debtor no less than ten days before the service of the writ of execution, a notice that the writ of execution may be served on the judgment debtor's employer. The notice must: (1) be substantially in the form set forth below; (2) be served personally, in the manner of a summons and complaint, or by first class mail to the last known address of the judgment debtor; (3) inform the judgment debtor that an execution levy may be served on the judgment debtor's employer in ten days, and that the judgment debtor may, within that time, cause to be served on the judgment creditor's attorney a signed statement under penalties of perjury asserting an entitlement to an exemption from execution; (4) inform the judgment debtor of the earnings exemptions contained in section 550.37, subdivision 14 ; and (5) advise the judgment debtor of the relief set forth in this chapter to which the judgment debtor may be entitled if a judgment creditor in bad faith disregards a valid claim and the fee, costs, and penalty that may be assessed against a judgment debtor who in bad faith falsely claims an exemption or in bad faith takes action to frustrate the execution process. The notice requirement of this subdivision does not apply to a levy on earnings being held by an employer pursuant to a garnishment summons served in compliance with chapter 571. The ten-day notice informing a judgment debtor that a writ of execution may be used to levy the earnings of an individual must be substantially in the following form: State of Minnesota District Court County of: . Judicial District: . Court File Number: . Case Type: . Creditor's full name: . Execution Exemption Notice and against Notice of Intent to Levy on Earnings Debtor's full name: . and Third Party (bank, employer, or other): . Notice : A levy may be served on your employer or other third parties. A levy means that part of your earnings can be taken to pay off debts that you owe. This can happen in 10 days or more after you get this notice. This can happen without any other court action or notice to you. But some of your money may be protected. Your earnings cannot be taken if: (i) you are getting government assistance based on need, (ii) you got any government assistance based on need in the last 6 months, or (iii) you were an inmate of a correctional institution in the last 6 months. These are called exemptions. Your money is NOT protected unless you fill out the Exemption Claim Notice attached and send it back to the creditor or the creditor's lawyer. If you are not sure if you have any exemptions, talk to a lawyer. You can also contact the creditor or their lawyer to talk about a settlement of the debt. Examples of government assistance based on need: (i) MFIP - Minnesota Family Investment Program (ii) DWP - MFIP Diversionary Work Program (iii) SNAP - Supplemental Nutrition Assistance Program (iv) GA - General Assistance (v) EGA - Emergency General Assistance (vi) MSA - Minnesota Supplemental Aid (vii) MSA-EA - MSA Emergency Assistance (viii) EA - Emergency Assistance (ix) Energy or Fuel Assistance (x) Work Participation Cash Benefit (xi) MA - Medical Assistance (xii) MinnesotaCare (xiii) Medicare Part B - Premium Payments help (xiv) Medicare Part D - Extra (xv) SSI - Supplemental Security Income (xvi) Tax Credits - federal Earned Income Tax Credit (EITC), Minnesota Working Family Credit (xvii) Renter's Refund (also called Renter's Property Tax Credit) Warnings and Fines (1) Even if you claim an exemption, a levy may still be served on your employer. If they take money from you after you claim an exemption, you may ask the court to review your exemption. If the court finds that the creditor ignored your claim of exemption in bad faith, you are entitled to costs, reasonable lawyer fees, actual damages, and a fine up to $100. Bad faith is when someone does something wrong on purpose. (2) BUT if you claim an exemption, the creditor can also ask the court to review your exemption. If the court finds that you claimed an exemption in bad faith, you are charged costs and reasonable lawyer fees, and a fine up to $100. (3) If you get this notice, then do something in bad faith to try to block or stop the levy and the creditor has to take you to court because of it, you will have to pay the creditor's costs, and reasonable lawyer's fees, and a fine up to $100. Date: . Creditor's Signature: . (or creditor's lawyer's signature) Creditor's Name: . (or creditor's lawyer's name) Street Address: . City/State/Zip: . Phone: . Fax: . Email: . Debtor's Exemption Claim Notice I claim that my earnings are exempt because: (check all that apply) ... I am getting government assistance based on need. (State the program, case number if you know it, and the county you got it from.) Program: . Case #: . County: . Program: . Case #: . County: . Program: . Case #: . County: . ... I am not getting assistance based on need right now, but I did get government assistance based on need within the last 6 months. (State the program, case number if you know it, and the county you got it from.) Program: . Case #: . County: . Program: . Case #: . County: . Program: . Case #: . County: . ... I was an inmate of a correctional institution within the last 6 months. (State the correctional institution and location.) Correctional Institution . Location . I give my permission to any agency listed above to give information about my benefits to the creditor named above, or to the creditor's lawyer. The information will ONLY be if I get assistance, or if I have gotten assistance in the past 6 months. If I was an inmate in the last 6 months, I give my permission to the correctional institution to tell the creditor named above or the creditor's lawyer that I was an inmate there. Date: . Debtor's Signature: . Debtor's Name: . Street Address: . City/State/Zip: . Phone: . Email: .

