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Notice To Defendant Of Right Against Garnishment Of Money, Including Wages, And Other Property - State Court Of Dekalb County Page 2

’

DEFENDANT

S CLAIM FORM

I CLAIM EXEMPTION from garnishment. Some of my money or property held by the garnishee is exempt because it is

[check all that apply]:

1. Social security benefits

2. Supplemental security income benefits

3. Unemployment benefits

4. Workers’ compensation

5. Veterans’ benefits

6. State pension benefit

7. Disability income benefits

8. Money that belongs to a joint account holder

9. Child support or alimony

10. Exempt wages, retirement, or pension benefits

11. Other exemptions as provided by law

Explain:__________________________________________________________________________________________

________________________________________________________________________________________________

I further state: (Check all that apply)

1. The plaintiff does not have a judgment against me.

2. The amount shown due on the plaintiff’s affidavit of garnishment is incorrect.

3. The plaintiff’s affidavit of garnishment is untrue or legally insufficient.

Send the notice of hearing on my claim to me at:

Address: _____________________________________________________________________________________________________

Phone Number: _______________________________________________________________________________________________

Email Address: ________________________________________________________________________________________________

The statements made in this claim form are true to the best of my knowledge and belief.

_______________________________________________

______________________________ 20 _________

Defendant’s Signature

Date

______________________________________________

Print name of defendant

ERTIFICATE OF

ERVICE

This is to certify that I have this day served the Plaintiff or Plaintiff’s Attorney and the Garnishee in the foregoing matter with a

copy of the defendant’s Claim form by depositing in the United States Mail in a properly addressed envelope with adequate postage

thereon.

This __________ day of _____________________________________, 20 ________.

Signed: _______________________________________________

Defendant or Defendant’s Attorney

G:/Notice of Defendant and Defendant’s Claim Form

Notice To Defendant Of Right Against Garnishment Of Money, Including Wages, And Other Property - State Court Of Dekalb County Page 2