In the District Court of _______________________ County State of Oklahoma
__________________________
Plaintiff vs. ____________________________ Defendant and ____________________________ Garnishee
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Case No. _______________
Claim for Exemption and Request for Hearing 1. Funds sought in garnishment are exempt from execution because they are (check applicable box):
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A. B. C. D. E. F. G. H. I. J. K. L. M. N. O. P. Q. R. S. T. U. V.
Social Security benefits 42 U.S.C. § 407. Supplemental security income 42 U.S.C. §1383(d). Unemployment benefits 40 O.S. §2-303. Workmen's Compensation benefits 85 O.S. §48. Welfare benefits 56 O.S. §173. Veterans' benefits 38 U.S.C. §3101, 31 O.S. §7. Monies in Possession of Police Pensions 11 O.S. §50-124. Monies in Possession of Firemen's Relief & Pension Fund 11 O.S. §49-126. Monies in Possession of County Employee's Retirement System 19 O.S. §959. Monies in Possession of Public Employee's Retirement Fund 74 O.S. §923. Teacher's Annuities or Retirement Allowance 70 O.S. §17-109. Annuities and pension payments under Railroad Retirement Act 45 U.S.C. §231(m) United States Civil Service Retirement and Disability Pension Fund Payments 5 U.S.C. §8346. United States Civil Service Survivor Annuities 5 U.S.C. §8346. Interest in Retirement, Pension and Profit Sharing Plans 60 O.S. §327, 60 O.S. §328. The Wages of Seamen 46 U.S.C. §601. Funds vested in the Alien Property Custodian 50 U.S.C. Appx. §9(f). Prepaid Burial Benefits 36 O.S. §6125. Proceeds of Group-Life Insurance Policy 36 O.S. 3632, and 36 O.S. §4026. Alimony, support, separate maintenance, or child support necessary for support of judgment debtor or dependent 31 O.S. §1.1. Personal wage exemption because of undue hardship 31 O.S. §1.1. Other (please state): ________________________________________________
2.
Check one box:
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All funds are exempt, or, I believe the following amount of money is exempt: $__________________________ (Fill in the amount of funds to be exempt).
3.
Check if applicable:
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4.
I have attached copies of the documents that show that my money is exempt.
If garnishment is for wages, this claim and request is filed for the pay period _________________ through ________________, inclusive. I request that this matter be set for hearing.
5.
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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