Free Application for Writ - District Court of Connecticut - Connecticut

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Case 3:02-cv-01826-JBA Document 16 Filed O4/O1/2004 Page 1 of 4 I
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UNITED STATES DISTRICT COURT Aglw if
DISTRICT OF CONNECTICUT L1 Q _ J 39 ,
A- ?Z.,’·>-if! r_ ,,. .. __ if
APPLICATION FOR AND WRIT OF EXECUTIO`N’*»·1 P_ ,
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BANKING INSTITUTION l 1
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APPLICATION 0
To the United States District Court for the District of Connecticut at New I
Haven, Connecticut, in connection with a judgment therein on February 10, I
2004, Docket No. 3:02-CV-1826 (JBA) Case Name Trustees of the Iron Workers’ ,
Locals 15 and 424 Pension Fund; Trustees of the Iron Workers’ Locals 15 and 424
Annuity Fund; Trustees of the Iron Workers’ Locals 15 and 424 Extended Benefit 1
Fund; Trustees of the Iron Workers’ Locals 15 and 424 Apprentice Training Fund vs.
Jeffrey Leibowitz d / b / a Ornamental Metals Group
NAME OF BANKING INSTITUTION:
First Union National Bank !
260 Amity Road, Woodbridge, CT 06525
NAME OF JUDGMENT CREDITOR MAKING APPLICATION: OF (TOWN) I
Trustees of the Iron Workers’ Locals 15 and 424 Pension Fund, et al Meriden \
NAME OF JUDGMENT DEBTOR: OF (TOWN)
Ornamental Metals Group Woodbridge
1. AMOUNT OF JUDGMENT: $4,091.31 1
2. AMOUNT OF INTEREST: 0.00 1
3. AMOUNT OF COSTS: 0.00 Q
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4. TOTAL JUDGMENT, INTEREST AND COSTS: $4,091.31
5. TOTAL PAID ON ACCOUNT: 900.00 i
6. TOTAL UNPAID JUDGMENT: $3, 19 1.31
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DATED March 31, 2004 `
Thomas M. Brockett I
ROBERT M. CHEVERIE 8.:. ASSOCIATES, P.C. 1
333 East River Drive, Suite 101
East Hartford, CT 06108 7
(860) 290-9610 5
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Case 3:02-cv-01826-JBA Document 16 Filed O4/O1/2004 Page 2 of 4
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E x E c U ·1· 1 0 N
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TO ANY PROPER OFFICER: I
Whereas on said Date of Judgment the above—named Judgment Creditor
recovered a judgment against the above-named Judgment Debtor before the
above-named Court for the amount of damages and costs above, as appears on I
record, whereof execution remained to be done. These thereby by AUTHORITY I
OF THE UNITED STATES TO COMMAND YOU:
Within seven {7) days from your receipt of this execution, make demand
upon the main office of any banking institution having its main office within I
your precincts, or if such main office is not within your precincts and such
banking institution has one or more branch ·office within your precincts, upon F
an employee of such a branch office, such employee and such branch office
having been designated by the banking institution in accordance with
regulations adopted by the banking commissioner, for payment to you pursuant
to section 52-367b of the Connecticut General Statutes and Connecticut Public
Act 83-384 for any nonexernpt debt due said Judgment Debtor, which sum shall I
not exceed the total unpaid debt damages and costs on said judgment as stated I
above, plus interest on the unpaid amount of said judgment from its date and
until the time when this execution shall be satisfied, plus your own fee. After
having made such demand, you are directed to serve a true and attested copy of
this execution, together with the attached affidavit and exemption claim form,
with your doings endorsed thereon, with the banking institution office upon I
whom such demand was made. Said sum shall be received by you and applied on
this execution in accordance with the provision of Section 52-367b of the
Connecticut General Statutes.
HEREON FAIL NOT, AND MAKE DUE RETURN OF THIS WRIT WITH YOUR
DOINGS THEREON, ACCORDING TO LAW. I
Dated at , Connecticut this day of , 2004.
