WORKSHEET FOR COMPUTING AMOUNT OF WAGES EXEMPT 
FROM ATTACHMENT, EXECUTION AND PAYMENT ORDERS 

This form is to be completed by a plaintiff or judgment creditor.  It should be based on information 
provided by or obtained from the defendant or judgment debtor (employee) by means of business 
records, testimony or discovery, including a written financial statement. 

COMPUTATION DATA 

Employee’s weekly “disposable earnings” 1

A.  ___________ 

Employee’s weekly “gross wages” 2

Federal minimum hourly wage 3 

Massachusetts minimum hourly wage 4

B.  ___________ 

C.  ___________ 

D.  ___________ 

COMPUTATION 

1. ____________ multiplied by 25%
               A 

C 

3. ____________ multiplied by 15%
               B 

2. ____________ minus ____________
               A

(____________ multiplied by 30) 

         =     2. 

$___________ 

         =     1. 

$___________ 

         =     3. 

$___________ 

4. ____________ minus ____________
               B

(greater of ____________ or ____________ multiplied by 50) 

         =     4. 

$___________ 

C                      D 

The MAXIMUM amount of weekly wages subject to attachment, execution or a payment order 

is the LOWEST of the amounts set forth in 1, 2, 3, and 4, above, namely:  $ ________________ 

1. This is the amount of wages or salary used for computing the exemption under federal law.
“Disposable earnings” are gross wages or salary minus amounts required by law to be
withheld. See 15 U.S.C.A. §§ 1671 – 1677.

2. This is the term used for computing the wage exemption under Massachusetts law.

3.
4.

See G.L. c. 246, § 28.
See 29 U.S.C. 206.
See G.L. c. 151, § 1.  The minimum wage is $11/hr. until 12/31/18; $12/hr. as of 1/1/19; $12.75/hr.
as of 1/1/20; $13.50/hr. as of 1/1/21; $14.25/hr. as of 1/1/22; and $15/hr. as of 1/1/23.

NOTES:  

(Rev. 11/18)