Form Osca (03-05) Cv 95-Affidavit For Head Of Family Exemption Of Wages Garnishment Form

IN THE ________ JUDICIAL CIRCUIT COURT, _______________________, MISSOURI

Judge or Division:

Case Number:

Plaintiff/Petitioner:

vs.

Defendant/Respondent:

Affiant’s SSN (Last Four Digits):

(Date File Stamp)

Affidavit for Head of Family Exemption of Wages Garnishment

I, ___________________________________________, being of lawful age and being duly sworn on

oath state that I am a resident of ___________________________________ County, Missouri,

residing at __________________________________________________________ and that I am the

head of a family and that I contribute to the support of my spouse and/or dependents and under the

laws of the State of Missouri I am entitled to a head of family exemption from garnishment of wages.

I swear/affirm under penalty of perjury that these facts are true according to my best knowledge and

belief.

____________________________________

Affiant’s Signature

OSCA (03-05) CV 95

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Rule 90.15, 513.440 and 525.030 RSMo

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