Claim of Exemption Sample Form
by Robin from Ocala, Florida, Marion County
Claim of Exemption Form:What type of form is required to file an affidavit for exemption of personal property from levy from civil judgement?
I am interested in filing an affidavit for exemption of personal property but am unable to locate the form.
Please advise if there is a website where I can download or locate this form.
Answer to Florida Court Forms Question
Dear Robin,
Pursuant to Florida Statutes - 77.041. Notice to individual defendant for claim of exemption from garnishment; procedure for hearing.--
To keep your wages, money, and other property from being garnished, or to get back anything already taken, you must complete a form for Claim of Exemption and Request for Hearing as set forth below and have the form notarized.
You must file the form with the Clerk's office within 20 days after the date you receive this notice or you may lose important rights. You must also mail or deliver a copy of this form to the Plaintiff and the Garnishee at the addresses listed in the Writ of Garnishment.The following is a sample Claim of Exemption & Request for Hearing form...
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Sample Form
CLAIM OF EXEMPTION AND REQUEST FOR HEARING
I claim exemptions from garnishment under the following categories as checked:
_____ 1. Head of family wages. (You must check a. or b. below.)
_____ a. I provide more than one-half of the support for a child or other dependent and have net earnings of $500 or less per week.
_____ b. I provide more than one-half of the support for a child or other dependent, have net earnings of more than $500 per week, but have not agreed in writing to have my wages garnished.
_____ 2. Social Security benefits.
_____ 3. Supplemental Security Income benefits.
_____ 4. Public assistance (welfare).
_____ 5. Workers' Compensation.
_____ 6. Unemployment Compensation.
_____ 7. Veterans' benefits.
_____ 8. Retirement or profit-sharing benefits or pension money.
_____ 9. Life insurance benefits or cash surrender value of a life insurance policy or proceeds of annuity contract.
_____ 10. Disability income benefits.
_____ 11. Prepaid College Trust Fund or Medical Savings Account.
_____ 12. Other exemptions as provided by law.
________________________________________(explain)
I request a hearing to decide the validity of my claim. Notice of the hearing should be given to me at:
Address: _____________________________________
Telephone number: _____________________________________
The statements made in this request are true to the best of my knowledge and belief.
________________________________________
Defendant's signature
Date________________________________________
STATE OF FLORIDA COUNTY OF ____________________
Sworn and subscribed to before me this __________ day of (month and year) , by (name of person making statement)
Notary Public/Deputy Clerk
Personally Known __________OR
Produced Identification_____
Type of Identification Produced __________________
End of Sample Form
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The formatting is going to be a little off on a web browser. You can copy and paste the above sample into your favorite word processor and edit it to suit your needs.
Alternatively, you can use our Petition Preparer service. We can create a custom Claim of Exemption form to your specifications for as little as $20.00 and have it filled out for you, too! Just ask us for a free quote.
Also, you can purchase our fillable Claim of Exemption form for immediate download ($2.95).
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