(2) A debt calculation form must be in substantially the following form:
______________________________________________________________________________
________ COURT
COUNTY OF ________
______ )
Plaintiff, ) DEBT
) CALCULATION
vs. ) Case No. _____
)
______ )
Defendant. )
TO: ________ (Debtor).
The following amounts have been calculated to be owing from you to ________ (Creditor). The amounts are owed by reason of:
__ A judgment entered against you dated _____, 2__, in Case No. _____, ______ Court, ______ County.
__ Other debt subject to garnishment under the law (provide details):
______________________
______________________
THE COURT ADMINISTRATOR HAS NOT CALCULATED ANY AMOUNTS FOR THE PURPOSE OF THIS FORM AND IS NOT LIABLE FOR ERRORS IN THIS FORM OR IN THE WRIT OF GARNISHMENT MADE BY THE CREDITOR OR GARNISHOR.
Original Debt Amount $______
+ Pre-adjudication Interest $______
+ Attorney Fees $______
+ Cost Bill $______
+ Post-adjudication Interest $______
+ Delivery Fee for Writ $______
+ Sheriff’s Fees other
than Delivery Fees $______
+ Other (Explain. Attach
additional sheets
if necessary.)
______ $______
______ $______
______ $______
______ $______
Total "Other"
from additional
sheets (if used)
+ Past Writ Issuance Fees $______
+ Past Delivery Fees $______
+ Transcript and Filing
Fees for Other Counties $______
= Subtotal $______
LESS Payments Made on Debt $(______)
= Total Amount Required to
Satisfy Debt in Full $______
NOTE: INSERTING ITEMS AND AMOUNTS NOT LAWFULLY SUBJECT TO COLLECTION BY GARNISHMENT MAY RESULT IN LIABILITY FOR WRONGFUL EXECUTION.
I certify that I have read this Debt Calculation form and to the best of my knowledge, information and belief the amount shown as owing is correct.
Creditor (Creditor must sign if writ issued by court administrator.)
Garnishor (Attorney for Creditor or other person authorized by law to issue writ.)
Address
Telephone Number
Oregon State Bar Number (if attorney)
_______________, 2__
Date of Calculation
______________________________________________________________________________ [2001 c.249 §60; 2003 c.576 §74]