§ Subd. 7. Additional notices. If the execution levy has not been served within one year after service of the exemption notice, the judgment creditor's attorney shall serve another notice upon the judgment debtor before serving the execution levy on the judgment debtor's employer. If more than one year has passed since the service of the judgment creditor's most recent execution levy, the judgment creditor shall, no less than ten days before service of a subsequent execution levy, serve notice that another execution levy may be served.

§ Subd. 8. Proceedings if no exemption statement is received. If no statement of exemption is received by the attorney for the judgment creditor on an earnings levy within ten days from the service of the notice, the attorney for the judgment creditor may proceed with the execution levy. Failure of the judgment debtor to serve a statement does not constitute a waiver of any right the judgment debtor may have to an exemption. If the statement of exemption is received by the attorney for the judgment creditor, the attorney may still cause a levy to be served subject to sanctions provided in section 551.05, subdivision 8 .

§ Subd. 9. Notice of levy on earnings, disclosure, and worksheet. The attorney for the judgment creditor shall serve upon the judgment debtor's employer a notice of levy on earnings and an execution earnings disclosure form and an earnings disclosure worksheet with the writ of execution, that must be substantially in the form set forth below. State of Minnesota District Court County of: . Judicial District: . Court File Number: . Case Type: . Creditor's full name: . Notice of Levy on Earnings for against Non-Child Support Judgments Debtor's full name: . and Third Party (Debtor's Employer): . To the employer: An employee of yours owes a judgment (money) to a creditor. The creditor's lawyer is starting a levy on the earnings you owe the employee. A levy means that you might have to hold part of the employee's earnings and send it to the creditor. By law, you have to do this. The limit on the levy is $10,000. A copy of the writ of execution from the court is enclosed. The amount of the judgment is $........ The levy applies to "nonexempt disposable earnings" that you owe the employee. There are definitions and instructions below on how to calculate the amount, if any, you have to hold. The levy starts with the pay period when you got this levy. It continues for all pay periods in the 90 days after you got this levy. You must complete the attached disclosure form and worksheet. Then mail it to the lawyer listed below. If any money is owed under the levy, you must also send a check payable to the creditor listed above. Follow the steps and the deadlines explained below. Creditor's Name: . Creditor's Lawyer's Name: . Street Address: . City/State/Zip: . Phone: . Fax: . Email: . State of Minnesota District Court County of: . Judicial District: . Court File Number: . Case Type: . Creditor's full name: . Earnings Disclosure and Worksheet against For Non-Child Support Judgments Debtor's full name: . and Third Party (Debtor's Employer): . This form is called an "Earnings Execution Disclosure" or "Disclosure." It is for the employer to fill out. The "debtor" is the person who owes money. The debtor gets a copy of this form for their own information. The employer is the "third party." The debtor is also called a "judgment debtor." If the debtor asks how the calculations in this document were made, the employer must provide information about it. Definitions "Earnings": what is paid or payable to an employee, independent contractor, or self-employed person for personal services (a job). Also called compensation. Compensation can be wages, salary, commission, bonuses, payments, profit-sharing distributions, severance payment, fees, or other. It includes periodic payments from a pension or retirement. It can also be compensation paid or payable to a producer for the sale of agricultural products. This can be things like milk or milk products, or fruit or other horticultural products. Or things produced in the operation of a family farm, a family farm corporation, or an authorized farm corporation. This is defined in Minnesota Statutes, section 500.24, subdivision 2 . "Disposable Earnings": the part of a person's earnings that are left after subtracting the amounts required by law to be withheld. Note: Amounts required by law to be withheld do not include things like health insurance, charitable contributions, or other voluntary wage deductions. "Payday": the date when the employer pays earnings to the debtor for doing their job. If the debtor has no regular payday, then "payday" means the 15th and the last day of each month. THE THIRD PARTY/EMPLOYER MUST ANSWER THE FOLLOWING QUESTIONS: 1. Right now, do you owe money to the debtor for earnings? Yes ..... No ..... 