Claim For Exemption And Request For Hearing Page 2

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2.
Check one box:
9
All funds are exempt, or,
9
I believe the following amount of money is exempt: $__________________________
(Fill in the amount of funds to be exempt).
3.
Check if applicable:
9
I have attached copies of the documents that show that my money is exempt.
4.
If garnishment is for wages, this claim and request is filed for the pay period
_________________ through ________________, inclusive.
5.
I request that this matter be set for hearing.
_________________________________________
Signature
Address for mailing of Court Hearing Notice
_________________________________________
_________________________________________
Address for mailing a copy of Claim to Judgment
Creditor’s Attorney:
_________________________________________
_________________________________________
You must mail the original to the Court Clerk of ____________________County at the following
address: _________________________________________________________________
_________________________________________________________________________
AOC Form 22
Revised 8/05

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