The demand shall be in substantially the following form:
"NOTICE OF COURT PROCEEDING TO COLLECT DEBT
Date of mailing or date of service by the court ______________
To: ______________________________
(Name of Judgment Debtor)
__________________________________
(Last Known Residence Address of Judgment Debtor)
You owe the undersigned _______________________ (Name of Judgment Creditor) $__________, including interest and court costs, for which a judgment was obtained against you or certified in the __________ court on __________, payment of which is hereby demanded.
If you do not do one of the three things listed below within fifteen days of the date of the mailing of this notice or of its service by the court, we will go to court, unless we are otherwise precluded by law from doing so, and ask that your employer be ordered to withhold money from your earnings until the judgment is paid in full or, if applicable, is paid to a certain extent and to pay the withheld money to the court in satisfaction of your debt. This is called garnishment of personal earnings.
It is to your advantage to avoid garnishment of personal earnings because the placing of the extra burden on your employer possibly could cause you to lose your job.
YOU CAN AVOID THE GARNISHMENT BY DOING ONE OF THESE THREE THINGS WITHIN THE FIFTEEN-DAY PERIOD:
You also may contact a budget and debt counseling service described in division (D) of section 2716.03 of the Revised Code for the purpose of entering into an agreement for debt scheduling. There may not be enough time to set up an agreement for debt scheduling in order to avoid a garnishment of your wages based upon this demand for payment, but entering into an agreement for debt scheduling might protect you from future garnishments of your wages. Under an agreement for debt scheduling, you will have to regularly pay a portion of your income to the service until the debts subject to the agreement are paid off. This portion of your income will be paid by the service to your creditors who are owed debts subject to the agreement. This can be to your advantage because these creditors cannot garnish your wages while you make your payments to the service on time.
______________________________
(Name of Judgment Creditor)
______________________________
(Signature of Judgment Creditor - or Judgment Creditor's Attorney)
________________________________
________________________________
________________________________
(Address of Judgment Creditor)
PAYMENT TO AVOID GARNISHMENT
To: ______________________________
(Name of Judgment Creditor)
__________________________________
__________________________________
(Address of Judgment Creditor)
To avoid the garnishment of personal earnings of which you have given me notice, I enclose $ _______________ to apply toward my indebtedness to you. The amount of the payment was computed as follows:
(1) $__________
during the current pay period (that is, the pay
period in which this demand is received
by you): (2) $___________
I certify that the statements contained above are true to the best of my knowledge and belief.
___________________________________ - (Signature of Judgment Debtor)
___________________________________
___________________________________
___________________________________ - (Print Name and Residence Address of - Judgment Debtor)
(To verify that the amount shown on line (2) is a true statement of your earnings, you must either have your employer certify below that the amount shown on line (2) is a true statement of your earnings or you may submit copies of your pay stubs for the two pay periods immediately prior to your receiving this notice.)
I certify that the amount shown on line (2) is a true statement of the judgment debtor's earnings.
___________________________________ - (Print Name of Employer)
___________________________________ - (Signature of Employer or Agent)
I certify that I have attached copies of my pay stubs for the two pay periods immediately prior to my receiving this notice.
___________________________________ - (Signature of Judgment Debtor)"
R.C. §2716.02