2. Within 90 days from the date you were served with the levy, will you or may you owe money to the debtor for earnings? Yes ..... No ..... 3. Does the debtor earn more than the current Minnesota or federal minimum wage per week? (use the number that is more) Yes ..... No ..... A. If you answer "No" to question 1, 2, or 3, you don't need to answer the rest of the questions. You don't have to do the Earnings Disclosure Worksheet. Sign the Earnings Disclosure Affirmation below and return this disclosure form to the sheriff. You must return it within 20 days after it was served on you. B. If you answer "Yes" to question 1 or 2, and "Yes" to question 3, sign the Earnings Disclosure Affirmation below. You must return it to the sheriff within 20 days. You must also fill out the rest of this form. Read the instructions for the Earnings Disclosure Worksheet. Earnings Disclosure Affirmation I, ................... (person signing Affirmation), am the third party/employer or I am authorized by the third party/employer to complete this earnings disclosure and have done so truthfully and to the best of my knowledge. Date: . Third Party's Name: . Third Party's Signature: . Phone: . Fax: . Email: . Instructions for Completing the Earnings Disclosure Worksheet For each payday that falls within 90 days from the date the levy was served on you, you must calculate the amount of earnings to be withheld. Enter the amounts on the Earnings Disclosure Worksheet. You must: 1. Withhold the amount of earnings listed in column I on the Earnings Disclosure Worksheet each payday. 2. After 90 days, return this Earnings Disclosure Worksheet to the sheriff. Include all the money withheld. Sign the Affirmation at the end of the worksheet before returning. 3. Deliver a copy of the disclosure and worksheet to the debtor within 10 days after the last payday that falls within the 90-day period. If the debt (judgment) is fully paid off or if the debtor's job ends before the 90-day period is over, you need to do the last disclosure and withholdings within 10 days of their last payday that you withheld money. Calculating Percentage of Disposable Earnings Note to Creditor: You must fill out this chart before sending this form to the employer. Use the current minimum wage found online at: https://www.dli.mn.gov/minwage. Minimum Wage = $MW/hour. if the weekly gross earnings are: then this percentage of the disposable earnings are withheld: Less than [40 X MW] 0% [40 X MW + .01] to [60 X MW] 10% [60 X MW + .01] to [80 X MW] 15% [80 X MW + .01] or more 25% Employer: Use this creditor's calculation chart to know what percentage of earnings should be withheld. Earnings Disclosure Worksheet . Debtor's Name A B C Payday Date Gross Earnings Disposable Earnings 1. . . . 2. . . . 3. . . . 4. . . . 5. . . . 6. . . . 7. . . . Column A. Enter the debtor's payday. Column B. Enter the debtor's gross earnings for each payday. Column C. Enter the debtor's disposable earnings for each payday. D E F % of withholding of Column C (Use the creditor's calculation chart) Greater of 40 X MN or Fed. Min. Wage Column C minus Column E 1. . . . 2. . . . 3. . . . 4. . . . 5. . . . 6. . . . 7. . . . Column D. Enter the percentage of disposable earnings that will be withheld. Get this number from the creditor's calculation chart. Column E. Calculate 40 times the current Minnesota minimum wage (or 40 times the current federal minimum wage) times the number of work weeks in each payday. Enter the bigger number here. Note: If a payday has extra days that are more than a full work week, count those extra days as part of a work week. Do this by dividing the number of extra workdays by the number of workdays in a normal week. Column F. Subtract the amount in Column E from the amount in Column C and enter here. G H I Lesser of Column D and Column F Setoff, Lien, Adverse Interest, or Other Claims Column G minus Column H 1. . . . 