WASHINGTON COUNTY SUPERIOR COURT Frank Newkirk, JR., Judge
Phone: 812-883-4949 Toll Free: 1-800-453-1978
Fax: 812-883-5488 E-Mail: superior@blueriver.net
Address: 801 Jackson St. (Hwy 60 East), Salem, IN 47167
Office Hours: Monday through Friday — 8:30 a.m. — 4:00 p.m.

 

88D01-_______________

INTERROGATORIES

1. State the correct name and address of your company or partnership.
ANSWER:_________________________________________________________

2. What is your position with the company?
ANSWER:_________________________________________________________

3. Does your company have an employee at the present time named_______________________________?
ANSWER:_________________________________________________________

4. If ____________________________ is not presently employed by you but has worked for you in the past, state the period of time in which this individual has worked for you?
ANSWER:_________________________________________________________

5. If ____________________________ is not currently employed by you but has worked for you in the past, state whether this individual has been fired, laid off, requested a temporary layoff, etc., and state the reason why this individual is not employed by you at this time.
ANSWER:_________________________________________________________

6. State the Social Security Number and current address of record of ____________.
ANSWER:_________________________________________________________

7. State the average weekly gross income paid by your company to ______________________, if this individual is presently employed by you or the average weekly gross income paid by your company to ___________________, for the period of time in which this individual was last employed by you.
ANSWER:_________________________________________________________

8. To the best of your knowledge, state whether or not there are any garnishment orders or wage assignments at this time with your company against __________________________, and if so, state the cause numbers and amounts.
ANSWER:_________________________________________________________

Answered by: (Printed)_____________________________________

(Signature)_______________________________________________

(Date)_________________________________

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