Writ Of Garnishment With Notice Of Exemption And Pending Levy - Colorado District Court Page 2

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The following questions MUST be answered by you under oath:

On the date and time this Writ was served upon you, did you possess or control any personal property of the Judgment Debtor or did you owe any rents,

payments, obligations, debts or money’s other than earnings of the Judgment Debtor?

YES

If “YES”, list all items of personal property and their location(s) and/or describe the nature and amount of the debt or obligation: (Attach additional pages

if necessary):

Do you claim and setoff against and property, debt of obligation listed above?

YES

If you said “YES” to question (c) describe the nature and amount of the setoff claimed: (Attach additional pages if necessary)

I affirm that I am authorized to act for the Garnishee and the above answers are true and correct:

Subscribed under oath before me on

(Date)

Name of Garnishee

Notary Public or Deputy Clerk

Address:

My Commission Expires:

Phone:

Name of Person Answering (print):

Signature of Person Answering:

NOTICE TO JUDGMENT DEBTOR OF EXEMPTION AND PENDING LEVY

This Writ with Notice is a court order which may cause your property or money to be held and taken to pay a judgment entered against you. You have legal rights which

may prevent all or part of your money or property from being taken. That part of the money or property which may not be taken is called "exempt property". A partial list

of "exempt property is shown below, along with the law which may make all or part of your money or property exempt. The purpose of this notice is to tell you about these

rights.

PARTIAL LIST OF EXEMPT PROPERTY (Numbered Statutory References are Subject to Change)

All or part of your property listed in Sections 13-54101 and 102, C.R.S., including clothing, jewelry, books burial sites, household goods, food and fuel, farm

animals, seed, tools, equipment and implements, military allowances stock in-trade and certain items used in our occupation, bicycles motor vehicles (greater for

disabled persons), life insurance, income tax refunds, money received because of loss or property or for personal injury, equipment that you need because of your

health, or money received because you were a victim of a crime.

All or part of your earnings under Section 13-54-104, C.R.S.

Worker's compensation benefits under Section 8-42-124 C.R.S.

Unemployment compensation benefits under Section 8-$0-103, C.R.S.

Group life insurance benefits under Section 10-7-205 C.R.S.

Heal insurance benefits under Section 10-16-212, C.R.S.

Fraternal society benefits under Section 10-14-403, C.R.S.

Family allowances under Section 1511-404, C.R.S.

Teachers' retirement fund benefits under Section 22-64-120, C.R.S.

10. Public Employees' retirement benefits (PERA) under Section 24-51-212, C.R.S. and Section 24-54-111, C.R.S.

11. Social security benefits under (OASDI. SSI) under 42 U.S.C. § 407.

12. Railroad employee retirement benefits under 45 U.S.C. g231.

13. Public assistance benefits (OAP, AFDC, AND, AB, LEAP under Section 26-2-131 C.R.S.

14. Police Officers and Firefighter’s pension fund payments under Section 31-30-1117, 31-30.5-208 & 31-31-203, C.R.S.

15. Utility and security deposits under Section 13-54-102(I)(r), C.R.S

16. Proceeds of the sale of homestead property under Sect ion 38-41-207, C.R.S.

17. Veteran's Administration benefits under 38 U.S.C. 5301.

18. Civil service retirement benefits under 5 U.S.C.

8346.

19. Mobile homes and trailers under Section 38-41-201.6, C.R.S.

20. Certain retirement and pension funds and benefits under Section 13-54102(s). C.R.S.

If the money or property which is being withheld from you includes and "exempt property", you must file within 10 days of receiving this notice a written Claim of Exemption with the Clerk

of Court describing what money or property you think is "exempt property" and the reason that it is exempt. YOU MUST USE THE APPROVED FORM attached to this Writ or a copy of it. When

you file the claim, you must immediately deliver, by certified mail, return receipt requested, a copy of your claim to the Garnishee (person/place that was garnished) and to Judgment Creditor's

attorney, or if none, to the judgment Creditor at the address shown on this Writ with Notice.

Once you have properly filed your claim, the court will schedule a h earing within 10 days. The Clerk of Court will notify you and the Judgment Creditor or attorney of the date and time of

the hearing, by telephone, by mail or in person.

When you come to your hearing you should be ready to explain why you believe your money or property is "exempt property". If you do not appear at the scheduled time, your money or

property may be taken by the Court to pay the judgment entered against you.

REMEMBER THAT THIS IS ONLY A PARTIAL LIST OF "EXEMPT PROPERTY"; you may wish to consult a lawyer who can advise you of your rights. If you cannot afford one, there

are listings of legal assistance and legal aid offices in the yellow pages of the telephone book.

You must act quickly to protect your rights. Remember you only have 10 days after receiving this notice to file your claim of exemption with the Clerk of Court.

RETURN OF SERVICE

STATE OF COLORADO

_________________________ County of _________________________

I, ____________________________________________________, affirm that I have served a copy of the Writ of Garnishment on ___________________________

________________________ (date) at ____________ (time), by ___________________________.

Subscribed under oath before me on _______________________.

__________________________________

Signature

__________________________________

My Commission Expires: ______________________

Service Fee $ _____________________________

Notary Public