2. . . . 3. . . . 4. . . . 5. . . . 6. . . . 7. . . . TOTAL OF COLUMN I . Column G. Look at column D and column F. Enter the smaller amount of the two here in column G. Column H. Enter any amount claimed by you that would lower the amount of earnings that will go to the debtor. Things like: (i) a setoff, (ii) a defense, (iii) a lien, (iv) a claim, or (v) any amount claimed by any other person as an exemption or adverse interest. Note: You must describe your claim(s) and the claims of others, if known, in the spaces after this worksheet. Enter zero in column H if there are no claims by you or others which would lower the amount of earnings owed to the debtor. Note: Any debt that happened within 10 days before you got the first levy on a debt may not be set off against the earnings that are affected by this levy. Any wage assignment made by the debtor within 10 days before you got the first levy on a debt is void. Wage assignment is when a debtor voluntarily agrees to money being taken out of their earnings. Column I. Subtract the amount in column H from the amount in column G and enter here. This is the amount of earnings that go to the creditor. If you entered any amount in Column H for any payday, describe those claims below. It doesn't matter if they are your claims, or the claims of others. For claims by others, list the names and addresses of each, and describe their claims, if you know. . . . . Earnings Worksheet Affirmation I, ................. (person signing Affirmation), am the third party/employer or I am authorized by the third party/employer to complete this earnings disclosure and have done so truthfully and to the best of my knowledge. Date: . Third Party's Name: . Third Party's Signature: . Phone: . Fax: . Email: .

§ Subd. 10. Notice of levy on earnings, disclosure, and worksheet for child support judgment. The attorney for the judgment creditor shall serve upon the judgment debtor's employer a notice of levy on earnings and an execution earnings disclosure form and an earnings disclosure worksheet with the writ of execution, that must be substantially in the form set forth below. STATE OF MINNESOTA DISTRICT COURT COUNTY OF . . JUDICIAL DISTRICT FILE NO. . . (Judgment Creditor) against NOTICE OF LEVY ON EARNINGS AND DISCLOSURE . (Judgment Debtor) and . (Third Party) PLEASE TAKE NOTICE that pursuant to Minnesota Statutes, sections 551.04 and 551.06 , the undersigned, as attorney for the judgment creditor, hereby makes demand and levies execution upon all earnings due and owing by you (up to $10,000) to the judgment debtor for the amount of the judgment specified below. A copy of the writ of execution issued by the court is enclosed. The unpaid judgment balance is $..... This levy attaches all unpaid nonexempt disposable earnings owing or to be owed by you and earned or to be earned by the judgment debtor before and within the pay period in which the writ of execution is served and within all subsequent pay periods whose paydays occur within the 70 days after the service of this levy. In responding to this levy, you are to complete the attached disclosure form and worksheet and mail it to the undersigned attorney for the judgment creditor, together with your check payable to the above-named judgment creditor, for the nonexempt amount owed by you to the judgment debtor or for which you are obligated to the judgment debtor, within the time limits set forth in the aforementioned statutes. . Attorney for the Judgment Creditor . . . Address (...) . Phone Number DISCLOSURE DEFINITIONS "EARNINGS": For the purpose of execution, "earnings" means compensation paid or payable to an employee for personal services or compensation paid or payable to the producer for the sale of agricultural products; milk or milk products; or fruit or other horticultural products produced when the producer is operating a family farm, a family farm corporation, or an authorized farm corporation, as defined in section 500.24, subdivision 2 , whether denominated as wages, salary, commission, bonus, or otherwise, and includes periodic payments pursuant to a pension or retirement, workers' compensation, or unemployment benefits. "DISPOSABLE EARNINGS": Means that part of the earnings of an individual remaining after the deduction from those earnings of amounts required by law to be withheld. (Amounts required by law