Assignment of a Specified Amount of Wages

An assignment of wages should be contained in a separate written instrument, signed by the person who has earned or will earn the wages or salary. The assignment should include statements identifying the transaction to which the assignment relates, the personal status of the assignor, and a recital, where appropriate, that no other assignment or order exists in connection with the same transaction.

This form is a generic example that may be referred to when preparing such a form for your particular state. It is for illustrative purposes only. Local laws should be consulted to determine any specific requirements for such a form in a particular jurisdiction.