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UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLORADO
Case No. OBJECTION TO CALCULATION OF THE AMOUNT OF EXEMPT EARNINGS

Plaintiff(s) vs.

Defend ant(s) NOTICE TO JUDGMENT DEBTOR: THIS FORM MUST BE USED TO OBJECT TO THE CALCULATION OF EXEMPT EARNINGS My Name: Phone: Add ress: 1. I object to the Garnishee's Calculation of the Amo unt of Exem pt Earnings b ecause I BELIEVE THE CORRECT CALCULATION IS: Gross Earnings for My Pay Period from thru Less Deductions Required by Law (For Example, Withholding Taxes, FICA) Dispo sable Ea rnings (Gro ss Earnings Less Deductions) Less S tatutory E xemption (Use Exemptio n Chart on W rit) Net Amo unt Subject to Garnishment Less W age/Income Assignment(s) D uring P ay Period (If Any) AMO UNT WH ICH SHOULD HAVE B EEN W ITHHELD

$ ­$ =$ ­$ =$ ­$

=$ OR 2. The earnings garnished are pension or retirement benefits/deferred compensation/health, accident or disability insurance AND THEY ARE TOTALLY EXEMPT BECAUSE: I understand that I must make a good faith effort to resolve my dispute with the Garnishee. I have have not attempted to resolve this dispute with the Garnishee. Name of Person I Talked to: Position: Phone N umber: TO GARNISHEE: BY FILING THIS OBJECTION, YOU ARE DIRECTED TO SEND MY NONEXEMPT EARNINGS TO THE COURT AT THE ADDRESS NOTED INSTEAD OF TO THE PARTY DESIGNATED IN PARAGRAPH 'e', ON THE FRONT OF THE WRIT OF CONTINUING GARNISHMENT. THE COURT WILL HOLD MY NONEXEMPT EARNINGS IN ITS REGISTRY UNTIL MY OBJECTION IS RESOLVED. I certify that I mailed a copy of this document by certified mail, return receipt requested, to: THE GARNISHEE Add ress: CO Subscribed under oath on:
Da te Signature of Judgment Debtor

JUDGMENT CREDITOR OR ATTORNEY Add ress: CO

No tary Pub lic/Dep uty Clerk

My Commission Exp ires:
Revised 1/98 OBJECTION TO CALCULATION OF THE AMOUNT OF EXEMPT EARNINGS