Free ______________________County, Colorado - Colorado

United States Bankruptcy Court, District of Colorado U. S. Custom House, 721 - 19th Street Denver, CO 80202-2508 Plaintiff(s)/Petitioner(s): v. Defendant(s)/Respondent(s): Judgment Creditor's Attorney or Judgment Creditor (Name and Address): COURT USE ONLY Case Number:

Phone Number: E-mail: Courtroom FAX Number: Atty. Reg.#: WRIT OF GARNISHMENT WITH NOTICE OF EXEMPTION AND PENDING LEVY
Judgment Debtor's name, last known address, other identifying information: _______________________________________ ____________________________________________________________________________________________________ $ ____________________ 1. Original Amount of Judgment Entered (date) ___________________________ 2. Plus any Interest Due on Judgment (________________% per annum) + $____________________ 3. Taxable Costs (including estimated cost of service of this Writ) + $____________________ 4. Less any Amount Paid - $____________________ 5. Principal Balance/Total Amount Due and Owing = $____________________ I affirm that I am authorized to act for the Judgment Creditor and this is a correct statement as of _______________________.
(date)

Subscribed under oath before me on __________________ _______________________________________________
Notary Public or Deputy Clerk

___________________________________________
Print Judgment Creditor's Name Address: ____________________________________

___________________________________________ My commission expires: ___________________________ By: ________________________________________
Signature (Type Name, Title, Address and Phone No.)

WRIT OF GARNISHMENT WITH NOTICE OF EXEMPTION AND PENDING LEVY THE PEOPLE OF THE STATE OF COLORADO to the Sheriff of any Colorado County, or to any person over the age of 18 years who is not a party to this action: You are directed to serve a copy of this Writ of Garnishment upon ______________________________________________ ______________________, Garnishee, with proper return of service to be made to the Clerk of the U.S. Bankruptcy Court. TO THE GARNISHEE: YOU ARE HEREBY SUMMONED AS GARNISHEE IN THIS ACTION AND ORDERED:
a. To answer the following questions under oath and file your answers with the Clerk of the Court (AND to mail a completed copy with your answers to the Judgment Creditor or attorney when a stamped envelope is attached) within 10 days following service of this Writ upon you. YOUR FAILURE TO ANSWER THIS WRIT WITH NOTICE MAY RESULT IN THE ENTRY OF A DEFAULT AGAINST YOU. b. To hold pending court order any personal property (other than earnings) owed to or owned by the Judgment Debtor and in your possession or control on the date and time this Writ was served upon you. YOU ARE NOTIFIED: a. This Writ with Notice applies to all personal property (other than earnings) owed to or owned by the Judgment Debtor and in your possession or control as of the date and time this Writ was served upon you. b. In no case may you withhold any personal property greater than the amount on Line 5 on the front of this Writ unless the personal property is incapable of being divided. c. If you are ordered to pay funds to the Court, tender your check for the amount ordered PAYABLE TO: Clerk, U. S. Bankruptcy Court, 721 - 19th Street, Denver, CO 80202-2508.

CLERK OF THE COURT Bradford L. Bolton
C.R.C.P. NO. 29 R4/02

By: Deputy Clerk: ___________________________________________ DATE: ____________________________________________________

WRIT OF GARNISHMENT WITH NOTICE OF EXEMPTION AND PENDING LEVY

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QUESTIONS TO BE ANSWERED BY GARNISHEE
The following questions MUST be answered by you under oath: a. 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 moneys other than earnings to the Judgment Debtor? ! YES ! NO b. 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): _______________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ c. Do you claim any setoff against any property, debt or obligation listed above? ! YES ! NO d. If you answered 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 _______________________
Signature of Person Answering Type or Print Name of Person Answering Date

________________________________________________________ _____________________________________________________
Notary Public/Deputy Clerk

________________________________________________________
Type or Print Name of Garnishee (address and telephone no. below)

________________________________________________________ My Commission Expires: ____________________________ _____ ________________________________________________________ ________________________________________________________

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
1. All or part of your property listed in Sections 13-54-101 & 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 your occupation, bicycles, motor vehicles (greater for disabled persons), life insurance, income tax refunds, money received because of loss of property or for personal injury, equipment that you need because of your health, or money received because you were a victim of a crime.

2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.

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 8-80-103, C.R.S. Group life insurance benefits under Section 10-7-205, C.R.S. Health 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 15-11-404, C.R.S. Teachers' retirement fund benefits under Section 22-64-120, C.R.S. Public employees' retirement benefits (PERA) under Sections 24-51-212 and 24-54-111, C.R.S. Social security benefits (OASDI, SSI) under 42 U.S.C. §407. Railroad employee retirement benefits under 45 U.S.C. §231m. Public assistance benefits (OAP, AFDC, AND, AB, LEAP) under Section 26-2-131, C.R.S. Police Officer's and Firefighter's pension fund payments under Sections 31-30-1117 & 31-30.5-208 & 31-31-203, C.R.S. Utility and security deposits under Section 13-54-102(1)(r), C.R.S. Proceeds of the sale of homestead property under Section 38-41-207, C.R.S. Veteran's Administration benefits under 38 U.S.C. §5301. Civil service retirement benefits under 5 U.S.C. §8346. Mobile homes and trailers under Section 38-41-201.6, C.R.S. Certain retirement and pension funds and benefits under Section 13-54-102(s), C.R.S.

If the money or property which is being withheld from you includes any "exempt property", you must file within 10 days of receiving this notice a written Claim of Exemption with the Clerk, U.S. Bankruptcy 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 the 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 you claim, the court will schedule a hearing within 10 days. The Clerk of the 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 with 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 the U.S. Bankruptcy Court. C.R.C.P. NO. 29 R4/02 WRIT OF GARNISHMENT WITH NOTICE OF EXEMPTION AND PENDING LEVY 2

RETURN OF SERVICE District of Colorado

I, ____________________________________________, affirm that I served one copy of the Writ of Garnishment on (date) ___________________________________,at (time) __________________, by ____________________________________ ___________________________________________________________________________________________________.

Subscribed under oath before me on (date) _________________

___________________________________________
Signature of Person Who Served Documents

My commission expires ________________________________ ___________________________________________________
Notary Public

Service Fee $ _____________________

C.R.C.P. NO. 29 R4/02

WRIT OF GARNISHMENT WITH NOTICE OF EXEMPTION AND PENDING LEVY

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