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:
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
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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