to be withheld do not include items such as health insurance, charitable contributions, or other voluntary wage deductions.) "PAYDAY": For the purpose of execution, "payday(s)" means the date(s) upon which the employer pays earnings to the debtor in the ordinary course of business. If the judgment debtor has no regular payday, payday(s) means the 15th and the last day of each month. THE THIRD PARTY/EMPLOYER MUST ANSWER THE FOLLOWING QUESTION: (1) Do you now owe, or within 70 days from the date the execution levy was served on you, will you or may you owe money to the judgment debtor for earnings? Yes ..... No ..... INSTRUCTIONS FOR COMPLETING THE EARNINGS DISCLOSURE A. If your answer to question 1 is "No," then you must sign the affirmation below and return this disclosure to the judgment creditor's attorney within 20 days after it was served on you, and you do not need to answer the remaining questions. B. If your answer to question 1 is "Yes," you must complete this form and the Earnings Disclosure Worksheet as follows: For each payday that falls within 70 days from the date the execution levy was served on you, YOU MUST calculate the amount of earnings to be retained by completing steps 2 through 8 on page 2, and enter the amounts on the Earnings Disclosure Worksheet. UPON REQUEST, THE EMPLOYER MUST PROVIDE THE DEBTOR WITH INFORMATION AS TO HOW THE CALCULATIONS REQUIRED BY THIS DISCLOSURE WERE MADE. Each payday, you must retain the amount of earnings listed in column G on the Earnings Disclosure Worksheet. You must pay the attached earnings and return this earnings disclosure form and the Earnings Disclosure Worksheet to the judgment creditor's attorney and deliver a copy of the disclosure and worksheet to the judgment debtor within ten days after the last payday that falls within the 70-day period. If the judgment is wholly satisfied or if the judgment debtor's employment ends before the expiration of the 70-day period, your disclosure and remittance should be made within ten days after the last payday for which earnings were attached. For steps 2 through 8, "columns" refers to columns on the Earnings Disclosure Worksheet. (2) COLUMN A. Enter the date of judgment debtor's payday. (3) COLUMN B. Enter judgment debtor's gross earnings for each payday. (4) COLUMN C. Enter judgment debtor's disposable earnings for each payday. (5) COLUMN D. Enter either 50, 55, 60, or 65 percent of disposable earnings, based on which of the following descriptions fits the child support judgment debtor: (a) 50 percent of the judgment debtor's disposable income, if the judgment debtor is supporting a spouse or dependent child and the judgment is 12 weeks old or less (12 weeks to be calculated to the beginning of the work week in which the execution levy is received); (b) 55 percent of the judgment debtor's disposable income, if the judgment debtor is supporting a spouse or dependent child, and the judgment is over 12 weeks old (12 weeks to be calculated to the beginning of the work week in which the execution levy is received); (c) 60 percent of the judgment debtor's disposable income, if the judgment debtor is not supporting a spouse or dependent child and the judgment is 12 weeks old or less (12 weeks to be calculated to the beginning of the work week in which the execution levy is received); or (d) 65 percent of the judgment debtor's disposable income, if the judgment debtor is not supporting a spouse or dependent child, and the judgment is over 12 weeks old (12 weeks to be calculated to the beginning of the work week in which the execution levy is received). (Multiply column C by .50, .55, .60, or .65, as appropriate.) (6) COLUMN E. 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 that would reduce the amount of earnings owing to the judgment debtor. (Note: Any indebtedness to you incurred within ten days prior to your receipt of the first execution levy on a debt may not be set off against the earnings otherwise subject to this levy. Any wage assignment made by the judgment debtor within ten days prior to your receipt of the first execution levy on a debt is void.) 