KEVIN F. ROWE, Clerk

By I
Deputy Clerk I
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I3ANK‘i£)tl:tJUl1urv — _ |
_ JD_C\,_2., ,,9,,_.,..,, case 3:02-cv-O1Q26,-JBA Sbi6tEfitIi@lit <·i>§>UFtFi'ileol 04/@52004 Page 2 or 4 (QI;} 2
ig G 5, 31.5ag)_ 52-331;, 52-Sous. 52-352b. S2-outa. _i
suave, za usc. zeeitnrn I
NAME AND ADDRESS OF JUDGMENT DEBTOR Ort ATTORNEY (Te be completed by preinrirr)
T0; ' "
L. _ J
. .SE¢TIONY$iY€= . r - · »abir¤" ‘rix:¤¤u> r isiir f l
Judicial Housing NAME AND ADDRESS OF COURT (No., Street. Town and Zip Code)
C] District ij Session UGA. No.
mus or iuoomertr oeerort oocicer no. ;
E
I secfribit II ztgtje be-eemeiat6uQ&e‘y‘ 3 niteg i‘‘‘ vert ‘ia»;a€s:i2¤=¢=2i§iiir stratai§€¤=¢&t;==:¤=-’*-·&?·‘·;e:ir
NAME NND ADDRESS or eauxinc msrmmon to WHICH exervtprlon OMIM me ANY) ts TO ee RETURNED MTE OF tM"—*NG T¤ JUDGNENT ¤E¤T¤¤ _ i
DESCRIPTION or Accourrrrsy AND AMOUNNSI REMOVED PURSUANT TO EXECUTION -
so Trtonatlt -; -·-- :5- ,;_.;;‘-;» - -_-- @[tjjif§§_,'i“;f` ° " T
As e result of a judgment entered against you, the attached execution has been Issued against fu nds deposited by i
you in the banking institution named above. In compliance with this execution, the banking institution has removed from i
the accounl(s) enumerated above the amount of money indicated above.
QhL- The money in your accountts) may be
protected from execution by stale statutes or by other laws or regulations of this state or of the United States. A checklist and
a description of the exemptions Bstabllsltéd by law are set forth on the reverse Side. `
EILJ§.I:I - if you wish to claim that the money in your account(s) is _
exempt by law from execution, you must fill out and sign before a proper olticial the Afndavit oftCIaim of Exemption below and
mail or deliver this exemption claim form to th at the above address. This form must be received by the {
banking institution no later than 15 days from the DATE OF MAILING TO THE JUDGMENT DEBTOR indicated above.
Upon receipt of this form the bank will forward it to the Superior Coun and the coun clerk will notify you and the judgment i
creditor ofthe date on which a hearing will be held by the coun to determine the issues raised by your claim. i
SECTION W S TAFFIDA its it, ttf ` E‘ §l*?" ’I j its ttiéi hté [ _£rf`*i? 1: r= .-r.- re-iI§=é.L73?:
I. the iuclgment debtor named above. hereby claim and certify under the penalty of false statement that the money in the
above account(s) is exempt by law from execution as follows: __
Account NUMBER "` oescitiee coumeo exempnou esmetieueo ev uw ` y
AMr‘»t1N’t’ (AAIMED T0 FIS FXEMDT `
Accourrr Number: Dtascrttee cr.AlMED EXEMPTION ESTABLISHED BY LAW n
Auounr cutiueo ro ee EXEMPT
[Z] Additional sheet(s) attached hereto and made a part hereof (ifnecessery).
SIGNED (Individual attorney or pro se perry) DATE SIGNED STATE OF CONNECTICUT, COUNTY OF
X ` } $5
COMPLETE MAILING ADDRESS OF JUDGMENT DEBTOR SUBSCRIBED AND SWORN TO BEFORE ME Tg-||$ I
my or . 19
SIGNED [NOIBVY Public, Commissioner or Supurfor Court)
retsenone no.
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‘· I I ·` I ’“· =~—·¤i°ES- Itiiititii =-0525-. Mrtnott new -. as·¤1.sIr.t.¤Iw- < 4-··· ‘4--.4 <-- I ·; -===;·e1.s·i; 44·.·
1. Publ' A ' I · . . . .
(CIS'; §QE€d§BVmE"I$ and 3"Y W¤9¢S Earned by e pubitc assistance recipient under en IHCQHIIVB earnings or similar program.