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. Enter zero in column E if there are no claims by you or others that would reduce the amount of earnings owing to the judgment debtor. (7) COLUMN F. Subtract the amount in column E from the amount in column D and enter here. This is the amount of earnings that you must remit for the payday for which the calculations were made. AFFIRMATION I, ................... (person signing Affirmation), am the third party/employer or I am authorized by the third party/employer to complete this earnings disclosure, and have done so truthfully and to the best of my knowledge. DATED: . . Signature . Title . Telephone Number EARNINGS DISCLOSURE WORKSHEET . Debtor's Name A B C Payday Date Gross Earnings Disposable Earnings 1. . $ . $ . 2. . . . 3. . . . 4. . . . 5. . . . 6. . . . 7. . . . 8. . . . 9. . . . 10. . . . D E F Either 50, 55, 60, or 65% of Column C Setoff, Lien, Adverse Interest, or Other Claims Column D minus Column E 1. . . . 2. . . . 3. . . . 4. . . . 5. . . . 6. . . . 7. . . . 8. . . . 9. . . . 10. . . . TOTAL OF COLUMN F $ . *If you entered any amount in column E for any payday(s), you must describe below either your claims, or the claims of others. For amounts claimed by others, you must both state the names and addresses of such persons, and the nature of their claim, if known. . . . AFFIRMATION I, ................. (person signing Affirmation), am the third party or I am authorized by the third party to complete this earnings disclosure worksheet, and have done so truthfully and to the best of my knowledge. . Signature Dated: . . (...) . Title Phone Number

§ Subd. 11. Postexecution notice to judgment debtor. The attorney for the judgment creditor shall serve by mail upon the judgment debtor not later than five days after service is made on the judgment debtor's employer, a copy of the writ of execution and copies of all other papers served on the judgment debtor's employer.

§ Subd. 12. Third-party disclosure and remittance obligation. If there are no attachable earnings, the third party shall serve the execution earnings disclosure form upon the attorney for the judgment creditor within 20 days after service of the writ of execution. However, if the judgment debtor has attachable earnings, the third party shall serve the execution earnings disclosure form upon both the attorney for the judgment creditor and the judgment debtor and remit to the attorney for the judgment creditor the attached earnings within ten days of the last payday to occur within the 90 days after the date of the service of the writ of execution. If the judgment is wholly satisfied or if the judgment debtor's employment ends before the expiration of the 90-day period, the disclosure and remittance should be made within ten days after the last payday for which earnings were attached. The amount of the third party's execution earnings disclosure form and remittance need not exceed 100 percent of the amount of the judgment creditor's judgment that remains unpaid, after subtracting the total of setoffs, defenses, exemption, or other adverse interests. If the disclosure is by a corporation, it shall be made by an officer or an authorized agent having knowledge of the facts.

§ Subd. 13. Penalty for retaliation for execution. (a) An employer shall not discharge or otherwise discipline an employee as a result of an earnings levy authorized by this chapter. (b) If an employer violates this section, a court may order the reinstatement of an aggrieved party who demonstrates a violation of this section, and other relief the court considers appropriate. The aggrieved party may bring a civil action within 90 days of the date of the prohibited action. If an employer-employee relationship existed before the violation of this section, the employee shall recover twice the wages lost as a result of this violation. (c) The rights guaranteed by this section are not subject to abridgment and may not be altered by employment contract.

§ Subd. 14. Public employees, levy on earnings. The salary or earnings of any public employee or officer may be levied upon pursuant to this chapter. Where the person is an officer, the writ shall be served upon the auditor, treasurer, or clerk of the subdivision or department of which the person is an officer. Where the person is an employee other than an officer, the writ must be served upon the person in charge of the office or department in which the employee works. When payment has been made pursuant to levy, a copy of the execution with certificate of satisfaction shall be delivered to the treasurer as a voucher for such payment.