Q. Health and disability Insurance payments. (C.G.S. 52s352b(ej)
3. W0rker‘S Compensation. social security, veterans and unemployment benefits. (C.t3.S. 52-352b{g))
4. Court approved payments forchtld support. ((:.6.6, 52-352b{h)) =
5. Any assets or interests ot a judgment debtor tn, or payments received bythe "ud ment debtor fro I ‘ I
in ms. 52.32I.. less. szsszermjj ’ 9 '“· B ’° "‘" °' “"""g""‘°"‘ "°i·°""°“ I
6. other than child support, but only tothe extent that wages are exempt from execution under section 52-3B1a'. I
7, An award under a crime reparations act. (C.G.S. 52-352b(o))
9_ all benetite allowed lby any association of persons in this state towards the support ot any of its members incapacitated by sickness or
rnlirmlty from attending to his usual business; and all monies due the debtor from any Insurance company upon any insurance policy I
issued on exempt property. to the same extent that the property was exempt. (C.G.S. 52·352b(p), (q)) I
9, Any ITIIETBSI DI IIi€ jUCIgt`t'tEt‘tI dEbt0l’ In any property HDL tu exceed In value one th¤u53j1d (jO|t5r5_ (C_G_5_ § 52..352b(j·))
10, irrevocable transfers of money to an account held by a bona tide nonprotit debt adjuster licensed pursuant to sections 36a-555 to
3Ga-685, inclusive, of the general statutes for the benetit of creditors of the judgment debtor. (C.G.S. 52—352b(u})
11, There may be other laws or regulations oi this state or ofthe United States which set iorth additional exemptions.
*The following is that part of C.G.S. 52-361 a which denotes what portion ot wages is exempt from execution;
_ The maximum part ofthe aggregate weekly eemings or an individual which may be subject to levy or other withholding for payment of a I
judgment rs the Ieseer or {1) twenty-tive percent or his disposable earnings for that week, or (2) the amount by which his disposable ·
earnings for that week exceed forty times the higher of (A) the minimum hourty wage prescribed by Section 6{a)(1) of the Fair Labor
Standards Act of 7938. U. S.C. tit. 29, Section 206(o)(1), or {B), the full minimum feir wogo established by subsection (j') of Section 31-58, in
effect at the time the eamings are payable.
C.G. S. 52·350a(4) derines "disposeble eemings" as that part ofthe earnings of an individuai remaining error the deduction from those I
earnings of amounts required to be withheid for payment or federal income and employment taxes, norms! retirement contributions, union
dues and initiation fees, group tifo insurance premiums, health insurance premiums, tederet tax revies, and state income tax deductions
authorized pursuant to C. GS. 12-34b. -
· · e I I : J ;¤I *;*.2*;: t ire i Q: :E5§§i¥*iFi"i -‘ ·‘ r ; ·· 122% ?f°T ·
TO BANKING INSTITUTION TO CLERK j
1. Complete sectlon It ot this form and send 2 1. Attach this form to each bank ertecutton issued in a civil or family matter
copies of this fomn and the bank execution against a judgment debtor that ts a_ natural person. _
form to the iudgment debtor pursuant to 2. Deliver the execution along with this form to the judgment creditor
section 52-36'Ib of the General Statutes. requesting the execution. _ _
3. If judgment debtor completes and returns this form claiming an
2. If this claim of exemption is returned exemption, enter the appearance of the judgment debtor wth address
completed. till out section V ot this form and set forth on reverse. _ _ j
mail. within two business days. to th issuing 4. Set matter dovrn for short calender heenng. _
clerics othce at the address ot court 5. Complete section VI botow. _ ` _ I
indicated on the front side. See additional 6. Sergio file-stamped copy of this form to judgment debtor and judgment j
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Instructions On me bank Bmcut on form 7. gte: hearing, send copy of any order entered to the banking instttutron.
SEt;Tt0N.y.f To be com Igrggitj ,'hgj·ik]rf" .}]f}`i§]] &6:j·iIfj` °"§I"f ' _$i§" =;)‘I5igI,;.+g·ri;I;¥5szj¤g;;+j;5 =-Yi?-¤t e
one CLAIM necetueo DATE MAILED TO COURT NAME OF BANK DFFIGER ·

‘ _ . . · ‘ ' d byt e anking ins u ron
The assets In dispute are berng heldjtor {1) forty·tive days from the date the exemption claim form was receive {
designated on th Iront ol this form or (2) until disposition is ordered by the court et o heenng to be herd at short calendar on the date se
forth below, whichever occurs earlier. GNED -——-·—-—-···
DATE or HEARING rttttz or HEARING C, A M, siotteo (Assistant creat; DATE SI
D PM" . . .. ~ . I. .,-,-1. . · -.,1.,.-;~ I:.I.I·;,..,r=.I.... .r ‘ ,y -1 V " · g;;:·::.--<:==="_5’§’i¤>1{»Z¤I‘_¢_;,,_;§"(£ ‘`.` =i:=T,‘i‘€§`-`
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The Courtiwtagistrate, having held a hearing to determine tho Issues raised by thIs eterm, hereby orders that. j
_____ I UATE SIGNED
SIGNED (Judge/Magistrate) · -
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